|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$51.04
|
|
|
Service Code
|
NDC 517096001
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.28 |
| Max. Negotiated Rate |
$51.04 |
| Rate for Payer: Aetna Commercial |
$45.94
|
| Rate for Payer: ASR ASR |
$49.51
|
| Rate for Payer: BCBS Trust/PPO |
$41.92
|
| Rate for Payer: BCN Commercial |
$41.92
|
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Cofinity Commercial |
$47.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$49.51
|
| Rate for Payer: Healthscope Whirlpool |
$51.04
|
| Rate for Payer: Mclaren Commercial |
$45.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.39
|
| Rate for Payer: Nomi Health Commercial |
$41.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.92
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061110
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare |
$5.86
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.35
|
|
|
Service Code
|
NDC 55150018810
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna Commercial |
$14.72
|
| Rate for Payer: ASR ASR |
$15.86
|
| Rate for Payer: BCBS Trust/PPO |
$13.43
|
| Rate for Payer: BCN Commercial |
$13.43
|
| Rate for Payer: Cash Price |
$13.08
|
| Rate for Payer: Cofinity Commercial |
$15.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.08
|
| Rate for Payer: Healthscope Commercial |
$15.86
|
| Rate for Payer: Healthscope Whirlpool |
$16.35
|
| Rate for Payer: Mclaren Commercial |
$14.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.90
|
| Rate for Payer: Nomi Health Commercial |
$13.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.39
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.39
|
|
|
Service Code
|
NDC 61990061100
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$19.39 |
| Rate for Payer: Aetna Commercial |
$17.45
|
| Rate for Payer: ASR ASR |
$18.81
|
| Rate for Payer: BCBS Trust/PPO |
$15.92
|
| Rate for Payer: BCN Commercial |
$15.92
|
| Rate for Payer: Cash Price |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$18.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.51
|
| Rate for Payer: Healthscope Commercial |
$18.81
|
| Rate for Payer: Healthscope Whirlpool |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.06
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.92
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.67
|
| Rate for Payer: BCN Commercial |
$18.67
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.05
|
|
|
Service Code
|
NDC 72485010710
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$8.90
|
| Rate for Payer: ASR ASR |
$23.33
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$19.83
|
| Rate for Payer: BCN Commercial |
$19.83
|
| Rate for Payer: Cash Price |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.44
|
| Rate for Payer: Nomi Health Commercial |
$19.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare |
$5.86
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061210
|
| Hospital Charge Code |
155937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare |
$5.86
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 81284061210
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCN Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
IP
|
$15.84
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCN Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061210
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare |
$5.86
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZED SOLUTION CUSTOM
|
Facility
|
OP
|
$15.84
|
|
|
Service Code
|
NDC 81284061200
|
| Hospital Charge Code |
301846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$15.84 |
| Rate for Payer: Aetna Commercial |
$14.25
|
| Rate for Payer: Aetna Medicare |
$5.86
|
| Rate for Payer: ASR ASR |
$15.36
|
| Rate for Payer: BCBS Complete |
$6.33
|
| Rate for Payer: BCBS Trust/PPO |
$13.06
|
| Rate for Payer: BCN Commercial |
$13.06
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cofinity Commercial |
$14.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.67
|
| Rate for Payer: Healthscope Commercial |
$15.36
|
| Rate for Payer: Healthscope Whirlpool |
$15.84
|
| Rate for Payer: Mclaren Commercial |
$14.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.46
|
| Rate for Payer: Nomi Health Commercial |
$12.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.88
|
| Rate for Payer: Priority Health Narrow Network |
$11.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.94
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
IP
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.67
|
| Rate for Payer: BCN Commercial |
$18.67
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) SOLUTION CUSTOM
|
Facility
|
OP
|
$22.74
|
|
|
Service Code
|
NDC 47781060191
|
| Hospital Charge Code |
300870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$22.74 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: ASR ASR |
$22.06
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$18.19
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$22.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.74
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.33
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.92
|
| Rate for Payer: Priority Health Narrow Network |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.01
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$4,899.10
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$4,429.37 |
| Max. Negotiated Rate |
$4,899.10 |
| Rate for Payer: BCBS Complete |
$4,899.10
|
| Rate for Payer: Mclaren Medicaid |
$4,665.81
|
| Rate for Payer: Meridian Medicaid |
$4,899.10
|
| Rate for Payer: PHP Medicaid |
$4,429.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,665.81
|
| Rate for Payer: UHC Medicaid |
$4,665.81
|
| Rate for Payer: UHCCP Medicaid |
$4,665.81
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$4,047.89
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$3,659.78 |
| Max. Negotiated Rate |
$4,047.89 |
| Rate for Payer: BCBS Complete |
$4,047.89
|
| Rate for Payer: Mclaren Medicaid |
$3,855.13
|
| Rate for Payer: Meridian Medicaid |
$4,047.89
|
| Rate for Payer: PHP Medicaid |
$3,659.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,855.13
|
| Rate for Payer: UHC Medicaid |
$3,855.13
|
| Rate for Payer: UHCCP Medicaid |
$3,855.13
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$6,277.82
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$5,675.90 |
| Max. Negotiated Rate |
$6,277.82 |
| Rate for Payer: BCBS Complete |
$6,277.82
|
| Rate for Payer: Mclaren Medicaid |
$5,978.88
|
| Rate for Payer: Meridian Medicaid |
$6,277.82
|
| Rate for Payer: PHP Medicaid |
$5,675.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,978.88
|
| Rate for Payer: UHC Medicaid |
$5,978.88
|
| Rate for Payer: UHCCP Medicaid |
$5,978.88
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$9,808.56
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$8,868.11 |
| Max. Negotiated Rate |
$9,808.56 |
| Rate for Payer: BCBS Complete |
$9,808.56
|
| Rate for Payer: Mclaren Medicaid |
$9,341.48
|
| Rate for Payer: Meridian Medicaid |
$9,808.56
|
| Rate for Payer: PHP Medicaid |
$8,868.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,341.48
|
| Rate for Payer: UHC Medicaid |
$9,341.48
|
| Rate for Payer: UHCCP Medicaid |
$9,341.48
|
|
|
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC
|
Facility
|
IP
|
$11,635.57
|
|
|
Service Code
|
MSDRG 069
|
| Min. Negotiated Rate |
$7,131.48 |
| Max. Negotiated Rate |
$11,635.57 |
| Rate for Payer: Aetna Medicare |
$7,506.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,383.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,383.52
|
| Rate for Payer: BCBS MAPPO |
$7,506.82
|
| Rate for Payer: BCN Medicare Advantage |
$7,506.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,506.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,506.82
|
| Rate for Payer: Mclaren Medicare |
$7,506.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,882.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,632.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,257.50
|
| Rate for Payer: PACE Medicare |
$7,131.48
|
| Rate for Payer: PACE SWMI |
$7,506.82
|
| Rate for Payer: PHP Commercial |
$8,257.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,506.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,974.55
|
| Rate for Payer: Priority Health Medicare |
$7,506.82
|
| Rate for Payer: Priority Health Narrow Network |
$8,779.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7,506.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,506.82
|
| Rate for Payer: UHC Exchange |
$11,635.57
|
| Rate for Payer: UHCCP DNSP |
$7,506.82
|
| Rate for Payer: VA VA |
$7,506.82
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$21,322.62
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$12,284.25 |
| Max. Negotiated Rate |
$21,322.62 |
| Rate for Payer: Aetna Medicare |
$12,930.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,163.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,163.49
|
| Rate for Payer: BCBS MAPPO |
$12,930.79
|
| Rate for Payer: BCN Medicare Advantage |
$12,930.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,930.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,930.79
|
| Rate for Payer: Mclaren Medicare |
$12,930.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,577.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,870.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,223.87
|
| Rate for Payer: PACE Medicare |
$12,284.25
|
| Rate for Payer: PACE SWMI |
$12,930.79
|
| Rate for Payer: PHP Commercial |
$14,223.87
|
| Rate for Payer: PHP Medicare Advantage |
$12,930.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21,322.62
|
| Rate for Payer: Priority Health Medicare |
$12,930.79
|
| Rate for Payer: Priority Health Narrow Network |
$17,058.09
|
| Rate for Payer: Railroad Medicare Medicare |
$12,930.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,930.79
|
| Rate for Payer: UHC Exchange |
$20,042.72
|
| Rate for Payer: UHCCP DNSP |
$12,930.79
|
| Rate for Payer: VA VA |
$12,930.79
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$40,117.30
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$21,642.99 |
| Max. Negotiated Rate |
$40,117.30 |
| Rate for Payer: Aetna Medicare |
$22,782.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,477.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,477.61
|
| Rate for Payer: BCBS MAPPO |
$22,782.09
|
| Rate for Payer: BCN Medicare Advantage |
$22,782.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,782.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,782.09
|
| Rate for Payer: Mclaren Medicare |
$22,782.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,921.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,199.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,060.30
|
| Rate for Payer: PACE Medicare |
$21,642.99
|
| Rate for Payer: PACE SWMI |
$22,782.09
|
| Rate for Payer: PHP Commercial |
$25,060.30
|
| Rate for Payer: PHP Medicare Advantage |
$22,782.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40,117.30
|
| Rate for Payer: Priority Health Medicare |
$22,782.09
|
| Rate for Payer: Priority Health Narrow Network |
$32,093.84
|
| Rate for Payer: Railroad Medicare Medicare |
$22,782.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,782.09
|
| Rate for Payer: UHC Exchange |
$35,312.24
|
| Rate for Payer: UHCCP DNSP |
$22,782.09
|
| Rate for Payer: VA VA |
$22,782.09
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,627.96
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$8,352.62 |
| Max. Negotiated Rate |
$13,627.96 |
| Rate for Payer: Aetna Medicare |
$8,792.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,990.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,990.29
|
| Rate for Payer: BCBS MAPPO |
$8,792.23
|
| Rate for Payer: BCN Medicare Advantage |
$8,792.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,792.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,792.23
|
| Rate for Payer: Mclaren Medicare |
$8,792.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,231.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,111.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,671.45
|
| Rate for Payer: PACE Medicare |
$8,352.62
|
| Rate for Payer: PACE SWMI |
$8,792.23
|
| Rate for Payer: PHP Commercial |
$9,671.45
|
| Rate for Payer: PHP Medicare Advantage |
$8,792.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,426.93
|
| Rate for Payer: Priority Health Medicare |
$8,792.23
|
| Rate for Payer: Priority Health Narrow Network |
$10,741.54
|
| Rate for Payer: Railroad Medicare Medicare |
$8,792.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,792.23
|
| Rate for Payer: UHC Exchange |
$13,627.96
|
| Rate for Payer: UHCCP DNSP |
$8,792.23
|
| Rate for Payer: VA VA |
$8,792.23
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$16,923.42
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$15,300.80 |
| Max. Negotiated Rate |
$16,923.42 |
| Rate for Payer: BCBS Complete |
$16,923.42
|
| Rate for Payer: Mclaren Medicaid |
$16,117.55
|
| Rate for Payer: Meridian Medicaid |
$16,923.42
|
| Rate for Payer: PHP Medicaid |
$15,300.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,117.55
|
| Rate for Payer: UHC Medicaid |
$16,117.55
|
| Rate for Payer: UHCCP Medicaid |
$16,117.55
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$4,954.69
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$4,479.63 |
| Max. Negotiated Rate |
$4,954.69 |
| Rate for Payer: BCBS Complete |
$4,954.69
|
| Rate for Payer: Mclaren Medicaid |
$4,718.75
|
| Rate for Payer: Meridian Medicaid |
$4,954.69
|
| Rate for Payer: PHP Medicaid |
$4,479.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,718.75
|
| Rate for Payer: UHC Medicaid |
$4,718.75
|
| Rate for Payer: UHCCP Medicaid |
$4,718.75
|
|
