|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,199.60
|
|
|
Service Code
|
MSDRG 624
|
| Min. Negotiated Rate |
$10,231.21 |
| Max. Negotiated Rate |
$17,199.60 |
| Rate for Payer: Aetna Medicare |
$10,769.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,462.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,462.11
|
| Rate for Payer: BCBS MAPPO |
$10,769.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,769.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,769.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,769.69
|
| Rate for Payer: Mclaren Medicare |
$10,769.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,308.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,385.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,846.66
|
| Rate for Payer: PACE Medicare |
$10,231.21
|
| Rate for Payer: PACE SWMI |
$10,769.69
|
| Rate for Payer: PHP Commercial |
$11,846.66
|
| Rate for Payer: PHP Medicare Advantage |
$10,769.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,199.60
|
| Rate for Payer: Priority Health Medicare |
$10,769.69
|
| Rate for Payer: Priority Health Narrow Network |
$13,759.68
|
| Rate for Payer: Railroad Medicare Medicare |
$10,769.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,769.69
|
| Rate for Payer: UHC Exchange |
$16,693.02
|
| Rate for Payer: UHCCP DNSP |
$10,769.69
|
| Rate for Payer: VA VA |
$10,769.69
|
|
|
SKIN GRAFTS FOR INJURIES WITH CC/MCC
|
Facility
|
IP
|
$50,463.99
|
|
|
Service Code
|
MSDRG 904
|
| Min. Negotiated Rate |
$26,795.07 |
| Max. Negotiated Rate |
$50,463.99 |
| Rate for Payer: Aetna Medicare |
$28,205.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,256.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,256.68
|
| Rate for Payer: BCBS MAPPO |
$28,205.34
|
| Rate for Payer: BCN Medicare Advantage |
$28,205.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,205.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,205.34
|
| Rate for Payer: Mclaren Medicare |
$28,205.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,615.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,436.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$31,025.87
|
| Rate for Payer: PACE Medicare |
$26,795.07
|
| Rate for Payer: PACE SWMI |
$28,205.34
|
| Rate for Payer: PHP Commercial |
$31,025.87
|
| Rate for Payer: PHP Medicare Advantage |
$28,205.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$50,463.99
|
| Rate for Payer: Priority Health Medicare |
$28,205.34
|
| Rate for Payer: Priority Health Narrow Network |
$40,371.19
|
| Rate for Payer: Railroad Medicare Medicare |
$28,205.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,205.34
|
| Rate for Payer: UHC Exchange |
$43,718.28
|
| Rate for Payer: UHCCP DNSP |
$28,205.34
|
| Rate for Payer: VA VA |
$28,205.34
|
|
|
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$20,380.14
|
|
|
Service Code
|
MSDRG 905
|
| Min. Negotiated Rate |
$11,814.95 |
| Max. Negotiated Rate |
$20,380.14 |
| Rate for Payer: Aetna Medicare |
$12,436.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,545.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,545.99
|
| Rate for Payer: BCBS MAPPO |
$12,436.79
|
| Rate for Payer: BCN Medicare Advantage |
$12,436.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,436.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,436.79
|
| Rate for Payer: Mclaren Medicare |
$12,436.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,058.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,302.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,680.47
|
| Rate for Payer: PACE Medicare |
$11,814.95
|
| Rate for Payer: PACE SWMI |
$12,436.79
|
| Rate for Payer: PHP Commercial |
$13,680.47
|
| Rate for Payer: PHP Medicare Advantage |
$12,436.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,380.14
|
| Rate for Payer: Priority Health Medicare |
$12,436.79
|
| Rate for Payer: Priority Health Narrow Network |
$16,304.11
|
| Rate for Payer: Railroad Medicare Medicare |
$12,436.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,436.79
|
| Rate for Payer: UHC Exchange |
$19,277.02
|
| Rate for Payer: UHCCP DNSP |
$12,436.79
|
| Rate for Payer: VA VA |
$12,436.79
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$7,654.91
|
|
|
Service Code
|
APR-DRG 3804
|
| Min. Negotiated Rate |
$6,920.96 |
| Max. Negotiated Rate |
$7,654.91 |
| Rate for Payer: BCBS Complete |
$7,654.91
|
| Rate for Payer: Mclaren Medicaid |
$7,290.39
|
| Rate for Payer: Meridian Medicaid |
$7,654.91
|
| Rate for Payer: PHP Medicaid |
$6,920.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,290.39
|
| Rate for Payer: UHC Medicaid |
$7,290.39
|
| Rate for Payer: UHCCP Medicaid |
$7,290.39
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$5,660.40
|
|
|
Service Code
|
APR-DRG 3803
|
| Min. Negotiated Rate |
$5,117.67 |
| Max. Negotiated Rate |
$5,660.40 |
| Rate for Payer: BCBS Complete |
$5,660.40
|
| Rate for Payer: Mclaren Medicaid |
$5,390.85
|
| Rate for Payer: Meridian Medicaid |
$5,660.40
|
| Rate for Payer: PHP Medicaid |
$5,117.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,390.85
|
| Rate for Payer: UHC Medicaid |
$5,390.85
|
| Rate for Payer: UHCCP Medicaid |
$5,390.85
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$4,575.40
|
|
|
Service Code
|
APR-DRG 3802
|
| Min. Negotiated Rate |
$4,136.71 |
| Max. Negotiated Rate |
$4,575.40 |
| Rate for Payer: BCBS Complete |
$4,575.40
|
| Rate for Payer: Mclaren Medicaid |
$4,357.52
|
| Rate for Payer: Meridian Medicaid |
$4,575.40
|
| Rate for Payer: PHP Medicaid |
$4,136.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,357.52
|
| Rate for Payer: UHC Medicaid |
$4,357.52
|
| Rate for Payer: UHCCP Medicaid |
$4,357.52
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$3,163.43
|
|
|
Service Code
|
APR-DRG 3801
|
| Min. Negotiated Rate |
$2,860.12 |
| Max. Negotiated Rate |
$3,163.43 |
| Rate for Payer: BCBS Complete |
$3,163.43
|
| Rate for Payer: Mclaren Medicaid |
$3,012.80
|
| Rate for Payer: Meridian Medicaid |
$3,163.43
|
| Rate for Payer: PHP Medicaid |
$2,860.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,012.80
|
| Rate for Payer: UHC Medicaid |
$3,012.80
|
| Rate for Payer: UHCCP Medicaid |
$3,012.80
|
|
|
SKIN ULCERS WITH CC
|
Facility
|
IP
|
$16,298.34
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$9,782.43 |
| Max. Negotiated Rate |
$16,298.34 |
| Rate for Payer: Aetna Medicare |
$10,297.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,871.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,871.62
|
| Rate for Payer: BCBS MAPPO |
$10,297.30
|
| Rate for Payer: BCN Medicare Advantage |
$10,297.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,297.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,297.30
|
| Rate for Payer: Mclaren Medicare |
$10,297.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,812.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,841.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,327.03
|
| Rate for Payer: PACE Medicare |
$9,782.43
|
| Rate for Payer: PACE SWMI |
$10,297.30
|
| Rate for Payer: PHP Commercial |
$11,327.03
|
| Rate for Payer: PHP Medicare Advantage |
$10,297.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,298.34
|
| Rate for Payer: Priority Health Medicare |
$10,297.30
|
| Rate for Payer: Priority Health Narrow Network |
$13,038.67
|
| Rate for Payer: Railroad Medicare Medicare |
$10,297.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,297.30
|
| Rate for Payer: UHC Exchange |
$15,960.82
|
| Rate for Payer: UHCCP DNSP |
$10,297.30
|
| Rate for Payer: VA VA |
$10,297.30
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$26,588.70
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$14,906.48 |
| Max. Negotiated Rate |
$26,588.70 |
| Rate for Payer: Aetna Medicare |
$15,691.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,613.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,613.79
|
| Rate for Payer: BCBS MAPPO |
$15,691.03
|
| Rate for Payer: BCN Medicare Advantage |
$15,691.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,691.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,691.03
|
| Rate for Payer: Mclaren Medicare |
$15,691.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,475.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,044.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,260.13
|
| Rate for Payer: PACE Medicare |
$14,906.48
|
| Rate for Payer: PACE SWMI |
$15,691.03
|
| Rate for Payer: PHP Commercial |
$17,260.13
|
| Rate for Payer: PHP Medicare Advantage |
$15,691.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,588.70
|
| Rate for Payer: Priority Health Medicare |
$15,691.03
|
| Rate for Payer: Priority Health Narrow Network |
$21,270.96
|
| Rate for Payer: Railroad Medicare Medicare |
$15,691.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,691.03
|
| Rate for Payer: UHC Exchange |
$24,321.10
|
| Rate for Payer: UHCCP DNSP |
$15,691.03
|
| Rate for Payer: VA VA |
$15,691.03
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,394.58
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$7,596.68 |
| Max. Negotiated Rate |
$12,394.58 |
| Rate for Payer: Aetna Medicare |
$7,996.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,995.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,995.62
|
| Rate for Payer: BCBS MAPPO |
$7,996.50
|
| Rate for Payer: BCN Medicare Advantage |
$7,996.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,996.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,996.50
|
| Rate for Payer: Mclaren Medicare |
$7,996.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,396.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,195.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,796.15
|
| Rate for Payer: PACE Medicare |
$7,596.68
|
| Rate for Payer: PACE SWMI |
$7,996.50
|
| Rate for Payer: PHP Commercial |
$8,796.15
|
| Rate for Payer: PHP Medicare Advantage |
$7,996.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,908.79
|
| Rate for Payer: Priority Health Medicare |
$7,996.50
|
| Rate for Payer: Priority Health Narrow Network |
$9,527.03
|
| Rate for Payer: Railroad Medicare Medicare |
$7,996.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,996.50
|
| Rate for Payer: UHC Exchange |
$12,394.58
|
| Rate for Payer: UHCCP DNSP |
$7,996.50
|
| Rate for Payer: VA VA |
$7,996.50
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 185
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 183
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 181
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 184
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$290.57
|
|
|
Service Code
|
LOCAL 182
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$290.57 |
| Rate for Payer: UHC Medicaid |
$290.57
|
|
|
SOAP BAR
|
Facility
|
OP
|
$12.56
|
|
|
Service Code
|
NDC 70501001010
|
| Hospital Charge Code |
108564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: ASR ASR |
$12.18
|
| Rate for Payer: BCBS Complete |
$5.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.35
|
| Rate for Payer: BCN Commercial |
$10.35
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.04
|
| Rate for Payer: Healthscope Commercial |
$12.18
|
| Rate for Payer: Healthscope Whirlpool |
$12.55
|
| Rate for Payer: Mclaren Commercial |
$11.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.67
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.00
|
| Rate for Payer: Priority Health Narrow Network |
$8.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.05
|
|
|
SOAP BAR
|
Facility
|
IP
|
$12.56
|
|
|
Service Code
|
NDC 70501001010
|
| Hospital Charge Code |
108564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: ASR ASR |
$12.18
|
| Rate for Payer: BCBS Trust/PPO |
$10.31
|
| Rate for Payer: BCN Commercial |
$10.31
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.04
|
| Rate for Payer: Healthscope Commercial |
$12.18
|
| Rate for Payer: Healthscope Whirlpool |
$12.55
|
| Rate for Payer: Mclaren Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.67
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.05
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$35.60
|
|
|
Service Code
|
NDC 409662530
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.70 |
| Max. Negotiated Rate |
$35.60 |
| Rate for Payer: Aetna Commercial |
$32.04
|
| Rate for Payer: ASR ASR |
$34.53
|
| Rate for Payer: BCBS Trust/PPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$29.23
|
| Rate for Payer: Cash Price |
$28.48
|
| Rate for Payer: Cofinity Commercial |
$33.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.48
|
| Rate for Payer: Healthscope Commercial |
$34.53
|
| Rate for Payer: Healthscope Whirlpool |
$35.60
|
| Rate for Payer: Mclaren Commercial |
$32.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.26
|
| Rate for Payer: Nomi Health Commercial |
$29.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.33
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.05
|
|
|
Service Code
|
NDC 51754500105
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$36.05 |
| Rate for Payer: Aetna Commercial |
$32.44
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: ASR ASR |
$34.96
|
| Rate for Payer: BCBS Complete |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$29.72
|
| Rate for Payer: BCN Commercial |
$29.72
|
| Rate for Payer: Cash Price |
$28.84
|
| Rate for Payer: Cofinity Commercial |
$33.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.84
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Whirlpool |
$36.05
|
| Rate for Payer: Mclaren Commercial |
$32.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.64
|
| Rate for Payer: Nomi Health Commercial |
$29.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.58
|
| Rate for Payer: Priority Health Narrow Network |
$25.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.72
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
NDC 81298762001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.69
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$33.82
|
|
|
Service Code
|
NDC 81665020025
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.51 |
| Max. Negotiated Rate |
$33.82 |
| Rate for Payer: Aetna Commercial |
$30.44
|
| Rate for Payer: Aetna Medicare |
$12.51
|
| Rate for Payer: ASR ASR |
$32.81
|
| Rate for Payer: BCBS Complete |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.88
|
| Rate for Payer: BCN Commercial |
$27.88
|
| Rate for Payer: Cash Price |
$27.06
|
| Rate for Payer: Cofinity Commercial |
$31.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.06
|
| Rate for Payer: Healthscope Commercial |
$32.81
|
| Rate for Payer: Healthscope Whirlpool |
$33.82
|
| Rate for Payer: Mclaren Commercial |
$30.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.75
|
| Rate for Payer: Nomi Health Commercial |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.63
|
| Rate for Payer: Priority Health Narrow Network |
$23.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.76
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.86
|
|
|
Service Code
|
NDC 81665020001
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.37 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: Aetna Commercial |
$59.27
|
| Rate for Payer: Aetna Medicare |
$24.37
|
| Rate for Payer: ASR ASR |
$63.88
|
| Rate for Payer: BCBS Complete |
$26.34
|
| Rate for Payer: BCBS Trust/PPO |
$54.30
|
| Rate for Payer: BCN Commercial |
$54.30
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Cofinity Commercial |
$61.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.69
|
| Rate for Payer: Healthscope Commercial |
$63.88
|
| Rate for Payer: Healthscope Whirlpool |
$65.86
|
| Rate for Payer: Mclaren Commercial |
$59.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.98
|
| Rate for Payer: Nomi Health Commercial |
$54.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.71
|
| Rate for Payer: Priority Health Narrow Network |
$46.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.96
|
|
|
SODIUM BICARBONATE 1 MEQ/ML (8.4 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.69
|
|
|
Service Code
|
NDC 81298762003
|
| Hospital Charge Code |
108819
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$20.69 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18.13
|
| Rate for Payer: Priority Health Narrow Network |
$14.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
