|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$19,214.13
|
|
|
Service Code
|
MS-DRG 349
|
| Min. Negotiated Rate |
$7,144.22 |
| Max. Negotiated Rate |
$19,214.13 |
| Rate for Payer: Aetna Medicare |
$7,821.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,400.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,400.29
|
| Rate for Payer: BCBS MAPPO |
$7,520.23
|
| Rate for Payer: BCBS Trust/PPO |
$19,214.13
|
| Rate for Payer: BCN Medicare Advantage |
$7,520.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,520.23
|
| Rate for Payer: Mclaren Medicare |
$7,520.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,896.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,648.26
|
| Rate for Payer: PACE Medicare |
$7,144.22
|
| Rate for Payer: PACE SWMI |
$7,520.23
|
| Rate for Payer: PHP Medicare Advantage |
$7,520.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,002.65
|
| Rate for Payer: Priority Health Medicare |
$7,520.23
|
| Rate for Payer: Priority Health Narrow Network |
$11,202.12
|
| Rate for Payer: Railroad Medicare Medicare |
$7,520.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,884.85
|
| Rate for Payer: UHC Core |
$9,133.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,520.23
|
| Rate for Payer: UHC Exchange |
$9,782.40
|
| Rate for Payer: UHC Medicare Advantage |
$7,745.84
|
| Rate for Payer: VA VA |
$7,520.23
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$4.05
|
|
|
Service Code
|
NDC 60687-112-11
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.63
|
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.44
|
| Rate for Payer: PHP Commercial |
$3.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.55
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$121.40
|
|
|
Service Code
|
NDC 60687-112-21
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$109.26 |
| Rate for Payer: Aetna Commercial |
$103.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.91
|
| Rate for Payer: Cash Price |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.40
|
| Rate for Payer: Cofinity Commercial |
$84.98
|
| Rate for Payer: Healthscope Commercial |
$109.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$103.19
|
| Rate for Payer: PHP Commercial |
$103.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.98
|
| Rate for Payer: Priority Health SBD |
$76.48
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$81.78
|
|
|
Service Code
|
NDC 16729-035-10
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.52 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$239.00
|
|
|
Service Code
|
NDC 16729-035-15
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.57 |
| Max. Negotiated Rate |
$215.10 |
| Rate for Payer: Aetna Commercial |
$203.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.35
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$167.30
|
| Rate for Payer: Cofinity Commercial |
$205.54
|
| Rate for Payer: Healthscope Commercial |
$215.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.15
|
| Rate for Payer: PHP Commercial |
$203.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.30
|
| Rate for Payer: Priority Health SBD |
$150.57
|
|
|
ANGINA PECTORIS
|
Facility
IP
|
$13,032.67
|
|
|
Service Code
|
MS-DRG 311
|
| Min. Negotiated Rate |
$5,244.28 |
| Max. Negotiated Rate |
$13,032.67 |
| Rate for Payer: Aetna Medicare |
$5,741.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,900.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,900.38
|
| Rate for Payer: BCBS MAPPO |
$5,520.30
|
| Rate for Payer: BCBS Trust/PPO |
$13,032.67
|
| Rate for Payer: BCN Medicare Advantage |
$5,520.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,520.30
|
| Rate for Payer: Mclaren Medicare |
$5,520.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,796.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,348.34
|
| Rate for Payer: PACE Medicare |
$5,244.28
|
| Rate for Payer: PACE SWMI |
$5,520.30
|
| Rate for Payer: PHP Medicare Advantage |
$5,520.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,017.68
|
| Rate for Payer: Priority Health Medicare |
$5,520.30
|
| Rate for Payer: Priority Health Narrow Network |
$8,014.14
|
| Rate for Payer: Railroad Medicare Medicare |
$5,520.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,648.82
|
| Rate for Payer: UHC Core |
$6,534.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,520.30
|
| Rate for Payer: UHC Exchange |
$6,998.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,685.91
|
| Rate for Payer: VA VA |
$5,520.30
|
|
|
ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$13,200.36
|
|
|
Service Code
|
HCPCS J0491
|
| Hospital Charge Code |
197996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,316.23 |
| Max. Negotiated Rate |
$11,880.32 |
| Rate for Payer: Aetna Commercial |
$11,220.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,580.23
|
| Rate for Payer: Cash Price |
$10,560.29
|
| Rate for Payer: Cofinity Commercial |
$11,352.31
|
| Rate for Payer: Cofinity Commercial |
$9,240.25
|
| Rate for Payer: Healthscope Commercial |
$11,880.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,220.31
|
| Rate for Payer: PHP Commercial |
$11,220.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,240.25
|
| Rate for Payer: Priority Health SBD |
$8,316.23
|
|
|
ANOSCOPY; DIAGNOSTIC, WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 46601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$28.39 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$28.39
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.85
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$91.68
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
|
Facility
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 46610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.59 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$967.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.45
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$78.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED
|
Facility
OP
|
$5,532.19
|
|
|
Service Code
|
CPT 57240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$606.10 |
| Max. Negotiated Rate |
$5,532.19 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,034.36
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$666.71
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$606.10
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 22845
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.20 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: BCBS Trust/PPO |
$1,508.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.32
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Exchange |
$711.20
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,200 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 2,400 UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$2.72
|
|
|
Service Code
|
HCPCS J7187
|
| Hospital Charge Code |
70406
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2.45 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.77
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.31
|
| Rate for Payer: PHP Commercial |
$2.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.71
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 1,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 2,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174374
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
|
|
ANTIHEMOPHILIC FVIII, B-DOM TRUNCATED 250 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 3,000 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174375
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
|
|
ANTIHEMOPHILIC FVIII,B-DOM TRUNCATED 500 (+/-) UNIT INTRAVENOUS SOLN
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
HCPCS J7182
|
| Hospital Charge Code |
174370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.51 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: PHP Commercial |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.76
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
IP
|
$104,561.59
|
|
|
Service Code
|
MS-DRG 268
|
| Min. Negotiated Rate |
$47,365.92 |
| Max. Negotiated Rate |
$104,561.59 |
| Rate for Payer: Aetna Medicare |
$51,853.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,323.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,323.58
|
| Rate for Payer: BCBS MAPPO |
$49,858.86
|
| Rate for Payer: BCBS Trust/PPO |
$100,862.08
|
| Rate for Payer: BCN Medicare Advantage |
$49,858.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,858.86
|
| Rate for Payer: Mclaren Medicare |
$49,858.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,351.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,337.69
|
| Rate for Payer: PACE Medicare |
$47,365.92
|
| Rate for Payer: PACE SWMI |
$49,858.86
|
| Rate for Payer: PHP Medicare Advantage |
$49,858.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98,364.40
|
| Rate for Payer: Priority Health Medicare |
$49,858.86
|
| Rate for Payer: Priority Health Narrow Network |
$78,691.52
|
| Rate for Payer: Railroad Medicare Medicare |
$49,858.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104,561.59
|
| Rate for Payer: UHC Core |
$64,159.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$49,858.86
|
| Rate for Payer: UHC Exchange |
$68,718.37
|
| Rate for Payer: UHC Medicare Advantage |
$51,354.63
|
| Rate for Payer: VA VA |
$49,858.86
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
IP
|
$65,222.62
|
|
|
Service Code
|
MS-DRG 269
|
| Min. Negotiated Rate |
$28,919.99 |
| Max. Negotiated Rate |
$65,222.62 |
| Rate for Payer: Aetna Medicare |
$31,659.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,052.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,052.61
|
| Rate for Payer: BCBS MAPPO |
$30,442.09
|
| Rate for Payer: BCBS Trust/PPO |
$65,222.62
|
| Rate for Payer: BCN Medicare Advantage |
$30,442.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,442.09
|
| Rate for Payer: Mclaren Medicare |
$30,442.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,964.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,008.40
|
| Rate for Payer: PACE Medicare |
$28,919.99
|
| Rate for Payer: PACE SWMI |
$30,442.09
|
| Rate for Payer: PHP Medicare Advantage |
$30,442.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59,675.58
|
| Rate for Payer: Priority Health Medicare |
$30,442.09
|
| Rate for Payer: Priority Health Narrow Network |
$47,740.46
|
| Rate for Payer: Railroad Medicare Medicare |
$30,442.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63,435.28
|
| Rate for Payer: UHC Core |
$38,924.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,442.09
|
| Rate for Payer: UHC Exchange |
$41,689.97
|
| Rate for Payer: UHC Medicare Advantage |
$31,355.35
|
| Rate for Payer: VA VA |
$30,442.09
|
|
|
APIXABAN 2.5 MG TABLET
|
Facility
IP
|
$669.60
|
|
|
Service Code
|
NDC 0003-0893-31
|
| Hospital Charge Code |
163984
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.85 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.72
|
| Rate for Payer: Priority Health SBD |
$421.85
|
|
|
APIXABAN 5 MG TABLET
|
Facility
IP
|
$669.60
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$421.85 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.72
|
| Rate for Payer: Priority Health SBD |
$421.85
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
IP
|
$25,259.44
|
|
|
Service Code
|
MS-DRG 398
|
| Min. Negotiated Rate |
$10,821.64 |
| Max. Negotiated Rate |
$25,259.44 |
| Rate for Payer: Aetna Medicare |
$11,846.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,239.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,239.00
|
| Rate for Payer: BCBS MAPPO |
$11,391.20
|
| Rate for Payer: BCBS Trust/PPO |
$25,259.44
|
| Rate for Payer: BCN Medicare Advantage |
$11,391.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,391.20
|
| Rate for Payer: Mclaren Medicare |
$11,391.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,960.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,099.88
|
| Rate for Payer: PACE Medicare |
$10,821.64
|
| Rate for Payer: PACE SWMI |
$11,391.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,391.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,715.73
|
| Rate for Payer: Priority Health Medicare |
$11,391.20
|
| Rate for Payer: Priority Health Narrow Network |
$17,372.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11,391.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,083.88
|
| Rate for Payer: UHC Core |
$14,164.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,391.20
|
| Rate for Payer: UHC Exchange |
$15,170.83
|
| Rate for Payer: UHC Medicare Advantage |
$11,732.94
|
| Rate for Payer: VA VA |
$11,391.20
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
IP
|
$34,269.64
|
|
|
Service Code
|
MS-DRG 397
|
| Min. Negotiated Rate |
$15,838.67 |
| Max. Negotiated Rate |
$34,269.64 |
| Rate for Payer: Aetna Medicare |
$17,339.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,840.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,840.35
|
| Rate for Payer: BCBS MAPPO |
$16,672.28
|
| Rate for Payer: BCBS Trust/PPO |
$28,867.30
|
| Rate for Payer: BCN Medicare Advantage |
$16,672.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,672.28
|
| Rate for Payer: Mclaren Medicare |
$16,672.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,505.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,173.12
|
| Rate for Payer: PACE Medicare |
$15,838.67
|
| Rate for Payer: PACE SWMI |
$16,672.28
|
| Rate for Payer: PHP Medicare Advantage |
$16,672.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,238.53
|
| Rate for Payer: Priority Health Medicare |
$16,672.28
|
| Rate for Payer: Priority Health Narrow Network |
$25,790.82
|
| Rate for Payer: Railroad Medicare Medicare |
$16,672.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,269.64
|
| Rate for Payer: UHC Core |
$21,028.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,672.28
|
| Rate for Payer: UHC Exchange |
$22,522.17
|
| Rate for Payer: UHC Medicare Advantage |
$17,172.45
|
| Rate for Payer: VA VA |
$16,672.28
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,333.17
|
|
|
Service Code
|
MS-DRG 399
|
| Min. Negotiated Rate |
$8,083.60 |
| Max. Negotiated Rate |
$21,333.17 |
| Rate for Payer: Aetna Medicare |
$8,849.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,636.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,636.31
|
| Rate for Payer: BCBS MAPPO |
$8,509.05
|
| Rate for Payer: BCBS Trust/PPO |
$21,333.17
|
| Rate for Payer: BCN Medicare Advantage |
$8,509.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,509.05
|
| Rate for Payer: Mclaren Medicare |
$8,509.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,934.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,785.41
|
| Rate for Payer: PACE Medicare |
$8,083.60
|
| Rate for Payer: PACE SWMI |
$8,509.05
|
| Rate for Payer: PHP Medicare Advantage |
$8,509.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,972.90
|
| Rate for Payer: Priority Health Medicare |
$8,509.05
|
| Rate for Payer: Priority Health Narrow Network |
$12,778.32
|
| Rate for Payer: Railroad Medicare Medicare |
$8,509.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,979.23
|
| Rate for Payer: UHC Core |
$10,418.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,509.05
|
| Rate for Payer: UHC Exchange |
$11,158.83
|
| Rate for Payer: UHC Medicare Advantage |
$8,764.32
|
| Rate for Payer: VA VA |
$8,509.05
|
|
