|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,743.21
|
|
|
Service Code
|
MSDRG 512
|
| Min. Negotiated Rate |
$12,991.63 |
| Max. Negotiated Rate |
$22,743.21 |
| Rate for Payer: Aetna Medicare |
$13,675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,094.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,094.25
|
| Rate for Payer: BCBS MAPPO |
$13,675.40
|
| Rate for Payer: BCN Medicare Advantage |
$13,675.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,675.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,675.40
|
| Rate for Payer: Mclaren Medicare |
$13,675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,359.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,726.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,042.94
|
| Rate for Payer: PACE Medicare |
$12,991.63
|
| Rate for Payer: PACE SWMI |
$13,675.40
|
| Rate for Payer: PHP Commercial |
$15,042.94
|
| Rate for Payer: PHP Medicare Advantage |
$13,675.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,743.21
|
| Rate for Payer: Priority Health Medicare |
$13,675.40
|
| Rate for Payer: Priority Health Narrow Network |
$18,194.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13,675.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,675.40
|
| Rate for Payer: UHC Exchange |
$21,196.87
|
| Rate for Payer: UHCCP DNSP |
$13,675.40
|
| Rate for Payer: VA VA |
$13,675.40
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$23,062.28
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$20,851.06 |
| Max. Negotiated Rate |
$23,062.28 |
| Rate for Payer: BCBS Complete |
$23,062.28
|
| Rate for Payer: Mclaren Medicaid |
$21,964.08
|
| Rate for Payer: Meridian Medicaid |
$23,062.28
|
| Rate for Payer: PHP Medicaid |
$20,851.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,964.08
|
| Rate for Payer: UHC Medicaid |
$21,964.08
|
| Rate for Payer: UHCCP Medicaid |
$21,964.08
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$14,700.57
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$13,291.08 |
| Max. Negotiated Rate |
$14,700.57 |
| Rate for Payer: BCBS Complete |
$14,700.57
|
| Rate for Payer: Mclaren Medicaid |
$14,000.54
|
| Rate for Payer: Meridian Medicaid |
$14,700.57
|
| Rate for Payer: PHP Medicaid |
$13,291.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,000.54
|
| Rate for Payer: UHC Medicaid |
$14,000.54
|
| Rate for Payer: UHCCP Medicaid |
$14,000.54
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$11,047.23
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$9,988.01 |
| Max. Negotiated Rate |
$11,047.23 |
| Rate for Payer: BCBS Complete |
$11,047.23
|
| Rate for Payer: Mclaren Medicaid |
$10,521.17
|
| Rate for Payer: Meridian Medicaid |
$11,047.23
|
| Rate for Payer: PHP Medicaid |
$9,988.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,521.17
|
| Rate for Payer: UHC Medicaid |
$10,521.17
|
| Rate for Payer: UHCCP Medicaid |
$10,521.17
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$7,428.76
|
|
|
Service Code
|
APR-DRG 3151
|
| Min. Negotiated Rate |
$6,716.49 |
| Max. Negotiated Rate |
$7,428.76 |
| Rate for Payer: BCBS Complete |
$7,428.76
|
| Rate for Payer: Mclaren Medicaid |
$7,075.01
|
| Rate for Payer: Meridian Medicaid |
$7,428.76
|
| Rate for Payer: PHP Medicaid |
$6,716.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,075.01
|
| Rate for Payer: UHC Medicaid |
$7,075.01
|
| Rate for Payer: UHCCP Medicaid |
$7,075.01
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$12,067.92
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$10,910.84 |
| Max. Negotiated Rate |
$12,067.92 |
| Rate for Payer: BCBS Complete |
$12,067.92
|
| Rate for Payer: Mclaren Medicaid |
$11,493.25
|
| Rate for Payer: Meridian Medicaid |
$12,067.92
|
| Rate for Payer: PHP Medicaid |
$10,910.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,493.25
|
| Rate for Payer: UHC Medicaid |
$11,493.25
|
| Rate for Payer: UHCCP Medicaid |
$11,493.25
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$3,131.28
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$2,831.05 |
| Max. Negotiated Rate |
$3,131.28 |
| Rate for Payer: BCBS Complete |
$3,131.28
|
| Rate for Payer: Mclaren Medicaid |
$2,982.17
|
| Rate for Payer: Meridian Medicaid |
$3,131.28
|
| Rate for Payer: PHP Medicaid |
$2,831.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,982.17
|
| Rate for Payer: UHC Medicaid |
$2,982.17
|
| Rate for Payer: UHCCP Medicaid |
$2,982.17
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$7,818.40
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$7,068.77 |
| Max. Negotiated Rate |
$7,818.40 |
| Rate for Payer: BCBS Complete |
$7,818.40
|
| Rate for Payer: Mclaren Medicaid |
$7,446.09
|
| Rate for Payer: Meridian Medicaid |
$7,818.40
|
| Rate for Payer: PHP Medicaid |
$7,068.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,446.09
|
| Rate for Payer: UHC Medicaid |
$7,446.09
|
| Rate for Payer: UHCCP Medicaid |
$7,446.09
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$4,543.25
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$4,107.64 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: BCBS Complete |
$4,543.25
|
| Rate for Payer: Mclaren Medicaid |
$4,326.90
|
| Rate for Payer: Meridian Medicaid |
$4,543.25
|
| Rate for Payer: PHP Medicaid |
$4,107.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,326.90
|
| Rate for Payer: UHC Medicaid |
$4,326.90
|
| Rate for Payer: UHCCP Medicaid |
$4,326.90
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$18,159.95
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$10,709.41 |
| Max. Negotiated Rate |
$18,159.95 |
| Rate for Payer: Aetna Medicare |
$11,273.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,091.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,091.33
|
| Rate for Payer: BCBS MAPPO |
$11,273.06
|
| Rate for Payer: BCN Medicare Advantage |
$11,273.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,273.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,273.06
|
| Rate for Payer: Mclaren Medicare |
$11,273.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,836.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,964.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,400.37
|
| Rate for Payer: PACE Medicare |
$10,709.41
|
| Rate for Payer: PACE SWMI |
$11,273.06
|
| Rate for Payer: PHP Commercial |
$12,400.37
|
| Rate for Payer: PHP Medicare Advantage |
$11,273.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,159.95
|
| Rate for Payer: Priority Health Medicare |
$11,273.06
|
| Rate for Payer: Priority Health Narrow Network |
$14,527.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11,273.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,273.06
|
| Rate for Payer: UHC Exchange |
$17,473.24
|
| Rate for Payer: UHCCP DNSP |
$11,273.06
|
| Rate for Payer: VA VA |
$11,273.06
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$11,990.51
|
|
|
Service Code
|
MSDRG 556
|
| Min. Negotiated Rate |
$7,349.02 |
| Max. Negotiated Rate |
$11,990.51 |
| Rate for Payer: Aetna Medicare |
$7,735.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,669.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,669.76
|
| Rate for Payer: BCBS MAPPO |
$7,735.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,735.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,735.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,735.81
|
| Rate for Payer: Mclaren Medicare |
$7,735.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,122.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,896.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,509.39
|
| Rate for Payer: PACE Medicare |
$7,349.02
|
| Rate for Payer: PACE SWMI |
$7,735.81
|
| Rate for Payer: PHP Commercial |
$8,509.39
|
| Rate for Payer: PHP Medicare Advantage |
$7,735.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,411.45
|
| Rate for Payer: Priority Health Medicare |
$7,735.81
|
| Rate for Payer: Priority Health Narrow Network |
$9,129.16
|
| Rate for Payer: Railroad Medicare Medicare |
$7,735.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,735.81
|
| Rate for Payer: UHC Exchange |
$11,990.51
|
| Rate for Payer: UHCCP DNSP |
$7,735.81
|
| Rate for Payer: VA VA |
$7,735.81
|
|
|
SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$17,440.03
|
|
|
Service Code
|
MSDRG 947
|
| Min. Negotiated Rate |
$10,350.93 |
| Max. Negotiated Rate |
$17,440.03 |
| Rate for Payer: Aetna Medicare |
$10,895.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,619.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,619.65
|
| Rate for Payer: BCBS MAPPO |
$10,895.72
|
| Rate for Payer: BCN Medicare Advantage |
$10,895.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,895.72
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,895.72
|
| Rate for Payer: Mclaren Medicare |
$10,895.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,440.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,530.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,985.29
|
| Rate for Payer: PACE Medicare |
$10,350.93
|
| Rate for Payer: PACE SWMI |
$10,895.72
|
| Rate for Payer: PHP Commercial |
$11,985.29
|
| Rate for Payer: PHP Medicare Advantage |
$10,895.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,440.03
|
| Rate for Payer: Priority Health Medicare |
$10,895.72
|
| Rate for Payer: Priority Health Narrow Network |
$13,952.03
|
| Rate for Payer: Railroad Medicare Medicare |
$10,895.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,895.72
|
| Rate for Payer: UHC Exchange |
$16,888.37
|
| Rate for Payer: UHCCP DNSP |
$10,895.72
|
| Rate for Payer: VA VA |
$10,895.72
|
|
|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$11,654.54
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$7,143.11 |
| Max. Negotiated Rate |
$11,654.54 |
| Rate for Payer: Aetna Medicare |
$7,519.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,398.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,398.83
|
| Rate for Payer: BCBS MAPPO |
$7,519.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,519.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,519.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,519.06
|
| Rate for Payer: Mclaren Medicare |
$7,519.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,895.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,646.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,270.97
|
| Rate for Payer: PACE Medicare |
$7,143.11
|
| Rate for Payer: PACE SWMI |
$7,519.06
|
| Rate for Payer: PHP Commercial |
$8,270.97
|
| Rate for Payer: PHP Medicare Advantage |
$7,519.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,997.91
|
| Rate for Payer: Priority Health Medicare |
$7,519.06
|
| Rate for Payer: Priority Health Narrow Network |
$8,798.33
|
| Rate for Payer: Railroad Medicare Medicare |
$7,519.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,519.06
|
| Rate for Payer: UHC Exchange |
$11,654.54
|
| Rate for Payer: UHCCP DNSP |
$7,519.06
|
| Rate for Payer: VA VA |
$7,519.06
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$3,994.48
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$3,611.49 |
| Max. Negotiated Rate |
$3,994.48 |
| Rate for Payer: BCBS Complete |
$3,994.48
|
| Rate for Payer: Mclaren Medicaid |
$3,804.27
|
| Rate for Payer: Meridian Medicaid |
$3,994.48
|
| Rate for Payer: PHP Medicaid |
$3,611.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,804.27
|
| Rate for Payer: UHC Medicaid |
$3,804.27
|
| Rate for Payer: UHCCP Medicaid |
$3,804.27
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$6,459.29
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$5,839.97 |
| Max. Negotiated Rate |
$6,459.29 |
| Rate for Payer: BCBS Complete |
$6,459.29
|
| Rate for Payer: Mclaren Medicaid |
$6,151.71
|
| Rate for Payer: Meridian Medicaid |
$6,459.29
|
| Rate for Payer: PHP Medicaid |
$5,839.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,151.71
|
| Rate for Payer: UHC Medicaid |
$6,151.71
|
| Rate for Payer: UHCCP Medicaid |
$6,151.71
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$8,828.19
|
|
|
Service Code
|
APR-DRG 8614
|
| Min. Negotiated Rate |
$7,981.74 |
| Max. Negotiated Rate |
$8,828.19 |
| Rate for Payer: BCBS Complete |
$8,828.19
|
| Rate for Payer: Mclaren Medicaid |
$8,407.80
|
| Rate for Payer: Meridian Medicaid |
$8,828.19
|
| Rate for Payer: PHP Medicaid |
$7,981.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,407.80
|
| Rate for Payer: UHC Medicaid |
$8,407.80
|
| Rate for Payer: UHCCP Medicaid |
$8,407.80
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$2,627.20
|
|
|
Service Code
|
APR-DRG 8611
|
| Min. Negotiated Rate |
$2,375.31 |
| Max. Negotiated Rate |
$2,627.20 |
| Rate for Payer: BCBS Complete |
$2,627.20
|
| Rate for Payer: Mclaren Medicaid |
$2,502.10
|
| Rate for Payer: Meridian Medicaid |
$2,627.20
|
| Rate for Payer: PHP Medicaid |
$2,375.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,502.10
|
| Rate for Payer: UHC Medicaid |
$2,502.10
|
| Rate for Payer: UHCCP Medicaid |
$2,502.10
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$190.35
|
|
|
Service Code
|
NDC 65162035109
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: Aetna Medicare |
$70.43
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Complete |
$76.14
|
| Rate for Payer: BCBS Trust/PPO |
$156.94
|
| Rate for Payer: BCN Commercial |
$156.94
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$166.78
|
| Rate for Payer: Priority Health Narrow Network |
$133.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$190.35
|
|
|
Service Code
|
NDC 65162035109
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.76 |
| Max. Negotiated Rate |
$190.35 |
| Rate for Payer: Aetna Commercial |
$171.31
|
| Rate for Payer: ASR ASR |
$184.64
|
| Rate for Payer: BCBS Trust/PPO |
$156.32
|
| Rate for Payer: BCN Commercial |
$156.32
|
| Rate for Payer: Cash Price |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$178.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.28
|
| Rate for Payer: Healthscope Commercial |
$184.64
|
| Rate for Payer: Healthscope Whirlpool |
$190.35
|
| Rate for Payer: Mclaren Commercial |
$171.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.80
|
| Rate for Payer: Nomi Health Commercial |
$156.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.51
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
IP
|
$5.16
|
|
|
Service Code
|
NDC 9900000976
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: ASR ASR |
$5.01
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Healthscope Whirlpool |
$5.16
|
| Rate for Payer: Mclaren Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.54
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
OP
|
$5.16
|
|
|
Service Code
|
NDC 9900000976
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Aetna Commercial |
$4.64
|
| Rate for Payer: Aetna Medicare |
$1.91
|
| Rate for Payer: ASR ASR |
$5.01
|
| Rate for Payer: BCBS Complete |
$2.06
|
| Rate for Payer: BCBS Trust/PPO |
$4.25
|
| Rate for Payer: BCN Commercial |
$4.25
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$4.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$5.01
|
| Rate for Payer: Healthscope Whirlpool |
$5.16
|
| Rate for Payer: Mclaren Commercial |
$4.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$3.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.54
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$35.98
|
|
|
Service Code
|
NDC 61570013120
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.98 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: BCBS Trust/PPO |
$29.55
|
| Rate for Payer: BCN Commercial |
$29.55
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$34.90
|
| Rate for Payer: Healthscope Whirlpool |
$35.98
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$22.58
|
|
|
Service Code
|
NDC 67877012425
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$22.57 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: ASR ASR |
$21.90
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: BCBS Trust/PPO |
$18.61
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$21.90
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Mclaren Commercial |
$20.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$18.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.78
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.87
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$22.58
|
|
|
Service Code
|
NDC 67877012425
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$22.57 |
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: ASR ASR |
$21.90
|
| Rate for Payer: BCBS Trust/PPO |
$18.54
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$21.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$21.90
|
| Rate for Payer: Healthscope Whirlpool |
$22.57
|
| Rate for Payer: Mclaren Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$18.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.87
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$26.33
|
|
|
Service Code
|
NDC 43598021025
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna Commercial |
$23.69
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: ASR ASR |
$25.54
|
| Rate for Payer: BCBS Complete |
$10.53
|
| Rate for Payer: BCBS Trust/PPO |
$21.70
|
| Rate for Payer: BCN Commercial |
$21.70
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$25.54
|
| Rate for Payer: Healthscope Whirlpool |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$23.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.38
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.07
|
| Rate for Payer: Priority Health Narrow Network |
$18.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.17
|
|
