|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 409669501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCN Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.23
|
| Rate for Payer: Healthscope Whirlpool |
$22.92
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.43
|
|
|
Service Code
|
NDC 65219044501
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$6.82
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Trust/PPO |
$15.19
|
| Rate for Payer: BCN Commercial |
$15.19
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health Narrow Network |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.23
|
|
|
Service Code
|
NDC 143931001
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.72
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.23
|
|
|
Service Code
|
NDC 143950601
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$25.23 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$9.34
|
| Rate for Payer: ASR ASR |
$24.47
|
| Rate for Payer: BCBS Complete |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$20.80
|
| Rate for Payer: BCN Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$23.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Whirlpool |
$25.23
|
| Rate for Payer: Mclaren Commercial |
$22.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$20.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.11
|
| Rate for Payer: Priority Health Narrow Network |
$17.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.20
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219044510
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: ASR ASR |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$15.13
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$15.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.21
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.92
|
|
|
Service Code
|
NDC 409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: Aetna Medicare |
$8.48
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$18.90
|
| Rate for Payer: BCN Commercial |
$18.90
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.23
|
| Rate for Payer: Healthscope Whirlpool |
$22.92
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.08
|
| Rate for Payer: Priority Health Narrow Network |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 409669501
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCN Commercial |
$18.82
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.23
|
| Rate for Payer: Healthscope Whirlpool |
$22.92
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.48
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
EUFLEXXA 10 MG/ML (MW 2.4-3.6 MILLION) INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$1,073.23
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.22 |
| Max. Negotiated Rate |
$1,073.23 |
| Rate for Payer: Aetna Commercial |
$965.91
|
| Rate for Payer: Aetna Medicare |
$105.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.97
|
| Rate for Payer: ASR ASR |
$1,041.03
|
| Rate for Payer: BCBS Complete |
$57.98
|
| Rate for Payer: BCBS MAPPO |
$105.58
|
| Rate for Payer: BCBS Trust/PPO |
$884.88
|
| Rate for Payer: BCN Commercial |
$884.88
|
| Rate for Payer: BCN Medicare Advantage |
$105.58
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cofinity Commercial |
$1,008.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.58
|
| Rate for Payer: Healthscope Commercial |
$1,041.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$105.58
|
| Rate for Payer: Mclaren Commercial |
$965.91
|
| Rate for Payer: Mclaren Medicaid |
$105.58
|
| Rate for Payer: Mclaren Medicare |
$105.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.86
|
| Rate for Payer: Meridian Medicaid |
$57.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.24
|
| Rate for Payer: Nomi Health Commercial |
$880.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.92
|
| Rate for Payer: PACE Medicare |
$100.30
|
| Rate for Payer: PACE SWMI |
$105.58
|
| Rate for Payer: PHP Commercial |
$116.14
|
| Rate for Payer: PHP Medicaid |
$56.59
|
| Rate for Payer: PHP Medicare Advantage |
$105.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.44
|
| Rate for Payer: Priority Health Medicare |
$105.58
|
| Rate for Payer: Priority Health Narrow Network |
$87.55
|
| Rate for Payer: Railroad Medicare Medicare |
$105.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.58
|
| Rate for Payer: UHC Exchange |
$163.65
|
| Rate for Payer: UHC Medicaid |
$55.22
|
| Rate for Payer: UHCCP DNSP |
$105.58
|
| Rate for Payer: UHCCP Medicaid |
$55.22
|
| Rate for Payer: VA VA |
$105.58
|
|
|
EUFLEXXA 10 MG/ML (MW 2.4-3.6 MILLION) INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$1,073.23
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$804.92 |
| Max. Negotiated Rate |
$1,073.23 |
| Rate for Payer: Aetna Commercial |
$965.91
|
| Rate for Payer: ASR ASR |
$1,041.03
|
| Rate for Payer: BCBS Trust/PPO |
$881.34
|
| Rate for Payer: BCN Commercial |
$881.34
|
| Rate for Payer: Cash Price |
$858.58
|
| Rate for Payer: Cofinity Commercial |
$1,008.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$858.58
|
| Rate for Payer: Healthscope Commercial |
$1,041.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,073.23
|
| Rate for Payer: Mclaren Commercial |
$965.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$912.24
|
| Rate for Payer: Nomi Health Commercial |
$880.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$804.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$944.44
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$926.89
|
|
|
Service Code
|
NDC 72511076001
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$342.95 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: Aetna Medicare |
$342.95
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: BCBS Complete |
$370.76
|
| Rate for Payer: BCBS Trust/PPO |
$764.22
|
| Rate for Payer: BCN Commercial |
$764.22
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$899.08
|
| Rate for Payer: Healthscope Whirlpool |
$926.89
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.85
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$812.14
|
| Rate for Payer: Priority Health Narrow Network |
$649.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
OP
|
$945.38
|
|
|
Service Code
|
NDC 72511076002
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$349.79 |
| Max. Negotiated Rate |
$945.38 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: Aetna Medicare |
$349.79
|
| Rate for Payer: ASR ASR |
$917.02
|
| Rate for Payer: BCBS Complete |
$378.15
|
| Rate for Payer: BCBS Trust/PPO |
$779.47
|
| Rate for Payer: BCN Commercial |
$779.47
|
| Rate for Payer: Cash Price |
$756.31
|
| Rate for Payer: Cofinity Commercial |
$888.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.31
|
| Rate for Payer: Healthscope Commercial |
$917.02
|
| Rate for Payer: Healthscope Whirlpool |
$945.38
|
| Rate for Payer: Mclaren Commercial |
$850.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$756.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.58
|
| Rate for Payer: Nomi Health Commercial |
$775.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$828.34
|
| Rate for Payer: Priority Health Narrow Network |
$662.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$831.94
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$945.38
|
|
|
Service Code
|
NDC 72511076002
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$709.04 |
| Max. Negotiated Rate |
$945.38 |
| Rate for Payer: Aetna Commercial |
$850.84
|
| Rate for Payer: ASR ASR |
$917.02
|
| Rate for Payer: BCBS Trust/PPO |
$776.35
|
| Rate for Payer: BCN Commercial |
$776.35
|
| Rate for Payer: Cash Price |
$756.31
|
| Rate for Payer: Cofinity Commercial |
$888.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$756.31
|
| Rate for Payer: Healthscope Commercial |
$917.02
|
| Rate for Payer: Healthscope Whirlpool |
$945.38
|
| Rate for Payer: Mclaren Commercial |
$850.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.58
|
| Rate for Payer: Nomi Health Commercial |
$775.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$831.94
|
|
|
EVOLOCUMAB 140 MG/ML SUBCUTANEOUS PEN INJECTOR
|
Facility
|
IP
|
$926.89
|
|
|
Service Code
|
NDC 72511076001
|
| Hospital Charge Code |
175551
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$695.17 |
| Max. Negotiated Rate |
$926.89 |
| Rate for Payer: Aetna Commercial |
$834.20
|
| Rate for Payer: ASR ASR |
$899.08
|
| Rate for Payer: BCBS Trust/PPO |
$761.16
|
| Rate for Payer: BCN Commercial |
$761.16
|
| Rate for Payer: Cash Price |
$741.51
|
| Rate for Payer: Cofinity Commercial |
$871.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$741.51
|
| Rate for Payer: Healthscope Commercial |
$899.08
|
| Rate for Payer: Healthscope Whirlpool |
$926.89
|
| Rate for Payer: Mclaren Commercial |
$834.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.85
|
| Rate for Payer: Nomi Health Commercial |
$760.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$815.66
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$13,298.41
|
|
|
Service Code
|
APR-DRG 9112
|
| Min. Negotiated Rate |
$12,023.36 |
| Max. Negotiated Rate |
$13,298.41 |
| Rate for Payer: BCBS Complete |
$13,298.41
|
| Rate for Payer: Mclaren Medicaid |
$12,665.16
|
| Rate for Payer: Meridian Medicaid |
$13,298.41
|
| Rate for Payer: PHP Medicaid |
$12,023.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,665.16
|
| Rate for Payer: UHC Medicaid |
$12,665.16
|
| Rate for Payer: UHCCP Medicaid |
$12,665.16
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$39,514.87
|
|
|
Service Code
|
APR-DRG 9114
|
| Min. Negotiated Rate |
$35,726.17 |
| Max. Negotiated Rate |
$39,514.87 |
| Rate for Payer: BCBS Complete |
$39,514.87
|
| Rate for Payer: Mclaren Medicaid |
$37,633.21
|
| Rate for Payer: Meridian Medicaid |
$39,514.87
|
| Rate for Payer: PHP Medicaid |
$35,726.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$37,633.21
|
| Rate for Payer: UHC Medicaid |
$37,633.21
|
| Rate for Payer: UHCCP Medicaid |
$37,633.21
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$19,137.55
|
|
|
Service Code
|
APR-DRG 9113
|
| Min. Negotiated Rate |
$17,302.64 |
| Max. Negotiated Rate |
$19,137.55 |
| Rate for Payer: BCBS Complete |
$19,137.55
|
| Rate for Payer: Mclaren Medicaid |
$18,226.24
|
| Rate for Payer: Meridian Medicaid |
$19,137.55
|
| Rate for Payer: PHP Medicaid |
$17,302.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,226.24
|
| Rate for Payer: UHC Medicaid |
$18,226.24
|
| Rate for Payer: UHCCP Medicaid |
$18,226.24
|
|
|
EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$11,044.50
|
|
|
Service Code
|
APR-DRG 9111
|
| Min. Negotiated Rate |
$9,985.55 |
| Max. Negotiated Rate |
$11,044.50 |
| Rate for Payer: BCBS Complete |
$11,044.50
|
| Rate for Payer: Mclaren Medicaid |
$10,518.57
|
| Rate for Payer: Meridian Medicaid |
$11,044.50
|
| Rate for Payer: PHP Medicaid |
$9,985.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,518.57
|
| Rate for Payer: UHC Medicaid |
$10,518.57
|
| Rate for Payer: UHCCP Medicaid |
$10,518.57
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$53,501.63
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$28,307.66 |
| Max. Negotiated Rate |
$53,501.63 |
| Rate for Payer: Aetna Medicare |
$29,797.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,246.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,246.93
|
| Rate for Payer: BCBS MAPPO |
$29,797.54
|
| Rate for Payer: BCN Medicare Advantage |
$29,797.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,797.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,797.54
|
| Rate for Payer: Mclaren Medicare |
$29,797.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,287.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,267.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,777.29
|
| Rate for Payer: PACE Medicare |
$28,307.66
|
| Rate for Payer: PACE SWMI |
$29,797.54
|
| Rate for Payer: PHP Commercial |
$32,777.29
|
| Rate for Payer: PHP Medicare Advantage |
$29,797.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53,501.63
|
| Rate for Payer: Priority Health Medicare |
$29,797.54
|
| Rate for Payer: Priority Health Narrow Network |
$42,801.31
|
| Rate for Payer: Railroad Medicare Medicare |
$29,797.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,797.54
|
| Rate for Payer: UHC Exchange |
$46,186.19
|
| Rate for Payer: UHCCP DNSP |
$29,797.54
|
| Rate for Payer: VA VA |
$29,797.54
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$293,330.25
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$147,729.38 |
| Max. Negotiated Rate |
$293,330.25 |
| Rate for Payer: Aetna Medicare |
$155,504.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$194,380.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$194,380.76
|
| Rate for Payer: BCBS MAPPO |
$155,504.61
|
| Rate for Payer: BCN Medicare Advantage |
$155,504.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155,504.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$155,504.61
|
| Rate for Payer: Mclaren Medicare |
$155,504.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163,279.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$178,830.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$171,055.07
|
| Rate for Payer: PACE Medicare |
$147,729.38
|
| Rate for Payer: PACE SWMI |
$155,504.61
|
| Rate for Payer: PHP Commercial |
$171,055.07
|
| Rate for Payer: PHP Medicare Advantage |
$155,504.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293,330.25
|
| Rate for Payer: Priority Health Medicare |
$155,504.61
|
| Rate for Payer: Priority Health Narrow Network |
$234,664.20
|
| Rate for Payer: Railroad Medicare Medicare |
$155,504.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155,504.61
|
| Rate for Payer: UHC Exchange |
$241,032.15
|
| Rate for Payer: UHCCP DNSP |
$155,504.61
|
| Rate for Payer: VA VA |
$155,504.61
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$8,991.67
|
|
|
Service Code
|
APR-DRG 7921
|
| Min. Negotiated Rate |
$8,129.55 |
| Max. Negotiated Rate |
$8,991.67 |
| Rate for Payer: BCBS Complete |
$8,991.67
|
| Rate for Payer: Mclaren Medicaid |
$8,563.50
|
| Rate for Payer: Meridian Medicaid |
$8,991.67
|
| Rate for Payer: PHP Medicaid |
$8,129.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,563.50
|
| Rate for Payer: UHC Medicaid |
$8,563.50
|
| Rate for Payer: UHCCP Medicaid |
$8,563.50
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$11,354.58
|
|
|
Service Code
|
APR-DRG 7922
|
| Min. Negotiated Rate |
$10,265.90 |
| Max. Negotiated Rate |
$11,354.58 |
| Rate for Payer: BCBS Complete |
$11,354.58
|
| Rate for Payer: Mclaren Medicaid |
$10,813.88
|
| Rate for Payer: Meridian Medicaid |
$11,354.58
|
| Rate for Payer: PHP Medicaid |
$10,265.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,813.88
|
| Rate for Payer: UHC Medicaid |
$10,813.88
|
| Rate for Payer: UHCCP Medicaid |
$10,813.88
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$16,195.37
|
|
|
Service Code
|
APR-DRG 7923
|
| Min. Negotiated Rate |
$14,642.55 |
| Max. Negotiated Rate |
$16,195.37 |
| Rate for Payer: BCBS Complete |
$16,195.37
|
| Rate for Payer: Mclaren Medicaid |
$15,424.16
|
| Rate for Payer: Meridian Medicaid |
$16,195.37
|
| Rate for Payer: PHP Medicaid |
$14,642.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,424.16
|
| Rate for Payer: UHC Medicaid |
$15,424.16
|
| Rate for Payer: UHCCP Medicaid |
$15,424.16
|
|
|
EXTENSIVE O.R. PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT
|
Facility
|
IP
|
$27,613.16
|
|
|
Service Code
|
APR-DRG 7924
|
| Min. Negotiated Rate |
$24,965.60 |
| Max. Negotiated Rate |
$27,613.16 |
| Rate for Payer: BCBS Complete |
$27,613.16
|
| Rate for Payer: Mclaren Medicaid |
$26,298.25
|
| Rate for Payer: Meridian Medicaid |
$27,613.16
|
| Rate for Payer: PHP Medicaid |
$24,965.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,298.25
|
| Rate for Payer: UHC Medicaid |
$26,298.25
|
| Rate for Payer: UHCCP Medicaid |
$26,298.25
|
|
