|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
IP
|
$340.75
|
|
|
Service Code
|
NDC 16729-331-01
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.67 |
| Max. Negotiated Rate |
$306.68 |
| Rate for Payer: Aetna Commercial |
$289.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.49
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$238.52
|
| Rate for Payer: Cofinity Commercial |
$293.04
|
| Rate for Payer: Healthscope Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: PHP Commercial |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: Priority Health SBD |
$214.67
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
IP
|
$456.77
|
|
|
Service Code
|
NDC 60687-578-21
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.77 |
| Max. Negotiated Rate |
$411.09 |
| Rate for Payer: Aetna Commercial |
$388.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.90
|
| Rate for Payer: Cash Price |
$365.42
|
| Rate for Payer: Cofinity Commercial |
$319.74
|
| Rate for Payer: Cofinity Commercial |
$392.82
|
| Rate for Payer: Healthscope Commercial |
$411.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.25
|
| Rate for Payer: PHP Commercial |
$388.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.74
|
| Rate for Payer: Priority Health SBD |
$287.77
|
|
|
ACETAZOLAMIDE ER 500 MG CAPSULE,EXTENDED RELEASE
|
Facility
IP
|
$444.60
|
|
|
Service Code
|
NDC 50742-233-01
|
| Hospital Charge Code |
8962
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.10 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$377.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.99
|
| Rate for Payer: Cash Price |
$355.68
|
| Rate for Payer: Cofinity Commercial |
$311.22
|
| Rate for Payer: Cofinity Commercial |
$382.36
|
| Rate for Payer: Healthscope Commercial |
$400.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.91
|
| Rate for Payer: PHP Commercial |
$377.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.22
|
| Rate for Payer: Priority Health SBD |
$280.10
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.18 |
| Max. Negotiated Rate |
$167.40 |
| Rate for Payer: Aetna Commercial |
$158.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.90
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$130.20
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Healthscope Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.10
|
| Rate for Payer: PHP Commercial |
$158.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health SBD |
$117.18
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$206.00
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna Commercial |
$175.10
|
| Rate for Payer: Aetna Commercial |
$575.48
|
| Rate for Payer: Aetna Commercial |
$110.87
|
| Rate for Payer: Aetna Commercial |
$146.05
|
| Rate for Payer: Aetna Commercial |
$522.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.07
|
| Rate for Payer: Cash Price |
$137.46
|
| Rate for Payer: Cash Price |
$491.95
|
| Rate for Payer: Cash Price |
$104.34
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cofinity Commercial |
$177.16
|
| Rate for Payer: Cofinity Commercial |
$528.85
|
| Rate for Payer: Cofinity Commercial |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$120.27
|
| Rate for Payer: Cofinity Commercial |
$147.77
|
| Rate for Payer: Cofinity Commercial |
$582.25
|
| Rate for Payer: Cofinity Commercial |
$473.92
|
| Rate for Payer: Cofinity Commercial |
$112.17
|
| Rate for Payer: Cofinity Commercial |
$144.20
|
| Rate for Payer: Cofinity Commercial |
$91.30
|
| Rate for Payer: Healthscope Commercial |
$553.45
|
| Rate for Payer: Healthscope Commercial |
$609.33
|
| Rate for Payer: Healthscope Commercial |
$154.64
|
| Rate for Payer: Healthscope Commercial |
$117.39
|
| Rate for Payer: Healthscope Commercial |
$185.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$522.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$575.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.87
|
| Rate for Payer: PHP Commercial |
$175.10
|
| Rate for Payer: PHP Commercial |
$110.87
|
| Rate for Payer: PHP Commercial |
$146.05
|
| Rate for Payer: PHP Commercial |
$522.70
|
| Rate for Payer: PHP Commercial |
$575.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.27
|
| Rate for Payer: Priority Health SBD |
$387.41
|
| Rate for Payer: Priority Health SBD |
$129.78
|
| Rate for Payer: Priority Health SBD |
$108.25
|
| Rate for Payer: Priority Health SBD |
$82.17
|
| Rate for Payer: Priority Health SBD |
$426.53
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
IP
|
$43.25
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.25 |
| Max. Negotiated Rate |
$38.92 |
| Rate for Payer: Aetna Commercial |
$36.76
|
| Rate for Payer: Aetna Commercial |
$40.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Cash Price |
$34.60
|
| Rate for Payer: Cash Price |
$38.57
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Cofinity Commercial |
$30.28
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$41.46
|
| Rate for Payer: Healthscope Commercial |
$38.92
|
| Rate for Payer: Healthscope Commercial |
$43.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.76
|
| Rate for Payer: PHP Commercial |
$40.98
|
| Rate for Payer: PHP Commercial |
$36.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.75
|
| Rate for Payer: Priority Health SBD |
$27.25
|
| Rate for Payer: Priority Health SBD |
$30.37
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$57.96
|
|
|
Service Code
|
NDC 0574-0121-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$52.16 |
| Rate for Payer: Aetna Commercial |
$49.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.67
|
| Rate for Payer: Cash Price |
$46.37
|
| Rate for Payer: Cofinity Commercial |
$40.57
|
| Rate for Payer: Cofinity Commercial |
$49.85
|
| Rate for Payer: Healthscope Commercial |
$52.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: PHP Commercial |
$49.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: Priority Health SBD |
$36.51
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689-201-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.82
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.21
|
| Rate for Payer: Priority Health SBD |
$61.39
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$78.12
|
|
|
Service Code
|
NDC 0574-0521-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.22 |
| Max. Negotiated Rate |
$70.31 |
| Rate for Payer: Aetna Commercial |
$66.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.78
|
| Rate for Payer: Cash Price |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$54.68
|
| Rate for Payer: Cofinity Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$70.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.40
|
| Rate for Payer: PHP Commercial |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.68
|
| Rate for Payer: Priority Health SBD |
$49.22
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689-202-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Cofinity Commercial |
$68.21
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.82
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.21
|
| Rate for Payer: Priority Health SBD |
$61.39
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
IP
|
$15,988.35
|
|
|
Service Code
|
MS-DRG 880
|
| Min. Negotiated Rate |
$6,999.18 |
| Max. Negotiated Rate |
$15,988.35 |
| Rate for Payer: Aetna Medicare |
$7,662.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,209.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,209.45
|
| Rate for Payer: BCBS MAPPO |
$7,367.56
|
| Rate for Payer: BCBS Trust/PPO |
$15,988.35
|
| Rate for Payer: BCN Medicare Advantage |
$7,367.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,367.56
|
| Rate for Payer: Mclaren Medicare |
$7,367.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,735.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,472.69
|
| Rate for Payer: PACE Medicare |
$6,999.18
|
| Rate for Payer: PACE SWMI |
$7,367.56
|
| Rate for Payer: PHP Medicare Advantage |
$7,367.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,698.43
|
| Rate for Payer: Priority Health Medicare |
$7,367.56
|
| Rate for Payer: Priority Health Narrow Network |
$10,958.74
|
| Rate for Payer: Railroad Medicare Medicare |
$7,367.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,561.47
|
| Rate for Payer: UHC Core |
$8,935.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,367.56
|
| Rate for Payer: UHC Exchange |
$9,569.87
|
| Rate for Payer: UHC Medicare Advantage |
$7,588.59
|
| Rate for Payer: VA VA |
$7,367.56
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
IP
|
$22,540.84
|
|
|
Service Code
|
MS-DRG 289
|
| Min. Negotiated Rate |
$10,578.09 |
| Max. Negotiated Rate |
$22,540.84 |
| Rate for Payer: Aetna Medicare |
$11,580.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,918.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,918.54
|
| Rate for Payer: BCBS MAPPO |
$11,134.83
|
| Rate for Payer: BCBS Trust/PPO |
$21,063.07
|
| Rate for Payer: BCN Medicare Advantage |
$11,134.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,134.83
|
| Rate for Payer: Mclaren Medicare |
$11,134.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,691.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,805.05
|
| Rate for Payer: PACE Medicare |
$10,578.09
|
| Rate for Payer: PACE SWMI |
$11,134.83
|
| Rate for Payer: PHP Medicare Advantage |
$11,134.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,204.88
|
| Rate for Payer: Priority Health Medicare |
$11,134.83
|
| Rate for Payer: Priority Health Narrow Network |
$16,963.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11,134.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,540.84
|
| Rate for Payer: UHC Core |
$13,831.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,134.83
|
| Rate for Payer: UHC Exchange |
$14,813.94
|
| Rate for Payer: UHC Medicare Advantage |
$11,468.87
|
| Rate for Payer: VA VA |
$11,134.83
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
IP
|
$59,372.74
|
|
|
Service Code
|
MS-DRG 288
|
| Min. Negotiated Rate |
$18,208.62 |
| Max. Negotiated Rate |
$59,372.74 |
| Rate for Payer: Aetna Medicare |
$19,933.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,958.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,958.71
|
| Rate for Payer: BCBS MAPPO |
$19,166.97
|
| Rate for Payer: BCBS Trust/PPO |
$59,372.74
|
| Rate for Payer: BCN Medicare Advantage |
$19,166.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,166.97
|
| Rate for Payer: Mclaren Medicare |
$19,166.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,125.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,042.02
|
| Rate for Payer: PACE Medicare |
$18,208.62
|
| Rate for Payer: PACE SWMI |
$19,166.97
|
| Rate for Payer: PHP Medicare Advantage |
$19,166.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,209.34
|
| Rate for Payer: Priority Health Medicare |
$19,166.97
|
| Rate for Payer: Priority Health Narrow Network |
$29,767.47
|
| Rate for Payer: Railroad Medicare Medicare |
$19,166.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,553.62
|
| Rate for Payer: UHC Core |
$24,270.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,166.97
|
| Rate for Payer: UHC Exchange |
$25,994.83
|
| Rate for Payer: UHC Medicare Advantage |
$19,741.98
|
| Rate for Payer: VA VA |
$19,166.97
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
IP
|
$18,054.69
|
|
|
Service Code
|
MS-DRG 290
|
| Min. Negotiated Rate |
$7,892.04 |
| Max. Negotiated Rate |
$18,054.69 |
| Rate for Payer: Aetna Medicare |
$8,639.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,384.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,384.26
|
| Rate for Payer: BCBS MAPPO |
$8,307.41
|
| Rate for Payer: BCBS Trust/PPO |
$18,054.69
|
| Rate for Payer: BCN Medicare Advantage |
$8,307.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,307.41
|
| Rate for Payer: Mclaren Medicare |
$8,307.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,722.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,553.52
|
| Rate for Payer: PACE Medicare |
$7,892.04
|
| Rate for Payer: PACE SWMI |
$8,307.41
|
| Rate for Payer: PHP Medicare Advantage |
$8,307.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,711.54
|
| Rate for Payer: Priority Health Medicare |
$8,307.41
|
| Rate for Payer: Priority Health Narrow Network |
$11,769.23
|
| Rate for Payer: Railroad Medicare Medicare |
$8,307.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,638.40
|
| Rate for Payer: UHC Core |
$9,595.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,307.41
|
| Rate for Payer: UHC Exchange |
$10,277.63
|
| Rate for Payer: UHC Medicare Advantage |
$8,556.63
|
| Rate for Payer: VA VA |
$8,307.41
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
IP
|
$86,992.77
|
|
|
Service Code
|
MS-DRG 835
|
| Min. Negotiated Rate |
$15,762.71 |
| Max. Negotiated Rate |
$86,992.77 |
| Rate for Payer: Aetna Medicare |
$17,256.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,740.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,740.41
|
| Rate for Payer: BCBS MAPPO |
$16,592.33
|
| Rate for Payer: BCBS Trust/PPO |
$86,992.77
|
| Rate for Payer: BCN Medicare Advantage |
$16,592.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,592.33
|
| Rate for Payer: Mclaren Medicare |
$16,592.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,421.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,081.18
|
| Rate for Payer: PACE Medicare |
$15,762.71
|
| Rate for Payer: PACE SWMI |
$16,592.33
|
| Rate for Payer: PHP Medicare Advantage |
$16,592.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,079.25
|
| Rate for Payer: Priority Health Medicare |
$16,592.33
|
| Rate for Payer: Priority Health Narrow Network |
$25,663.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16,592.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,100.32
|
| Rate for Payer: UHC Core |
$20,924.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,592.33
|
| Rate for Payer: UHC Exchange |
$22,410.89
|
| Rate for Payer: UHC Medicare Advantage |
$17,090.10
|
| Rate for Payer: VA VA |
$16,592.33
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$160,024.02
|
|
|
Service Code
|
MS-DRG 834
|
| Min. Negotiated Rate |
$38,774.78 |
| Max. Negotiated Rate |
$160,024.02 |
| Rate for Payer: Aetna Medicare |
$42,448.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,019.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,019.45
|
| Rate for Payer: BCBS MAPPO |
$40,815.56
|
| Rate for Payer: BCBS Trust/PPO |
$160,024.02
|
| Rate for Payer: BCN Medicare Advantage |
$40,815.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,815.56
|
| Rate for Payer: Mclaren Medicare |
$40,815.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,856.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,937.89
|
| Rate for Payer: PACE Medicare |
$38,774.78
|
| Rate for Payer: PACE SWMI |
$40,815.56
|
| Rate for Payer: PHP Medicare Advantage |
$40,815.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80,345.20
|
| Rate for Payer: Priority Health Medicare |
$40,815.56
|
| Rate for Payer: Priority Health Narrow Network |
$64,276.16
|
| Rate for Payer: Railroad Medicare Medicare |
$40,815.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85,407.15
|
| Rate for Payer: UHC Core |
$52,406.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$40,815.56
|
| Rate for Payer: UHC Exchange |
$56,129.98
|
| Rate for Payer: UHC Medicare Advantage |
$42,040.03
|
| Rate for Payer: VA VA |
$40,815.56
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$22,395.98
|
|
|
Service Code
|
MS-DRG 836
|
| Min. Negotiated Rate |
$10,127.90 |
| Max. Negotiated Rate |
$22,395.98 |
| Rate for Payer: Aetna Medicare |
$11,087.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,326.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,326.19
|
| Rate for Payer: BCBS MAPPO |
$10,660.95
|
| Rate for Payer: BCBS Trust/PPO |
$22,395.98
|
| Rate for Payer: BCN Medicare Advantage |
$10,660.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,660.95
|
| Rate for Payer: Mclaren Medicare |
$10,660.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,194.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,260.09
|
| Rate for Payer: PACE Medicare |
$10,127.90
|
| Rate for Payer: PACE SWMI |
$10,660.95
|
| Rate for Payer: PHP Medicare Advantage |
$10,660.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,181.16
|
| Rate for Payer: Priority Health Medicare |
$10,660.95
|
| Rate for Payer: Priority Health Narrow Network |
$13,744.93
|
| Rate for Payer: Railroad Medicare Medicare |
$10,660.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,263.61
|
| Rate for Payer: UHC Core |
$11,206.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,660.95
|
| Rate for Payer: UHC Exchange |
$12,002.93
|
| Rate for Payer: UHC Medicare Advantage |
$10,980.78
|
| Rate for Payer: VA VA |
$10,660.95
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$19,543.42
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$9,233.68 |
| Max. Negotiated Rate |
$19,543.42 |
| Rate for Payer: Aetna Medicare |
$10,108.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,149.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,149.58
|
| Rate for Payer: BCBS MAPPO |
$9,719.66
|
| Rate for Payer: BCBS Trust/PPO |
$10,118.71
|
| Rate for Payer: BCN Medicare Advantage |
$9,719.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,719.66
|
| Rate for Payer: Mclaren Medicare |
$9,719.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,205.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,177.61
|
| Rate for Payer: PACE Medicare |
$9,233.68
|
| Rate for Payer: PACE SWMI |
$9,719.66
|
| Rate for Payer: PHP Medicare Advantage |
$9,719.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,385.12
|
| Rate for Payer: Priority Health Medicare |
$9,719.66
|
| Rate for Payer: Priority Health Narrow Network |
$14,708.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9,719.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,543.42
|
| Rate for Payer: UHC Core |
$11,992.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,719.66
|
| Rate for Payer: UHC Exchange |
$12,844.03
|
| Rate for Payer: UHC Medicare Advantage |
$10,011.25
|
| Rate for Payer: VA VA |
$9,719.66
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$11,356.60
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$5,561.74 |
| Max. Negotiated Rate |
$11,356.60 |
| Rate for Payer: Aetna Medicare |
$6,088.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,318.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,318.08
|
| Rate for Payer: BCBS MAPPO |
$5,854.46
|
| Rate for Payer: BCBS Trust/PPO |
$8,976.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,854.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,854.46
|
| Rate for Payer: Mclaren Medicare |
$5,854.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,147.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,732.63
|
| Rate for Payer: PACE Medicare |
$5,561.74
|
| Rate for Payer: PACE SWMI |
$5,854.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,854.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,683.52
|
| Rate for Payer: Priority Health Medicare |
$5,854.46
|
| Rate for Payer: Priority Health Narrow Network |
$8,546.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5,854.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,356.60
|
| Rate for Payer: UHC Core |
$6,968.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,854.46
|
| Rate for Payer: UHC Exchange |
$7,463.61
|
| Rate for Payer: UHC Medicare Advantage |
$6,030.09
|
| Rate for Payer: VA VA |
$5,854.46
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
IP
|
$17,292.71
|
|
|
Service Code
|
MS-DRG 281
|
| Min. Negotiated Rate |
$6,714.56 |
| Max. Negotiated Rate |
$17,292.71 |
| Rate for Payer: Aetna Medicare |
$7,350.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,834.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,834.95
|
| Rate for Payer: BCBS MAPPO |
$7,067.96
|
| Rate for Payer: BCBS Trust/PPO |
$17,292.71
|
| Rate for Payer: BCN Medicare Advantage |
$7,067.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,067.96
|
| Rate for Payer: Mclaren Medicare |
$7,067.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,421.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,128.15
|
| Rate for Payer: PACE Medicare |
$6,714.56
|
| Rate for Payer: PACE SWMI |
$7,067.96
|
| Rate for Payer: PHP Medicare Advantage |
$7,067.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,101.48
|
| Rate for Payer: Priority Health Medicare |
$7,067.96
|
| Rate for Payer: Priority Health Narrow Network |
$10,481.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,067.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,926.90
|
| Rate for Payer: UHC Core |
$8,545.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,067.96
|
| Rate for Payer: UHC Exchange |
$9,152.83
|
| Rate for Payer: UHC Medicare Advantage |
$7,280.00
|
| Rate for Payer: VA VA |
$7,067.96
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
IP
|
$24,864.18
|
|
|
Service Code
|
MS-DRG 280
|
| Min. Negotiated Rate |
$11,322.46 |
| Max. Negotiated Rate |
$24,864.18 |
| Rate for Payer: Aetna Medicare |
$12,395.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,897.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,897.98
|
| Rate for Payer: BCBS MAPPO |
$11,918.38
|
| Rate for Payer: BCBS Trust/PPO |
$24,864.18
|
| Rate for Payer: BCN Medicare Advantage |
$11,918.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,918.38
|
| Rate for Payer: Mclaren Medicare |
$11,918.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,514.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,706.14
|
| Rate for Payer: PACE Medicare |
$11,322.46
|
| Rate for Payer: PACE SWMI |
$11,918.38
|
| Rate for Payer: PHP Medicare Advantage |
$11,918.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,766.15
|
| Rate for Payer: Priority Health Medicare |
$11,918.38
|
| Rate for Payer: Priority Health Narrow Network |
$18,212.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,918.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,200.47
|
| Rate for Payer: UHC Core |
$14,849.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,918.38
|
| Rate for Payer: UHC Exchange |
$15,904.66
|
| Rate for Payer: UHC Medicare Advantage |
$12,275.93
|
| Rate for Payer: VA VA |
$11,918.38
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
IP
|
$15,004.58
|
|
|
Service Code
|
MS-DRG 282
|
| Min. Negotiated Rate |
$5,381.11 |
| Max. Negotiated Rate |
$15,004.58 |
| Rate for Payer: Aetna Medicare |
$5,890.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,080.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,080.41
|
| Rate for Payer: BCBS MAPPO |
$5,664.33
|
| Rate for Payer: BCBS Trust/PPO |
$15,004.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,664.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,664.33
|
| Rate for Payer: Mclaren Medicare |
$5,664.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,947.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,513.98
|
| Rate for Payer: PACE Medicare |
$5,381.11
|
| Rate for Payer: PACE SWMI |
$5,664.33
|
| Rate for Payer: PHP Medicare Advantage |
$5,664.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,304.68
|
| Rate for Payer: Priority Health Medicare |
$5,664.33
|
| Rate for Payer: Priority Health Narrow Network |
$8,243.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5,664.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,953.90
|
| Rate for Payer: UHC Core |
$6,721.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,664.33
|
| Rate for Payer: UHC Exchange |
$7,198.95
|
| Rate for Payer: UHC Medicare Advantage |
$5,834.26
|
| Rate for Payer: VA VA |
$5,664.33
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
IP
|
$14,387.54
|
|
|
Service Code
|
MS-DRG 284
|
| Min. Negotiated Rate |
$5,528.90 |
| Max. Negotiated Rate |
$14,387.54 |
| Rate for Payer: Aetna Medicare |
$6,052.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,274.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,274.88
|
| Rate for Payer: BCBS MAPPO |
$5,819.90
|
| Rate for Payer: BCBS Trust/PPO |
$14,387.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,819.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,819.90
|
| Rate for Payer: Mclaren Medicare |
$5,819.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,110.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,692.88
|
| Rate for Payer: PACE Medicare |
$5,528.90
|
| Rate for Payer: PACE SWMI |
$5,819.90
|
| Rate for Payer: PHP Medicare Advantage |
$5,819.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,614.64
|
| Rate for Payer: Priority Health Medicare |
$5,819.90
|
| Rate for Payer: Priority Health Narrow Network |
$8,491.71
|
| Rate for Payer: Railroad Medicare Medicare |
$5,819.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,283.38
|
| Rate for Payer: UHC Core |
$6,923.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,819.90
|
| Rate for Payer: UHC Exchange |
$7,415.49
|
| Rate for Payer: UHC Medicare Advantage |
$5,994.50
|
| Rate for Payer: VA VA |
$5,819.90
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
IP
|
$38,068.12
|
|
|
Service Code
|
MS-DRG 283
|
| Min. Negotiated Rate |
$13,955.82 |
| Max. Negotiated Rate |
$38,068.12 |
| Rate for Payer: Aetna Medicare |
$15,277.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,362.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,362.92
|
| Rate for Payer: BCBS MAPPO |
$14,690.34
|
| Rate for Payer: BCBS Trust/PPO |
$38,068.12
|
| Rate for Payer: BCN Medicare Advantage |
$14,690.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,690.34
|
| Rate for Payer: Mclaren Medicare |
$14,690.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,424.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,893.89
|
| Rate for Payer: PACE Medicare |
$13,955.82
|
| Rate for Payer: PACE SWMI |
$14,690.34
|
| Rate for Payer: PHP Medicare Advantage |
$14,690.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,289.43
|
| Rate for Payer: Priority Health Medicare |
$14,690.34
|
| Rate for Payer: Priority Health Narrow Network |
$22,631.54
|
| Rate for Payer: Railroad Medicare Medicare |
$14,690.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,071.74
|
| Rate for Payer: UHC Core |
$18,452.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,690.34
|
| Rate for Payer: UHC Exchange |
$19,763.29
|
| Rate for Payer: UHC Medicare Advantage |
$15,131.05
|
| Rate for Payer: VA VA |
$14,690.34
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
IP
|
$9,503.86
|
|
|
Service Code
|
MS-DRG 285
|
| Min. Negotiated Rate |
$3,811.64 |
| Max. Negotiated Rate |
$9,503.86 |
| Rate for Payer: Aetna Medicare |
$4,172.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,015.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,015.31
|
| Rate for Payer: BCBS MAPPO |
$4,012.25
|
| Rate for Payer: BCBS Trust/PPO |
$9,503.86
|
| Rate for Payer: BCN Medicare Advantage |
$4,012.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,012.25
|
| Rate for Payer: Mclaren Medicare |
$4,012.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,212.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,614.09
|
| Rate for Payer: PACE Medicare |
$3,811.64
|
| Rate for Payer: PACE SWMI |
$4,012.25
|
| Rate for Payer: PHP Medicare Advantage |
$4,012.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,012.81
|
| Rate for Payer: Priority Health Medicare |
$4,012.25
|
| Rate for Payer: Priority Health Narrow Network |
$5,610.25
|
| Rate for Payer: Railroad Medicare Medicare |
$4,012.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,454.63
|
| Rate for Payer: UHC Core |
$4,574.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,012.25
|
| Rate for Payer: UHC Exchange |
$4,899.22
|
| Rate for Payer: UHC Medicare Advantage |
$4,132.62
|
| Rate for Payer: VA VA |
$4,012.25
|
|
