|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$6,691.99
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$6,050.36 |
| Max. Negotiated Rate |
$6,691.99 |
| Rate for Payer: BCBS Complete |
$6,691.99
|
| Rate for Payer: Mclaren Medicaid |
$6,373.32
|
| Rate for Payer: Meridian Medicaid |
$6,691.99
|
| Rate for Payer: PHP Medicaid |
$6,050.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,373.32
|
| Rate for Payer: UHC Medicaid |
$6,373.32
|
| Rate for Payer: UHCCP Medicaid |
$6,373.32
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$10,935.51
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$9,887.01 |
| Max. Negotiated Rate |
$10,935.51 |
| Rate for Payer: BCBS Complete |
$10,935.51
|
| Rate for Payer: Mclaren Medicaid |
$10,414.77
|
| Rate for Payer: Meridian Medicaid |
$10,935.51
|
| Rate for Payer: PHP Medicaid |
$9,887.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,414.77
|
| Rate for Payer: UHC Medicaid |
$10,414.77
|
| Rate for Payer: UHCCP Medicaid |
$10,414.77
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$20,654.91
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$11,951.76 |
| Max. Negotiated Rate |
$20,654.91 |
| Rate for Payer: Aetna Medicare |
$12,580.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,726.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,726.00
|
| Rate for Payer: BCBS MAPPO |
$12,580.80
|
| Rate for Payer: BCN Medicare Advantage |
$12,580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,580.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,580.80
|
| Rate for Payer: Mclaren Medicare |
$12,580.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,209.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,467.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,838.88
|
| Rate for Payer: PACE Medicare |
$11,951.76
|
| Rate for Payer: PACE SWMI |
$12,580.80
|
| Rate for Payer: PHP Commercial |
$13,838.88
|
| Rate for Payer: PHP Medicare Advantage |
$12,580.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,654.91
|
| Rate for Payer: Priority Health Medicare |
$12,580.80
|
| Rate for Payer: Priority Health Narrow Network |
$16,523.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12,580.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,580.80
|
| Rate for Payer: UHC Exchange |
$19,500.24
|
| Rate for Payer: UHCCP DNSP |
$12,580.80
|
| Rate for Payer: VA VA |
$12,580.80
|
|
|
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$14,527.41
|
|
|
Service Code
|
MSDRG 714
|
| Min. Negotiated Rate |
$8,900.60 |
| Max. Negotiated Rate |
$14,527.41 |
| Rate for Payer: Aetna Medicare |
$9,369.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,711.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,711.31
|
| Rate for Payer: BCBS MAPPO |
$9,369.05
|
| Rate for Payer: BCN Medicare Advantage |
$9,369.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,369.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,369.05
|
| Rate for Payer: Mclaren Medicare |
$9,369.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,837.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,774.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,305.95
|
| Rate for Payer: PACE Medicare |
$8,900.60
|
| Rate for Payer: PACE SWMI |
$9,369.05
|
| Rate for Payer: PHP Commercial |
$10,305.95
|
| Rate for Payer: PHP Medicare Advantage |
$9,369.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,527.41
|
| Rate for Payer: Priority Health Medicare |
$9,369.05
|
| Rate for Payer: Priority Health Narrow Network |
$11,621.93
|
| Rate for Payer: Railroad Medicare Medicare |
$9,369.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,369.05
|
| Rate for Payer: UHC Exchange |
$14,522.03
|
| Rate for Payer: UHCCP DNSP |
$9,369.05
|
| Rate for Payer: VA VA |
$9,369.05
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$22,457.44
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$12,849.34 |
| Max. Negotiated Rate |
$22,457.44 |
| Rate for Payer: Aetna Medicare |
$13,525.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,907.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,907.03
|
| Rate for Payer: BCBS MAPPO |
$13,525.62
|
| Rate for Payer: BCN Medicare Advantage |
$13,525.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,525.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,525.62
|
| Rate for Payer: Mclaren Medicare |
$13,525.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,201.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,554.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,878.18
|
| Rate for Payer: PACE Medicare |
$12,849.34
|
| Rate for Payer: PACE SWMI |
$13,525.62
|
| Rate for Payer: PHP Commercial |
$14,878.18
|
| Rate for Payer: PHP Medicare Advantage |
$13,525.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,457.44
|
| Rate for Payer: Priority Health Medicare |
$13,525.62
|
| Rate for Payer: Priority Health Narrow Network |
$17,965.95
|
| Rate for Payer: Railroad Medicare Medicare |
$13,525.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,525.62
|
| Rate for Payer: UHC Exchange |
$20,964.71
|
| Rate for Payer: UHCCP DNSP |
$13,525.62
|
| Rate for Payer: VA VA |
$13,525.62
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$12,603.30
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$7,724.60 |
| Max. Negotiated Rate |
$12,603.30 |
| Rate for Payer: Aetna Medicare |
$8,131.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,163.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,163.95
|
| Rate for Payer: BCBS MAPPO |
$8,131.16
|
| Rate for Payer: BCN Medicare Advantage |
$8,131.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,131.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,131.16
|
| Rate for Payer: Mclaren Medicare |
$8,131.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,537.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,350.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,944.28
|
| Rate for Payer: PACE Medicare |
$7,724.60
|
| Rate for Payer: PACE SWMI |
$8,131.16
|
| Rate for Payer: PHP Commercial |
$8,944.28
|
| Rate for Payer: PHP Medicare Advantage |
$8,131.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,165.71
|
| Rate for Payer: Priority Health Medicare |
$8,131.16
|
| Rate for Payer: Priority Health Narrow Network |
$9,732.57
|
| Rate for Payer: Railroad Medicare Medicare |
$8,131.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,131.16
|
| Rate for Payer: UHC Exchange |
$12,603.30
|
| Rate for Payer: UHCCP DNSP |
$8,131.16
|
| Rate for Payer: VA VA |
$8,131.16
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$17,897.53
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$10,578.73 |
| Max. Negotiated Rate |
$17,897.53 |
| Rate for Payer: Aetna Medicare |
$11,135.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,919.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,919.39
|
| Rate for Payer: BCBS MAPPO |
$11,135.51
|
| Rate for Payer: BCN Medicare Advantage |
$11,135.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,135.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,135.51
|
| Rate for Payer: Mclaren Medicare |
$11,135.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,692.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,805.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,249.06
|
| Rate for Payer: PACE Medicare |
$10,578.73
|
| Rate for Payer: PACE SWMI |
$11,135.51
|
| Rate for Payer: PHP Commercial |
$12,249.06
|
| Rate for Payer: PHP Medicare Advantage |
$11,135.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,897.53
|
| Rate for Payer: Priority Health Medicare |
$11,135.51
|
| Rate for Payer: Priority Health Narrow Network |
$14,318.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11,135.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,135.51
|
| Rate for Payer: UHC Exchange |
$17,260.04
|
| Rate for Payer: UHCCP DNSP |
$11,135.51
|
| Rate for Payer: VA VA |
$11,135.51
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$19,176.62
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$11,215.66 |
| Max. Negotiated Rate |
$19,176.62 |
| Rate for Payer: Aetna Medicare |
$11,805.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,757.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,757.45
|
| Rate for Payer: BCBS MAPPO |
$11,805.96
|
| Rate for Payer: BCN Medicare Advantage |
$11,805.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,805.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,805.96
|
| Rate for Payer: Mclaren Medicare |
$11,805.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,396.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,576.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,986.56
|
| Rate for Payer: PACE Medicare |
$11,215.66
|
| Rate for Payer: PACE SWMI |
$11,805.96
|
| Rate for Payer: PHP Commercial |
$12,986.56
|
| Rate for Payer: PHP Medicare Advantage |
$11,805.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,176.62
|
| Rate for Payer: Priority Health Medicare |
$11,805.96
|
| Rate for Payer: Priority Health Narrow Network |
$15,341.29
|
| Rate for Payer: Railroad Medicare Medicare |
$11,805.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,805.96
|
| Rate for Payer: UHC Exchange |
$18,299.24
|
| Rate for Payer: UHCCP DNSP |
$11,805.96
|
| Rate for Payer: VA VA |
$11,805.96
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$31,213.18
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$17,209.22 |
| Max. Negotiated Rate |
$31,213.18 |
| Rate for Payer: Aetna Medicare |
$18,114.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,643.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,643.71
|
| Rate for Payer: BCBS MAPPO |
$18,114.97
|
| Rate for Payer: BCN Medicare Advantage |
$18,114.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,114.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,114.97
|
| Rate for Payer: Mclaren Medicare |
$18,114.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,020.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,832.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,926.47
|
| Rate for Payer: PACE Medicare |
$17,209.22
|
| Rate for Payer: PACE SWMI |
$18,114.97
|
| Rate for Payer: PHP Commercial |
$19,926.47
|
| Rate for Payer: PHP Medicare Advantage |
$18,114.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31,213.18
|
| Rate for Payer: Priority Health Medicare |
$18,114.97
|
| Rate for Payer: Priority Health Narrow Network |
$24,970.54
|
| Rate for Payer: Railroad Medicare Medicare |
$18,114.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,114.97
|
| Rate for Payer: UHC Exchange |
$28,078.20
|
| Rate for Payer: UHCCP DNSP |
$18,114.97
|
| Rate for Payer: VA VA |
$18,114.97
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$31,401.40
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$17,302.94 |
| Max. Negotiated Rate |
$31,401.40 |
| Rate for Payer: Aetna Medicare |
$18,213.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,767.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,767.03
|
| Rate for Payer: BCBS MAPPO |
$18,213.62
|
| Rate for Payer: BCN Medicare Advantage |
$18,213.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,213.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,213.62
|
| Rate for Payer: Mclaren Medicare |
$18,213.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,124.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,945.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,034.98
|
| Rate for Payer: PACE Medicare |
$17,302.94
|
| Rate for Payer: PACE SWMI |
$18,213.62
|
| Rate for Payer: PHP Commercial |
$20,034.98
|
| Rate for Payer: PHP Medicare Advantage |
$18,213.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31,401.40
|
| Rate for Payer: Priority Health Medicare |
$18,213.62
|
| Rate for Payer: Priority Health Narrow Network |
$25,121.12
|
| Rate for Payer: Railroad Medicare Medicare |
$18,213.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,213.62
|
| Rate for Payer: UHC Exchange |
$28,231.11
|
| Rate for Payer: UHCCP DNSP |
$18,213.62
|
| Rate for Payer: VA VA |
$18,213.62
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$12,929.23
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$7,924.37 |
| Max. Negotiated Rate |
$12,929.23 |
| Rate for Payer: Aetna Medicare |
$8,341.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,426.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,426.80
|
| Rate for Payer: BCBS MAPPO |
$8,341.44
|
| Rate for Payer: BCN Medicare Advantage |
$8,341.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,341.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,341.44
|
| Rate for Payer: Mclaren Medicare |
$8,341.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,758.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,592.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,175.58
|
| Rate for Payer: PACE Medicare |
$7,924.37
|
| Rate for Payer: PACE SWMI |
$8,341.44
|
| Rate for Payer: PHP Commercial |
$9,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$8,341.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,566.88
|
| Rate for Payer: Priority Health Medicare |
$8,341.44
|
| Rate for Payer: Priority Health Narrow Network |
$10,053.50
|
| Rate for Payer: Railroad Medicare Medicare |
$8,341.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,341.44
|
| Rate for Payer: UHC Exchange |
$12,929.23
|
| Rate for Payer: UHCCP DNSP |
$8,341.44
|
| Rate for Payer: VA VA |
$8,341.44
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$13,387.99
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$8,205.54 |
| Max. Negotiated Rate |
$13,387.99 |
| Rate for Payer: Aetna Medicare |
$8,637.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,796.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,796.76
|
| Rate for Payer: BCBS MAPPO |
$8,637.41
|
| Rate for Payer: BCN Medicare Advantage |
$8,637.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,637.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,637.41
|
| Rate for Payer: Mclaren Medicare |
$8,637.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,069.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,933.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,501.15
|
| Rate for Payer: PACE Medicare |
$8,205.54
|
| Rate for Payer: PACE SWMI |
$8,637.41
|
| Rate for Payer: PHP Commercial |
$9,501.15
|
| Rate for Payer: PHP Medicare Advantage |
$8,637.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,131.55
|
| Rate for Payer: Priority Health Medicare |
$8,637.41
|
| Rate for Payer: Priority Health Narrow Network |
$10,505.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8,637.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,637.41
|
| Rate for Payer: UHC Exchange |
$13,387.99
|
| Rate for Payer: UHCCP DNSP |
$8,637.41
|
| Rate for Payer: VA VA |
$8,637.41
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$20,224.89
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$11,737.64 |
| Max. Negotiated Rate |
$20,224.89 |
| Rate for Payer: Aetna Medicare |
$12,355.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,444.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,444.26
|
| Rate for Payer: BCBS MAPPO |
$12,355.41
|
| Rate for Payer: BCN Medicare Advantage |
$12,355.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,355.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,355.41
|
| Rate for Payer: Mclaren Medicare |
$12,355.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,973.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,208.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,590.95
|
| Rate for Payer: PACE Medicare |
$11,737.64
|
| Rate for Payer: PACE SWMI |
$12,355.41
|
| Rate for Payer: PHP Commercial |
$13,590.95
|
| Rate for Payer: PHP Medicare Advantage |
$12,355.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,224.89
|
| Rate for Payer: Priority Health Medicare |
$12,355.41
|
| Rate for Payer: Priority Health Narrow Network |
$16,179.91
|
| Rate for Payer: Railroad Medicare Medicare |
$12,355.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,355.41
|
| Rate for Payer: UHC Exchange |
$19,150.89
|
| Rate for Payer: UHCCP DNSP |
$12,355.41
|
| Rate for Payer: VA VA |
$12,355.41
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$12,943.74
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$7,933.26 |
| Max. Negotiated Rate |
$12,943.74 |
| Rate for Payer: Aetna Medicare |
$8,350.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,438.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,438.50
|
| Rate for Payer: BCBS MAPPO |
$8,350.80
|
| Rate for Payer: BCN Medicare Advantage |
$8,350.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,350.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,350.80
|
| Rate for Payer: Mclaren Medicare |
$8,350.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,768.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,603.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,185.88
|
| Rate for Payer: PACE Medicare |
$7,933.26
|
| Rate for Payer: PACE SWMI |
$8,350.80
|
| Rate for Payer: PHP Commercial |
$9,185.88
|
| Rate for Payer: PHP Medicare Advantage |
$8,350.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,584.74
|
| Rate for Payer: Priority Health Medicare |
$8,350.80
|
| Rate for Payer: Priority Health Narrow Network |
$10,067.79
|
| Rate for Payer: Railroad Medicare Medicare |
$8,350.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,350.80
|
| Rate for Payer: UHC Exchange |
$12,943.74
|
| Rate for Payer: UHCCP DNSP |
$8,350.80
|
| Rate for Payer: VA VA |
$8,350.80
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.26 |
| Max. Negotiated Rate |
$103.40 |
| Rate for Payer: Aetna Commercial |
$93.06
|
| Rate for Payer: Aetna Medicare |
$38.26
|
| Rate for Payer: ASR ASR |
$100.30
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.25
|
| Rate for Payer: BCN Commercial |
$85.25
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$100.30
|
| Rate for Payer: Healthscope Whirlpool |
$103.40
|
| Rate for Payer: Mclaren Commercial |
$93.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$90.60
|
| Rate for Payer: Priority Health Narrow Network |
$72.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.99
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 50111056001
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.55 |
| Max. Negotiated Rate |
$103.40 |
| Rate for Payer: Aetna Commercial |
$93.06
|
| Rate for Payer: ASR ASR |
$100.30
|
| Rate for Payer: BCBS Trust/PPO |
$84.91
|
| Rate for Payer: BCN Commercial |
$84.91
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$97.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$100.30
|
| Rate for Payer: Healthscope Whirlpool |
$103.40
|
| Rate for Payer: Mclaren Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.99
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$244.40
|
|
|
Service Code
|
NDC 904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.43 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Medicare |
$90.43
|
| Rate for Payer: ASR ASR |
$237.07
|
| Rate for Payer: BCBS Complete |
$97.76
|
| Rate for Payer: BCBS Trust/PPO |
$201.51
|
| Rate for Payer: BCN Commercial |
$201.51
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$237.07
|
| Rate for Payer: Healthscope Whirlpool |
$244.40
|
| Rate for Payer: Mclaren Commercial |
$219.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$214.14
|
| Rate for Payer: Priority Health Narrow Network |
$171.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.07
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.35
|
| Rate for Payer: Priority Health Narrow Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$108.10
|
|
|
Service Code
|
NDC 13107007901
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$108.10 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: Aetna Medicare |
$40.00
|
| Rate for Payer: ASR ASR |
$104.86
|
| Rate for Payer: BCBS Complete |
$43.24
|
| Rate for Payer: BCBS Trust/PPO |
$89.13
|
| Rate for Payer: BCN Commercial |
$89.13
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$101.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$104.86
|
| Rate for Payer: Healthscope Whirlpool |
$108.10
|
| Rate for Payer: Mclaren Commercial |
$97.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.72
|
| Rate for Payer: Priority Health Narrow Network |
$75.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 13107007901
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.08 |
| Max. Negotiated Rate |
$108.10 |
| Rate for Payer: Aetna Commercial |
$97.29
|
| Rate for Payer: ASR ASR |
$104.86
|
| Rate for Payer: BCBS Trust/PPO |
$88.77
|
| Rate for Payer: BCN Commercial |
$88.77
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$101.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$104.86
|
| Rate for Payer: Healthscope Whirlpool |
$108.10
|
| Rate for Payer: Mclaren Commercial |
$97.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.89
|
| Rate for Payer: Nomi Health Commercial |
$88.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.13
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: ASR ASR |
$259.86
|
| Rate for Payer: BCBS Trust/PPO |
$220.00
|
| Rate for Payer: BCN Commercial |
$220.00
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$251.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$259.86
|
| Rate for Payer: Healthscope Whirlpool |
$267.90
|
| Rate for Payer: Mclaren Commercial |
$241.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 60687044311
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.20
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.68
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
OP
|
$267.90
|
|
|
Service Code
|
NDC 60687044301
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$241.11
|
| Rate for Payer: Aetna Medicare |
$99.12
|
| Rate for Payer: ASR ASR |
$259.86
|
| Rate for Payer: BCBS Complete |
$107.16
|
| Rate for Payer: BCBS Trust/PPO |
$220.88
|
| Rate for Payer: BCN Commercial |
$220.88
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cofinity Commercial |
$251.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.32
|
| Rate for Payer: Healthscope Commercial |
$259.86
|
| Rate for Payer: Healthscope Whirlpool |
$267.90
|
| Rate for Payer: Mclaren Commercial |
$241.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.72
|
| Rate for Payer: Nomi Health Commercial |
$219.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$234.73
|
| Rate for Payer: Priority Health Narrow Network |
$187.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.75
|
|
|
TRAZODONE 50 MG TABLET
|
Facility
|
IP
|
$244.40
|
|
|
Service Code
|
NDC 904686861
|
| Hospital Charge Code |
8085
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.30 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: ASR ASR |
$237.07
|
| Rate for Payer: BCBS Trust/PPO |
$200.70
|
| Rate for Payer: BCN Commercial |
$200.70
|
| Rate for Payer: Cash Price |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$229.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.52
|
| Rate for Payer: Healthscope Commercial |
$237.07
|
| Rate for Payer: Healthscope Whirlpool |
$244.40
|
| Rate for Payer: Mclaren Commercial |
$219.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.74
|
| Rate for Payer: Nomi Health Commercial |
$200.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.07
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$17.75
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$17.75 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: ASR ASR |
$17.22
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS Trust/PPO |
$14.64
|
| Rate for Payer: BCN Commercial |
$14.64
|
| Rate for Payer: Cash Price |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$16.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.20
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Healthscope Whirlpool |
$17.75
|
| Rate for Payer: Mclaren Commercial |
$15.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.09
|
| Rate for Payer: Nomi Health Commercial |
$14.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15.56
|
| Rate for Payer: Priority Health Narrow Network |
$12.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.62
|
|
