|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
|
IP
|
$9,554.36
|
|
|
Service Code
|
MS-DRG 298
|
| Min. Negotiated Rate |
$3,476.40 |
| Max. Negotiated Rate |
$9,554.36 |
| Rate for Payer: Aetna Medicare |
$3,805.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,574.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,574.21
|
| Rate for Payer: BCBS MAPPO |
$3,659.37
|
| Rate for Payer: BCBS Trust/PPO |
$9,554.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,659.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,659.37
|
| Rate for Payer: Mclaren Medicare |
$3,659.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,842.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,208.28
|
| Rate for Payer: PACE Medicare |
$3,476.40
|
| Rate for Payer: PACE SWMI |
$3,659.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,659.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,298.18
|
| Rate for Payer: Priority Health Medicare |
$3,659.37
|
| Rate for Payer: Priority Health Narrow Network |
$5,038.54
|
| Rate for Payer: Railroad Medicare Medicare |
$3,659.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,694.98
|
| Rate for Payer: UHC Core |
$4,108.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,659.37
|
| Rate for Payer: UHC Exchange |
$4,399.97
|
| Rate for Payer: UHC Medicare Advantage |
$3,769.15
|
| Rate for Payer: VA VA |
$3,659.37
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
|
IP
|
$12,207.01
|
|
|
Service Code
|
MS-DRG 309
|
| Min. Negotiated Rate |
$5,563.11 |
| Max. Negotiated Rate |
$12,207.01 |
| Rate for Payer: Aetna Medicare |
$6,090.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,319.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,319.89
|
| Rate for Payer: BCBS MAPPO |
$5,855.91
|
| Rate for Payer: BCBS Trust/PPO |
$12,207.01
|
| Rate for Payer: BCN Medicare Advantage |
$5,855.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,855.91
|
| Rate for Payer: Mclaren Medicare |
$5,855.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,148.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,734.30
|
| Rate for Payer: PACE Medicare |
$5,563.11
|
| Rate for Payer: PACE SWMI |
$5,855.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,855.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,686.39
|
| Rate for Payer: Priority Health Medicare |
$5,855.91
|
| Rate for Payer: Priority Health Narrow Network |
$8,549.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5,855.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,359.65
|
| Rate for Payer: UHC Core |
$6,970.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,855.91
|
| Rate for Payer: UHC Exchange |
$7,465.62
|
| Rate for Payer: UHC Medicare Advantage |
$6,031.59
|
| Rate for Payer: VA VA |
$5,855.91
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
|
IP
|
$18,592.69
|
|
|
Service Code
|
MS-DRG 308
|
| Min. Negotiated Rate |
$8,693.18 |
| Max. Negotiated Rate |
$18,592.69 |
| Rate for Payer: Aetna Medicare |
$9,516.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,438.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,438.40
|
| Rate for Payer: BCBS MAPPO |
$9,150.72
|
| Rate for Payer: BCBS Trust/PPO |
$18,592.69
|
| Rate for Payer: BCN Medicare Advantage |
$9,150.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,150.72
|
| Rate for Payer: Mclaren Medicare |
$9,150.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,608.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,523.33
|
| Rate for Payer: PACE Medicare |
$8,693.18
|
| Rate for Payer: PACE SWMI |
$9,150.72
|
| Rate for Payer: PHP Medicare Advantage |
$9,150.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,251.47
|
| Rate for Payer: Priority Health Medicare |
$9,150.72
|
| Rate for Payer: Priority Health Narrow Network |
$13,801.18
|
| Rate for Payer: Railroad Medicare Medicare |
$9,150.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,338.36
|
| Rate for Payer: UHC Core |
$11,252.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,150.72
|
| Rate for Payer: UHC Exchange |
$12,052.06
|
| Rate for Payer: UHC Medicare Advantage |
$9,425.24
|
| Rate for Payer: VA VA |
$9,150.72
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,385.28
|
|
|
Service Code
|
MS-DRG 310
|
| Min. Negotiated Rate |
$4,251.55 |
| Max. Negotiated Rate |
$9,385.28 |
| Rate for Payer: Aetna Medicare |
$4,654.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,594.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,594.15
|
| Rate for Payer: BCBS MAPPO |
$4,475.32
|
| Rate for Payer: BCBS Trust/PPO |
$9,385.28
|
| Rate for Payer: BCN Medicare Advantage |
$4,475.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,475.32
|
| Rate for Payer: Mclaren Medicare |
$4,475.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,699.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,146.62
|
| Rate for Payer: PACE Medicare |
$4,251.55
|
| Rate for Payer: PACE SWMI |
$4,475.32
|
| Rate for Payer: PHP Medicare Advantage |
$4,475.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,935.51
|
| Rate for Payer: Priority Health Medicare |
$4,475.32
|
| Rate for Payer: Priority Health Narrow Network |
$6,348.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4,475.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,435.46
|
| Rate for Payer: UHC Core |
$5,176.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,475.32
|
| Rate for Payer: UHC Exchange |
$5,543.83
|
| Rate for Payer: UHC Medicare Advantage |
$4,609.58
|
| Rate for Payer: VA VA |
$4,475.32
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$34,016.69
|
|
|
Service Code
|
MS-DRG 306
|
| Min. Negotiated Rate |
$10,982.42 |
| Max. Negotiated Rate |
$34,016.69 |
| Rate for Payer: Aetna Medicare |
$12,022.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,450.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,450.55
|
| Rate for Payer: BCBS MAPPO |
$11,560.44
|
| Rate for Payer: BCBS Trust/PPO |
$34,016.69
|
| Rate for Payer: BCN Medicare Advantage |
$11,560.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,560.44
|
| Rate for Payer: Mclaren Medicare |
$11,560.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,138.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,294.51
|
| Rate for Payer: PACE Medicare |
$10,982.42
|
| Rate for Payer: PACE SWMI |
$11,560.44
|
| Rate for Payer: PHP Medicare Advantage |
$11,560.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,052.96
|
| Rate for Payer: Priority Health Medicare |
$11,560.44
|
| Rate for Payer: Priority Health Narrow Network |
$17,642.37
|
| Rate for Payer: Railroad Medicare Medicare |
$11,560.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,442.35
|
| Rate for Payer: UHC Core |
$14,384.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,560.44
|
| Rate for Payer: UHC Exchange |
$15,406.42
|
| Rate for Payer: UHC Medicare Advantage |
$11,907.25
|
| Rate for Payer: VA VA |
$11,560.44
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$18,500.46
|
|
|
Service Code
|
MS-DRG 307
|
| Min. Negotiated Rate |
$6,917.07 |
| Max. Negotiated Rate |
$18,500.46 |
| Rate for Payer: Aetna Medicare |
$7,572.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,101.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,101.41
|
| Rate for Payer: BCBS MAPPO |
$7,281.13
|
| Rate for Payer: BCBS Trust/PPO |
$18,500.46
|
| Rate for Payer: BCN Medicare Advantage |
$7,281.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,281.13
|
| Rate for Payer: Mclaren Medicare |
$7,281.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,645.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,373.30
|
| Rate for Payer: PACE Medicare |
$6,917.07
|
| Rate for Payer: PACE SWMI |
$7,281.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,281.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,526.23
|
| Rate for Payer: Priority Health Medicare |
$7,281.13
|
| Rate for Payer: Priority Health Narrow Network |
$10,820.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,281.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,378.42
|
| Rate for Payer: UHC Core |
$8,822.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,281.13
|
| Rate for Payer: UHC Exchange |
$9,449.57
|
| Rate for Payer: UHC Medicare Advantage |
$7,499.56
|
| Rate for Payer: VA VA |
$7,281.13
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
|
IP
|
$125,467.14
|
|
|
Service Code
|
MS-DRG 275
|
| Min. Negotiated Rate |
$48,604.94 |
| Max. Negotiated Rate |
$125,467.14 |
| Rate for Payer: Aetna Medicare |
$53,209.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63,953.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63,953.86
|
| Rate for Payer: BCBS MAPPO |
$51,163.09
|
| Rate for Payer: BCBS Trust/PPO |
$125,467.14
|
| Rate for Payer: BCN Medicare Advantage |
$51,163.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,163.09
|
| Rate for Payer: Mclaren Medicare |
$51,163.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53,721.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,837.55
|
| Rate for Payer: PACE Medicare |
$48,604.94
|
| Rate for Payer: PACE SWMI |
$51,163.09
|
| Rate for Payer: PHP Medicare Advantage |
$51,163.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100,963.17
|
| Rate for Payer: Priority Health Medicare |
$51,163.09
|
| Rate for Payer: Priority Health Narrow Network |
$80,770.54
|
| Rate for Payer: Railroad Medicare Medicare |
$51,163.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107,324.09
|
| Rate for Payer: UHC Core |
$65,855.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$51,163.09
|
| Rate for Payer: UHC Exchange |
$70,533.90
|
| Rate for Payer: UHC Medicare Advantage |
$52,697.98
|
| Rate for Payer: VA VA |
$51,163.09
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
|
IP
|
$123,673.09
|
|
|
Service Code
|
MS-DRG 276
|
| Min. Negotiated Rate |
$42,956.44 |
| Max. Negotiated Rate |
$123,673.09 |
| Rate for Payer: Aetna Medicare |
$47,025.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,521.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,521.62
|
| Rate for Payer: BCBS MAPPO |
$45,217.30
|
| Rate for Payer: BCBS Trust/PPO |
$123,673.09
|
| Rate for Payer: BCN Medicare Advantage |
$45,217.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,217.30
|
| Rate for Payer: Mclaren Medicare |
$45,217.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,478.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,999.90
|
| Rate for Payer: PACE Medicare |
$42,956.44
|
| Rate for Payer: PACE SWMI |
$45,217.30
|
| Rate for Payer: PHP Medicare Advantage |
$45,217.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89,115.87
|
| Rate for Payer: Priority Health Medicare |
$45,217.30
|
| Rate for Payer: Priority Health Narrow Network |
$71,292.70
|
| Rate for Payer: Railroad Medicare Medicare |
$45,217.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,730.39
|
| Rate for Payer: UHC Core |
$58,127.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$45,217.30
|
| Rate for Payer: UHC Exchange |
$62,257.26
|
| Rate for Payer: UHC Medicare Advantage |
$46,573.82
|
| Rate for Payer: VA VA |
$45,217.30
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
|
IP
|
$98,903.34
|
|
|
Service Code
|
MS-DRG 277
|
| Min. Negotiated Rate |
$33,187.84 |
| Max. Negotiated Rate |
$98,903.34 |
| Rate for Payer: Aetna Medicare |
$36,331.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,668.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,668.21
|
| Rate for Payer: BCBS MAPPO |
$34,934.57
|
| Rate for Payer: BCBS Trust/PPO |
$98,903.34
|
| Rate for Payer: BCN Medicare Advantage |
$34,934.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,934.57
|
| Rate for Payer: Mclaren Medicare |
$34,934.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,681.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,174.76
|
| Rate for Payer: PACE Medicare |
$33,187.84
|
| Rate for Payer: PACE SWMI |
$34,934.57
|
| Rate for Payer: PHP Medicare Advantage |
$34,934.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,627.06
|
| Rate for Payer: Priority Health Medicare |
$34,934.57
|
| Rate for Payer: Priority Health Narrow Network |
$54,901.65
|
| Rate for Payer: Railroad Medicare Medicare |
$34,934.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72,950.73
|
| Rate for Payer: UHC Core |
$44,763.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,934.57
|
| Rate for Payer: UHC Exchange |
$47,943.56
|
| Rate for Payer: UHC Medicare Advantage |
$35,982.61
|
| Rate for Payer: VA VA |
$34,934.57
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$47,701.54
|
|
|
Service Code
|
MS-DRG 258
|
| Min. Negotiated Rate |
$18,999.52 |
| Max. Negotiated Rate |
$47,701.54 |
| Rate for Payer: Aetna Medicare |
$20,799.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,999.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,999.38
|
| Rate for Payer: BCBS MAPPO |
$19,999.50
|
| Rate for Payer: BCBS Trust/PPO |
$47,701.54
|
| Rate for Payer: BCN Medicare Advantage |
$19,999.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,999.50
|
| Rate for Payer: Mclaren Medicare |
$19,999.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,999.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,999.42
|
| Rate for Payer: PACE Medicare |
$18,999.52
|
| Rate for Payer: PACE SWMI |
$19,999.50
|
| Rate for Payer: PHP Medicare Advantage |
$19,999.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,868.19
|
| Rate for Payer: Priority Health Medicare |
$19,999.50
|
| Rate for Payer: Priority Health Narrow Network |
$31,094.55
|
| Rate for Payer: Railroad Medicare Medicare |
$19,999.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,316.98
|
| Rate for Payer: UHC Core |
$25,352.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,999.50
|
| Rate for Payer: UHC Exchange |
$27,153.72
|
| Rate for Payer: UHC Medicare Advantage |
$20,599.48
|
| Rate for Payer: VA VA |
$19,999.50
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
|
IP
|
$31,096.14
|
|
|
Service Code
|
MS-DRG 259
|
| Min. Negotiated Rate |
$13,238.82 |
| Max. Negotiated Rate |
$31,096.14 |
| Rate for Payer: Aetna Medicare |
$14,493.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,419.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,419.50
|
| Rate for Payer: BCBS MAPPO |
$13,935.60
|
| Rate for Payer: BCBS Trust/PPO |
$31,096.14
|
| Rate for Payer: BCN Medicare Advantage |
$13,935.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,935.60
|
| Rate for Payer: Mclaren Medicare |
$13,935.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,632.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,025.94
|
| Rate for Payer: PACE Medicare |
$13,238.82
|
| Rate for Payer: PACE SWMI |
$13,935.60
|
| Rate for Payer: PHP Medicare Advantage |
$13,935.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,785.56
|
| Rate for Payer: Priority Health Medicare |
$13,935.60
|
| Rate for Payer: Priority Health Narrow Network |
$21,428.45
|
| Rate for Payer: Railroad Medicare Medicare |
$13,935.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,473.12
|
| Rate for Payer: UHC Core |
$17,471.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,935.60
|
| Rate for Payer: UHC Exchange |
$18,712.67
|
| Rate for Payer: UHC Medicare Advantage |
$14,353.67
|
| Rate for Payer: VA VA |
$13,935.60
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
|
IP
|
$38,874.02
|
|
|
Service Code
|
MS-DRG 261
|
| Min. Negotiated Rate |
$13,342.81 |
| Max. Negotiated Rate |
$38,874.02 |
| Rate for Payer: Aetna Medicare |
$14,606.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,556.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,556.32
|
| Rate for Payer: BCBS MAPPO |
$14,045.06
|
| Rate for Payer: BCBS Trust/PPO |
$38,874.02
|
| Rate for Payer: BCN Medicare Advantage |
$14,045.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,045.06
|
| Rate for Payer: Mclaren Medicare |
$14,045.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,747.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,151.82
|
| Rate for Payer: PACE Medicare |
$13,342.81
|
| Rate for Payer: PACE SWMI |
$14,045.06
|
| Rate for Payer: PHP Medicare Advantage |
$14,045.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,003.68
|
| Rate for Payer: Priority Health Medicare |
$14,045.06
|
| Rate for Payer: Priority Health Narrow Network |
$21,602.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14,045.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,704.98
|
| Rate for Payer: UHC Core |
$17,613.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,045.06
|
| Rate for Payer: UHC Exchange |
$18,865.05
|
| Rate for Payer: UHC Medicare Advantage |
$14,466.41
|
| Rate for Payer: VA VA |
$14,045.06
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$72,704.05
|
|
|
Service Code
|
MS-DRG 260
|
| Min. Negotiated Rate |
$23,149.71 |
| Max. Negotiated Rate |
$72,704.05 |
| Rate for Payer: Aetna Medicare |
$25,342.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,460.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,460.15
|
| Rate for Payer: BCBS MAPPO |
$24,368.12
|
| Rate for Payer: BCBS Trust/PPO |
$72,704.05
|
| Rate for Payer: BCN Medicare Advantage |
$24,368.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,368.12
|
| Rate for Payer: Mclaren Medicare |
$24,368.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,586.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,023.34
|
| Rate for Payer: PACE Medicare |
$23,149.71
|
| Rate for Payer: PACE SWMI |
$24,368.12
|
| Rate for Payer: PHP Medicare Advantage |
$24,368.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47,572.85
|
| Rate for Payer: Priority Health Medicare |
$24,368.12
|
| Rate for Payer: Priority Health Narrow Network |
$38,058.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24,368.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,570.06
|
| Rate for Payer: UHC Core |
$31,030.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,368.12
|
| Rate for Payer: UHC Exchange |
$33,234.88
|
| Rate for Payer: UHC Medicare Advantage |
$25,099.16
|
| Rate for Payer: VA VA |
$24,368.12
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$33,988.14
|
|
|
Service Code
|
MS-DRG 262
|
| Min. Negotiated Rate |
$11,724.75 |
| Max. Negotiated Rate |
$33,988.14 |
| Rate for Payer: Aetna Medicare |
$12,835.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,427.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,427.30
|
| Rate for Payer: BCBS MAPPO |
$12,341.84
|
| Rate for Payer: BCBS Trust/PPO |
$33,988.14
|
| Rate for Payer: BCN Medicare Advantage |
$12,341.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,341.84
|
| Rate for Payer: Mclaren Medicare |
$12,341.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,958.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,193.12
|
| Rate for Payer: PACE Medicare |
$11,724.75
|
| Rate for Payer: PACE SWMI |
$12,341.84
|
| Rate for Payer: PHP Medicare Advantage |
$12,341.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,609.92
|
| Rate for Payer: Priority Health Medicare |
$12,341.84
|
| Rate for Payer: Priority Health Narrow Network |
$18,887.94
|
| Rate for Payer: Railroad Medicare Medicare |
$12,341.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,097.41
|
| Rate for Payer: UHC Core |
$15,400.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,341.84
|
| Rate for Payer: UHC Exchange |
$16,494.13
|
| Rate for Payer: UHC Medicare Advantage |
$12,712.10
|
| Rate for Payer: VA VA |
$12,341.84
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$120,741.56
|
|
|
Service Code
|
MS-DRG 217
|
| Min. Negotiated Rate |
$44,017.58 |
| Max. Negotiated Rate |
$120,741.56 |
| Rate for Payer: Aetna Medicare |
$48,187.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,917.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,917.88
|
| Rate for Payer: BCBS MAPPO |
$46,334.30
|
| Rate for Payer: BCBS Trust/PPO |
$120,741.56
|
| Rate for Payer: BCN Medicare Advantage |
$46,334.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,334.30
|
| Rate for Payer: Mclaren Medicare |
$46,334.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48,651.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,284.44
|
| Rate for Payer: PACE Medicare |
$44,017.58
|
| Rate for Payer: PACE SWMI |
$46,334.30
|
| Rate for Payer: PHP Medicare Advantage |
$46,334.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91,341.55
|
| Rate for Payer: Priority Health Medicare |
$46,334.30
|
| Rate for Payer: Priority Health Narrow Network |
$73,073.24
|
| Rate for Payer: Railroad Medicare Medicare |
$46,334.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97,096.29
|
| Rate for Payer: UHC Core |
$59,579.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$46,334.30
|
| Rate for Payer: UHC Exchange |
$63,812.13
|
| Rate for Payer: UHC Medicare Advantage |
$47,724.33
|
| Rate for Payer: VA VA |
$46,334.30
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$180,197.75
|
|
|
Service Code
|
MS-DRG 216
|
| Min. Negotiated Rate |
$66,868.88 |
| Max. Negotiated Rate |
$180,197.75 |
| Rate for Payer: Aetna Medicare |
$73,203.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87,985.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87,985.36
|
| Rate for Payer: BCBS MAPPO |
$70,388.29
|
| Rate for Payer: BCBS Trust/PPO |
$180,197.75
|
| Rate for Payer: BCN Medicare Advantage |
$70,388.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70,388.29
|
| Rate for Payer: Mclaren Medicare |
$70,388.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73,907.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80,946.53
|
| Rate for Payer: PACE Medicare |
$66,868.88
|
| Rate for Payer: PACE SWMI |
$70,388.29
|
| Rate for Payer: PHP Medicare Advantage |
$70,388.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139,270.28
|
| Rate for Payer: Priority Health Medicare |
$70,388.29
|
| Rate for Payer: Priority Health Narrow Network |
$111,416.22
|
| Rate for Payer: Railroad Medicare Medicare |
$70,388.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148,044.65
|
| Rate for Payer: UHC Core |
$90,841.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$70,388.29
|
| Rate for Payer: UHC Exchange |
$97,295.63
|
| Rate for Payer: UHC Medicare Advantage |
$72,499.94
|
| Rate for Payer: VA VA |
$70,388.29
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$97,109.29
|
|
|
Service Code
|
MS-DRG 218
|
| Min. Negotiated Rate |
$39,443.22 |
| Max. Negotiated Rate |
$97,109.29 |
| Rate for Payer: Aetna Medicare |
$43,179.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,898.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,898.98
|
| Rate for Payer: BCBS MAPPO |
$41,519.18
|
| Rate for Payer: BCBS Trust/PPO |
$97,109.29
|
| Rate for Payer: BCN Medicare Advantage |
$41,519.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,519.18
|
| Rate for Payer: Mclaren Medicare |
$41,519.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,595.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,747.06
|
| Rate for Payer: PACE Medicare |
$39,443.22
|
| Rate for Payer: PACE SWMI |
$41,519.18
|
| Rate for Payer: PHP Medicare Advantage |
$41,519.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,747.19
|
| Rate for Payer: Priority Health Medicare |
$41,519.18
|
| Rate for Payer: Priority Health Narrow Network |
$65,397.75
|
| Rate for Payer: Railroad Medicare Medicare |
$41,519.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,897.46
|
| Rate for Payer: UHC Core |
$53,321.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$41,519.18
|
| Rate for Payer: UHC Exchange |
$57,109.42
|
| Rate for Payer: UHC Medicare Advantage |
$42,764.76
|
| Rate for Payer: VA VA |
$41,519.18
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
|
IP
|
$97,664.85
|
|
|
Service Code
|
MS-DRG 220
|
| Min. Negotiated Rate |
$36,350.09 |
| Max. Negotiated Rate |
$97,664.85 |
| Rate for Payer: Aetna Medicare |
$39,793.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,829.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,829.06
|
| Rate for Payer: BCBS MAPPO |
$38,263.25
|
| Rate for Payer: BCBS Trust/PPO |
$97,664.85
|
| Rate for Payer: BCN Medicare Advantage |
$38,263.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,263.25
|
| Rate for Payer: Mclaren Medicare |
$38,263.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40,176.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,002.74
|
| Rate for Payer: PACE Medicare |
$36,350.09
|
| Rate for Payer: PACE SWMI |
$38,263.25
|
| Rate for Payer: PHP Medicare Advantage |
$38,263.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,259.59
|
| Rate for Payer: Priority Health Medicare |
$38,263.25
|
| Rate for Payer: Priority Health Narrow Network |
$60,207.67
|
| Rate for Payer: Railroad Medicare Medicare |
$38,263.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80,001.13
|
| Rate for Payer: UHC Core |
$49,089.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$38,263.25
|
| Rate for Payer: UHC Exchange |
$52,577.12
|
| Rate for Payer: UHC Medicare Advantage |
$39,411.15
|
| Rate for Payer: VA VA |
$38,263.25
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$130,825.13
|
|
|
Service Code
|
MS-DRG 219
|
| Min. Negotiated Rate |
$53,225.83 |
| Max. Negotiated Rate |
$130,825.13 |
| Rate for Payer: Aetna Medicare |
$58,268.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,033.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,033.99
|
| Rate for Payer: BCBS MAPPO |
$56,027.19
|
| Rate for Payer: BCBS Trust/PPO |
$130,825.13
|
| Rate for Payer: BCN Medicare Advantage |
$56,027.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,027.19
|
| Rate for Payer: Mclaren Medicare |
$56,027.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58,828.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,431.27
|
| Rate for Payer: PACE Medicare |
$53,225.83
|
| Rate for Payer: PACE SWMI |
$56,027.19
|
| Rate for Payer: PHP Medicare Advantage |
$56,027.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110,655.10
|
| Rate for Payer: Priority Health Medicare |
$56,027.19
|
| Rate for Payer: Priority Health Narrow Network |
$88,524.08
|
| Rate for Payer: Railroad Medicare Medicare |
$56,027.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117,626.64
|
| Rate for Payer: UHC Core |
$72,176.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$56,027.19
|
| Rate for Payer: UHC Exchange |
$77,304.78
|
| Rate for Payer: UHC Medicare Advantage |
$57,708.01
|
| Rate for Payer: VA VA |
$56,027.19
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$86,812.71
|
|
|
Service Code
|
MS-DRG 221
|
| Min. Negotiated Rate |
$32,272.43 |
| Max. Negotiated Rate |
$86,812.71 |
| Rate for Payer: Aetna Medicare |
$35,329.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,463.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,463.72
|
| Rate for Payer: BCBS MAPPO |
$33,970.98
|
| Rate for Payer: BCBS Trust/PPO |
$86,812.71
|
| Rate for Payer: BCN Medicare Advantage |
$33,970.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,970.98
|
| Rate for Payer: Mclaren Medicare |
$33,970.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35,669.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,066.63
|
| Rate for Payer: PACE Medicare |
$32,272.43
|
| Rate for Payer: PACE SWMI |
$33,970.98
|
| Rate for Payer: PHP Medicare Advantage |
$33,970.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,707.04
|
| Rate for Payer: Priority Health Medicare |
$33,970.98
|
| Rate for Payer: Priority Health Narrow Network |
$53,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$33,970.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70,909.74
|
| Rate for Payer: UHC Core |
$43,510.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$33,970.98
|
| Rate for Payer: UHC Exchange |
$46,602.22
|
| Rate for Payer: UHC Medicare Advantage |
$34,990.11
|
| Rate for Payer: VA VA |
$33,970.98
|
|
|
CARFILZOMIB 30 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,022.01
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
179327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$6,319.81 |
| Rate for Payer: Aetna Commercial |
$5,968.71
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,564.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.86
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: BCBS MAPPO |
$47.08
|
| Rate for Payer: BCBS Trust/PPO |
$139.39
|
| Rate for Payer: BCN Medicare Advantage |
$47.08
|
| Rate for Payer: Cash Price |
$5,617.61
|
| Rate for Payer: Cash Price |
$5,617.61
|
| Rate for Payer: Cofinity Commercial |
$6,038.93
|
| Rate for Payer: Cofinity Commercial |
$4,915.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.08
|
| Rate for Payer: Healthscope Commercial |
$6,319.81
|
| Rate for Payer: Mclaren Medicaid |
$25.76
|
| Rate for Payer: Mclaren Medicare |
$47.08
|
| Rate for Payer: Meridian Medicaid |
$27.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,968.71
|
| Rate for Payer: PACE Medicare |
$44.73
|
| Rate for Payer: PACE SWMI |
$47.08
|
| Rate for Payer: PHP Commercial |
$5,968.71
|
| Rate for Payer: PHP Medicare Advantage |
$47.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,915.41
|
| Rate for Payer: Priority Health Medicare |
$47.08
|
| Rate for Payer: Priority Health SBD |
$4,423.87
|
| Rate for Payer: Railroad Medicare Medicare |
$47.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.08
|
| Rate for Payer: UHC Medicare Advantage |
$48.50
|
| Rate for Payer: VA VA |
$47.08
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,044.05
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$12,639.64 |
| Rate for Payer: Aetna Commercial |
$11,937.44
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,128.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.86
|
| Rate for Payer: BCBS Complete |
$27.05
|
| Rate for Payer: BCBS MAPPO |
$47.08
|
| Rate for Payer: BCBS Trust/PPO |
$139.39
|
| Rate for Payer: BCN Medicare Advantage |
$47.08
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cofinity Commercial |
$9,830.84
|
| Rate for Payer: Cofinity Commercial |
$12,077.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.08
|
| Rate for Payer: Healthscope Commercial |
$12,639.64
|
| Rate for Payer: Mclaren Medicaid |
$25.76
|
| Rate for Payer: Mclaren Medicare |
$47.08
|
| Rate for Payer: Meridian Medicaid |
$27.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,937.44
|
| Rate for Payer: PACE Medicare |
$44.73
|
| Rate for Payer: PACE SWMI |
$47.08
|
| Rate for Payer: PHP Commercial |
$11,937.44
|
| Rate for Payer: PHP Medicare Advantage |
$47.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,830.84
|
| Rate for Payer: Priority Health Medicare |
$47.08
|
| Rate for Payer: Priority Health SBD |
$8,847.75
|
| Rate for Payer: Railroad Medicare Medicare |
$47.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.08
|
| Rate for Payer: UHC Medicare Advantage |
$48.50
|
| Rate for Payer: VA VA |
$47.08
|
|
|
CARFILZOMIB 60 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,044.05
|
|
|
Service Code
|
HCPCS J9047
|
| Hospital Charge Code |
161768
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,847.75 |
| Max. Negotiated Rate |
$12,639.64 |
| Rate for Payer: Aetna Commercial |
$11,937.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,128.63
|
| Rate for Payer: Cash Price |
$11,235.24
|
| Rate for Payer: Cofinity Commercial |
$12,077.88
|
| Rate for Payer: Cofinity Commercial |
$9,830.84
|
| Rate for Payer: Healthscope Commercial |
$12,639.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,937.44
|
| Rate for Payer: PHP Commercial |
$11,937.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,830.84
|
| Rate for Payer: Priority Health SBD |
$8,847.75
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$1,579.42
|
|
|
Service Code
|
NDC 61874-115-11
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$995.03 |
| Max. Negotiated Rate |
$1,421.48 |
| Rate for Payer: Aetna Commercial |
$1,342.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.62
|
| Rate for Payer: Cash Price |
$1,263.54
|
| Rate for Payer: Cofinity Commercial |
$1,105.59
|
| Rate for Payer: Cofinity Commercial |
$1,358.30
|
| Rate for Payer: Healthscope Commercial |
$1,421.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,342.51
|
| Rate for Payer: PHP Commercial |
$1,342.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.59
|
| Rate for Payer: Priority Health SBD |
$995.03
|
|
|
CARIPRAZINE 1.5 MG CAPSULE
|
Facility
|
IP
|
$3,158.84
|
|
|
Service Code
|
NDC 61874-115-20
|
| Hospital Charge Code |
177102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,990.07 |
| Max. Negotiated Rate |
$2,842.96 |
| Rate for Payer: Aetna Commercial |
$2,685.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,053.25
|
| Rate for Payer: Cash Price |
$2,527.07
|
| Rate for Payer: Cofinity Commercial |
$2,211.19
|
| Rate for Payer: Cofinity Commercial |
$2,716.60
|
| Rate for Payer: Healthscope Commercial |
$2,842.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,685.01
|
| Rate for Payer: PHP Commercial |
$2,685.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,211.19
|
| Rate for Payer: Priority Health SBD |
$1,990.07
|
|
