|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$37,533.99
|
|
|
Service Code
|
MS-DRG 473
|
| Min. Negotiated Rate |
$17,302.79 |
| Max. Negotiated Rate |
$37,533.99 |
| Rate for Payer: Aetna Medicare |
$18,942.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,766.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,766.82
|
| Rate for Payer: BCBS MAPPO |
$18,213.46
|
| Rate for Payer: BCBS Trust/PPO |
$35,037.78
|
| Rate for Payer: BCN Medicare Advantage |
$18,213.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,213.46
|
| Rate for Payer: Mclaren Medicare |
$18,213.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,124.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,945.48
|
| Rate for Payer: PACE Medicare |
$17,302.79
|
| Rate for Payer: PACE SWMI |
$18,213.46
|
| Rate for Payer: PHP Medicare Advantage |
$18,213.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,309.41
|
| Rate for Payer: Priority Health Medicare |
$18,213.46
|
| Rate for Payer: Priority Health Narrow Network |
$28,247.53
|
| Rate for Payer: Railroad Medicare Medicare |
$18,213.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,533.99
|
| Rate for Payer: UHC Core |
$23,031.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,213.46
|
| Rate for Payer: UHC Exchange |
$24,667.52
|
| Rate for Payer: UHC Medicare Advantage |
$18,759.86
|
| Rate for Payer: VA VA |
$18,213.46
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$16,033.48
|
|
|
Service Code
|
MS-DRG 787
|
| Min. Negotiated Rate |
$7,659.40 |
| Max. Negotiated Rate |
$16,033.48 |
| Rate for Payer: Aetna Medicare |
$8,385.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,078.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,078.16
|
| Rate for Payer: BCBS MAPPO |
$8,062.53
|
| Rate for Payer: BCBS Trust/PPO |
$13,946.16
|
| Rate for Payer: BCN Medicare Advantage |
$8,062.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,062.53
|
| Rate for Payer: Mclaren Medicare |
$8,062.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,465.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,271.91
|
| Rate for Payer: PACE Medicare |
$7,659.40
|
| Rate for Payer: PACE SWMI |
$8,062.53
|
| Rate for Payer: PHP Medicare Advantage |
$8,062.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,083.20
|
| Rate for Payer: Priority Health Medicare |
$8,062.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,066.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,062.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,033.48
|
| Rate for Payer: UHC Core |
$9,838.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,062.53
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,304.41
|
| Rate for Payer: VA VA |
$8,062.53
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$26,686.87
|
|
|
Service Code
|
MS-DRG 786
|
| Min. Negotiated Rate |
$9,193.00 |
| Max. Negotiated Rate |
$26,686.87 |
| Rate for Payer: Aetna Medicare |
$13,615.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,365.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,365.32
|
| Rate for Payer: BCBS MAPPO |
$13,092.26
|
| Rate for Payer: BCBS Trust/PPO |
$19,229.50
|
| Rate for Payer: BCN Medicare Advantage |
$13,092.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,092.26
|
| Rate for Payer: Mclaren Medicare |
$13,092.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,746.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,056.10
|
| Rate for Payer: PACE Medicare |
$12,437.65
|
| Rate for Payer: PACE SWMI |
$13,092.26
|
| Rate for Payer: PHP Medicare Advantage |
$13,092.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,105.19
|
| Rate for Payer: Priority Health Medicare |
$13,092.26
|
| Rate for Payer: Priority Health Narrow Network |
$20,084.15
|
| Rate for Payer: Railroad Medicare Medicare |
$13,092.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,686.87
|
| Rate for Payer: UHC Core |
$16,375.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,092.26
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$13,485.03
|
| Rate for Payer: VA VA |
$13,092.26
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,042.17
|
|
|
Service Code
|
MS-DRG 788
|
| Min. Negotiated Rate |
$6,317.76 |
| Max. Negotiated Rate |
$13,042.17 |
| Rate for Payer: Aetna Medicare |
$6,916.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,312.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,312.84
|
| Rate for Payer: BCBS MAPPO |
$6,650.27
|
| Rate for Payer: BCBS Trust/PPO |
$12,749.40
|
| Rate for Payer: BCN Medicare Advantage |
$6,650.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,650.27
|
| Rate for Payer: Mclaren Medicare |
$6,650.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,982.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,647.81
|
| Rate for Payer: PACE Medicare |
$6,317.76
|
| Rate for Payer: PACE SWMI |
$6,650.27
|
| Rate for Payer: PHP Medicare Advantage |
$6,650.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,269.18
|
| Rate for Payer: Priority Health Medicare |
$6,650.27
|
| Rate for Payer: Priority Health Narrow Network |
$9,815.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,650.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,042.17
|
| Rate for Payer: UHC Core |
$8,002.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,650.27
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,849.78
|
| Rate for Payer: VA VA |
$6,650.27
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$15,621.62
|
|
|
Service Code
|
MS-DRG 784
|
| Min. Negotiated Rate |
$7,474.68 |
| Max. Negotiated Rate |
$15,621.62 |
| Rate for Payer: Aetna Medicare |
$8,182.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,835.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,835.10
|
| Rate for Payer: BCBS MAPPO |
$7,868.08
|
| Rate for Payer: BCBS Trust/PPO |
$14,646.65
|
| Rate for Payer: BCN Medicare Advantage |
$7,868.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,868.08
|
| Rate for Payer: Mclaren Medicare |
$7,868.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,261.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,048.29
|
| Rate for Payer: PACE Medicare |
$7,474.68
|
| Rate for Payer: PACE SWMI |
$7,868.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,868.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,695.75
|
| Rate for Payer: Priority Health Medicare |
$7,868.08
|
| Rate for Payer: Priority Health Narrow Network |
$11,756.60
|
| Rate for Payer: Railroad Medicare Medicare |
$7,868.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,621.62
|
| Rate for Payer: UHC Core |
$9,585.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,868.08
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,104.12
|
| Rate for Payer: VA VA |
$7,868.08
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$27,027.04
|
|
|
Service Code
|
MS-DRG 783
|
| Min. Negotiated Rate |
$9,193.00 |
| Max. Negotiated Rate |
$27,027.04 |
| Rate for Payer: Aetna Medicare |
$13,782.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,566.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,566.09
|
| Rate for Payer: BCBS MAPPO |
$13,252.87
|
| Rate for Payer: BCBS Trust/PPO |
$21,258.51
|
| Rate for Payer: BCN Medicare Advantage |
$13,252.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,252.87
|
| Rate for Payer: Mclaren Medicare |
$13,252.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,915.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,240.80
|
| Rate for Payer: PACE Medicare |
$12,590.23
|
| Rate for Payer: PACE SWMI |
$13,252.87
|
| Rate for Payer: PHP Medicare Advantage |
$13,252.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,425.19
|
| Rate for Payer: Priority Health Medicare |
$13,252.87
|
| Rate for Payer: Priority Health Narrow Network |
$20,340.15
|
| Rate for Payer: Railroad Medicare Medicare |
$13,252.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,027.04
|
| Rate for Payer: UHC Core |
$16,584.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,252.87
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$13,650.46
|
| Rate for Payer: VA VA |
$13,252.87
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,214.54
|
|
|
Service Code
|
MS-DRG 785
|
| Min. Negotiated Rate |
$6,395.07 |
| Max. Negotiated Rate |
$13,214.54 |
| Rate for Payer: Aetna Medicare |
$7,000.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,414.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,414.56
|
| Rate for Payer: BCBS MAPPO |
$6,731.65
|
| Rate for Payer: BCBS Trust/PPO |
$12,521.02
|
| Rate for Payer: BCN Medicare Advantage |
$6,731.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,731.65
|
| Rate for Payer: Mclaren Medicare |
$6,731.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,068.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,741.40
|
| Rate for Payer: PACE Medicare |
$6,395.07
|
| Rate for Payer: PACE SWMI |
$6,731.65
|
| Rate for Payer: PHP Medicare Advantage |
$6,731.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,431.34
|
| Rate for Payer: Priority Health Medicare |
$6,731.65
|
| Rate for Payer: Priority Health Narrow Network |
$9,945.07
|
| Rate for Payer: Railroad Medicare Medicare |
$6,731.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,214.54
|
| Rate for Payer: UHC Core |
$8,108.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,731.65
|
| Rate for Payer: UHC Exchange |
$9,193.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,933.60
|
| Rate for Payer: VA VA |
$6,731.65
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,451.02
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$3,105.92 |
| Rate for Payer: Aetna Commercial |
$2,933.37
|
| Rate for Payer: Aetna Medicare |
$76.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,243.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.15
|
| Rate for Payer: BCBS Complete |
$42.34
|
| Rate for Payer: BCBS MAPPO |
$73.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.25
|
| Rate for Payer: BCN Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cofinity Commercial |
$2,415.71
|
| Rate for Payer: Cofinity Commercial |
$2,967.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$3,105.92
|
| Rate for Payer: Mclaren Medicaid |
$40.32
|
| Rate for Payer: Mclaren Medicare |
$73.72
|
| Rate for Payer: Meridian Medicaid |
$42.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,933.37
|
| Rate for Payer: PACE Medicare |
$70.03
|
| Rate for Payer: PACE SWMI |
$73.72
|
| Rate for Payer: PHP Commercial |
$2,933.37
|
| Rate for Payer: PHP Medicare Advantage |
$73.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,415.71
|
| Rate for Payer: Priority Health Medicare |
$73.72
|
| Rate for Payer: Priority Health SBD |
$2,174.14
|
| Rate for Payer: Railroad Medicare Medicare |
$73.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.72
|
| Rate for Payer: UHC Medicare Advantage |
$75.93
|
| Rate for Payer: VA VA |
$73.72
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,451.02
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,174.14 |
| Max. Negotiated Rate |
$3,105.92 |
| Rate for Payer: Aetna Commercial |
$2,933.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,243.16
|
| Rate for Payer: Cash Price |
$2,760.82
|
| Rate for Payer: Cofinity Commercial |
$2,967.88
|
| Rate for Payer: Cofinity Commercial |
$2,415.71
|
| Rate for Payer: Healthscope Commercial |
$3,105.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,933.37
|
| Rate for Payer: PHP Commercial |
$2,933.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,415.71
|
| Rate for Payer: Priority Health SBD |
$2,174.14
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$6,902.03
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,348.28 |
| Max. Negotiated Rate |
$6,211.83 |
| Rate for Payer: Aetna Commercial |
$5,866.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,486.32
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cofinity Commercial |
$4,831.42
|
| Rate for Payer: Cofinity Commercial |
$5,935.75
|
| Rate for Payer: Healthscope Commercial |
$6,211.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,866.73
|
| Rate for Payer: PHP Commercial |
$5,866.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,831.42
|
| Rate for Payer: Priority Health SBD |
$4,348.28
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$6,902.03
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$6,211.83 |
| Rate for Payer: Aetna Commercial |
$5,866.73
|
| Rate for Payer: Aetna Medicare |
$76.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,486.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$92.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$92.15
|
| Rate for Payer: BCBS Complete |
$42.34
|
| Rate for Payer: BCBS MAPPO |
$73.72
|
| Rate for Payer: BCBS Trust/PPO |
$218.25
|
| Rate for Payer: BCN Medicare Advantage |
$73.72
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cash Price |
$5,521.62
|
| Rate for Payer: Cofinity Commercial |
$4,831.42
|
| Rate for Payer: Cofinity Commercial |
$5,935.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.72
|
| Rate for Payer: Healthscope Commercial |
$6,211.83
|
| Rate for Payer: Mclaren Medicaid |
$40.32
|
| Rate for Payer: Mclaren Medicare |
$73.72
|
| Rate for Payer: Meridian Medicaid |
$42.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,866.73
|
| Rate for Payer: PACE Medicare |
$70.03
|
| Rate for Payer: PACE SWMI |
$73.72
|
| Rate for Payer: PHP Commercial |
$5,866.73
|
| Rate for Payer: PHP Medicare Advantage |
$73.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,831.42
|
| Rate for Payer: Priority Health Medicare |
$73.72
|
| Rate for Payer: Priority Health SBD |
$4,348.28
|
| Rate for Payer: Railroad Medicare Medicare |
$73.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.72
|
| Rate for Payer: UHC Medicare Advantage |
$75.93
|
| Rate for Payer: VA VA |
$73.72
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$300.69
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.09
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$78.26
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$134.32
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.47
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Exchange |
$50.43
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$247.22 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.94
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$247.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$88,883.44
|
|
|
Service Code
|
MS-DRG 837
|
| Min. Negotiated Rate |
$33,609.30 |
| Max. Negotiated Rate |
$88,883.44 |
| Rate for Payer: Aetna Medicare |
$36,793.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,222.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,222.76
|
| Rate for Payer: BCBS MAPPO |
$35,378.21
|
| Rate for Payer: BCBS Trust/PPO |
$88,883.44
|
| Rate for Payer: BCN Medicare Advantage |
$35,378.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,378.21
|
| Rate for Payer: Mclaren Medicare |
$35,378.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,147.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,684.94
|
| Rate for Payer: PACE Medicare |
$33,609.30
|
| Rate for Payer: PACE SWMI |
$35,378.21
|
| Rate for Payer: PHP Medicare Advantage |
$35,378.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,256.83
|
| Rate for Payer: Priority Health Medicare |
$35,378.21
|
| Rate for Payer: Priority Health Narrow Network |
$54,605.46
|
| Rate for Payer: Railroad Medicare Medicare |
$35,378.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72,557.18
|
| Rate for Payer: UHC Core |
$44,521.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,378.21
|
| Rate for Payer: UHC Exchange |
$47,684.92
|
| Rate for Payer: UHC Medicare Advantage |
$36,439.56
|
| Rate for Payer: VA VA |
$35,378.21
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$39,671.13
|
|
|
Service Code
|
MS-DRG 838
|
| Min. Negotiated Rate |
$14,163.12 |
| Max. Negotiated Rate |
$39,671.13 |
| Rate for Payer: Aetna Medicare |
$15,504.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,635.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,635.69
|
| Rate for Payer: BCBS MAPPO |
$14,908.55
|
| Rate for Payer: BCBS Trust/PPO |
$39,671.13
|
| Rate for Payer: BCN Medicare Advantage |
$14,908.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,908.55
|
| Rate for Payer: Mclaren Medicare |
$14,908.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,653.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,144.83
|
| Rate for Payer: PACE Medicare |
$14,163.12
|
| Rate for Payer: PACE SWMI |
$14,908.55
|
| Rate for Payer: PHP Medicare Advantage |
$14,908.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,016.78
|
| Rate for Payer: Priority Health Medicare |
$14,908.55
|
| Rate for Payer: Priority Health Narrow Network |
$22,413.42
|
| Rate for Payer: Railroad Medicare Medicare |
$14,908.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,781.91
|
| Rate for Payer: UHC Core |
$18,274.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,908.55
|
| Rate for Payer: UHC Exchange |
$19,572.81
|
| Rate for Payer: UHC Medicare Advantage |
$15,355.81
|
| Rate for Payer: VA VA |
$14,908.55
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,877.49
|
|
|
Service Code
|
MS-DRG 839
|
| Min. Negotiated Rate |
$9,383.51 |
| Max. Negotiated Rate |
$19,877.49 |
| Rate for Payer: Aetna Medicare |
$10,272.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,346.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,346.72
|
| Rate for Payer: BCBS MAPPO |
$9,877.38
|
| Rate for Payer: BCBS Trust/PPO |
$19,719.18
|
| Rate for Payer: BCN Medicare Advantage |
$9,877.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,877.38
|
| Rate for Payer: Mclaren Medicare |
$9,877.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,371.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,358.99
|
| Rate for Payer: PACE Medicare |
$9,383.51
|
| Rate for Payer: PACE SWMI |
$9,877.38
|
| Rate for Payer: PHP Medicare Advantage |
$9,877.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,699.38
|
| Rate for Payer: Priority Health Medicare |
$9,877.38
|
| Rate for Payer: Priority Health Narrow Network |
$14,959.50
|
| Rate for Payer: Railroad Medicare Medicare |
$9,877.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,877.49
|
| Rate for Payer: UHC Core |
$12,197.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,877.38
|
| Rate for Payer: UHC Exchange |
$13,063.58
|
| Rate for Payer: UHC Medicare Advantage |
$10,173.70
|
| Rate for Payer: VA VA |
$9,877.38
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$20,626.09
|
|
|
Service Code
|
MS-DRG 847
|
| Min. Negotiated Rate |
$8,764.35 |
| Max. Negotiated Rate |
$20,626.09 |
| Rate for Payer: Aetna Medicare |
$9,594.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,532.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,532.04
|
| Rate for Payer: BCBS MAPPO |
$9,225.63
|
| Rate for Payer: BCBS Trust/PPO |
$20,626.09
|
| Rate for Payer: BCN Medicare Advantage |
$9,225.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,225.63
|
| Rate for Payer: Mclaren Medicare |
$9,225.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,686.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,609.47
|
| Rate for Payer: PACE Medicare |
$8,764.35
|
| Rate for Payer: PACE SWMI |
$9,225.63
|
| Rate for Payer: PHP Medicare Advantage |
$9,225.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,400.71
|
| Rate for Payer: Priority Health Medicare |
$9,225.63
|
| Rate for Payer: Priority Health Narrow Network |
$13,920.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9,225.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,497.00
|
| Rate for Payer: UHC Core |
$11,349.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,225.63
|
| Rate for Payer: UHC Exchange |
$12,156.32
|
| Rate for Payer: UHC Medicare Advantage |
$9,502.40
|
| Rate for Payer: VA VA |
$9,225.63
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$38,805.94
|
|
|
Service Code
|
MS-DRG 846
|
| Min. Negotiated Rate |
$17,189.21 |
| Max. Negotiated Rate |
$38,805.94 |
| Rate for Payer: Aetna Medicare |
$18,817.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,617.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,617.39
|
| Rate for Payer: BCBS MAPPO |
$18,093.91
|
| Rate for Payer: BCBS Trust/PPO |
$38,805.94
|
| Rate for Payer: BCN Medicare Advantage |
$18,093.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,093.91
|
| Rate for Payer: Mclaren Medicare |
$18,093.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,998.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,808.00
|
| Rate for Payer: PACE Medicare |
$17,189.21
|
| Rate for Payer: PACE SWMI |
$18,093.91
|
| Rate for Payer: PHP Medicare Advantage |
$18,093.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,071.20
|
| Rate for Payer: Priority Health Medicare |
$18,093.91
|
| Rate for Payer: Priority Health Narrow Network |
$28,056.96
|
| Rate for Payer: Railroad Medicare Medicare |
$18,093.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,280.78
|
| Rate for Payer: UHC Core |
$22,875.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,093.91
|
| Rate for Payer: UHC Exchange |
$24,501.10
|
| Rate for Payer: UHC Medicare Advantage |
$18,636.73
|
| Rate for Payer: VA VA |
$18,093.91
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,798.57
|
|
|
Service Code
|
MS-DRG 848
|
| Min. Negotiated Rate |
$6,189.11 |
| Max. Negotiated Rate |
$11,798.57 |
| Rate for Payer: Aetna Medicare |
$6,775.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,143.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,143.56
|
| Rate for Payer: BCBS MAPPO |
$6,514.85
|
| Rate for Payer: BCBS Trust/PPO |
$11,798.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,514.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,514.85
|
| Rate for Payer: Mclaren Medicare |
$6,514.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,840.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,492.08
|
| Rate for Payer: PACE Medicare |
$6,189.11
|
| Rate for Payer: PACE SWMI |
$6,514.85
|
| Rate for Payer: PHP Medicare Advantage |
$6,514.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,898.76
|
| Rate for Payer: Priority Health Medicare |
$6,514.85
|
| Rate for Payer: Priority Health Narrow Network |
$8,719.01
|
| Rate for Payer: Railroad Medicare Medicare |
$6,514.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,585.41
|
| Rate for Payer: UHC Core |
$7,108.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,514.85
|
| Rate for Payer: UHC Exchange |
$7,613.99
|
| Rate for Payer: UHC Medicare Advantage |
$6,710.30
|
| Rate for Payer: VA VA |
$6,514.85
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.36
|
| Rate for Payer: Priority Health SBD |
$85.82
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$12,929.46
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$5,418.74 |
| Max. Negotiated Rate |
$12,929.46 |
| Rate for Payer: Aetna Medicare |
$5,932.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,129.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,129.92
|
| Rate for Payer: BCBS MAPPO |
$5,703.94
|
| Rate for Payer: BCBS Trust/PPO |
$12,929.46
|
| Rate for Payer: BCN Medicare Advantage |
$5,703.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,703.94
|
| Rate for Payer: Mclaren Medicare |
$5,703.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,989.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,559.53
|
| Rate for Payer: PACE Medicare |
$5,418.74
|
| Rate for Payer: PACE SWMI |
$5,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$5,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,383.60
|
| Rate for Payer: Priority Health Medicare |
$5,703.94
|
| Rate for Payer: Priority Health Narrow Network |
$8,306.88
|
| Rate for Payer: Railroad Medicare Medicare |
$5,703.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,037.79
|
| Rate for Payer: UHC Core |
$6,772.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,703.94
|
| Rate for Payer: UHC Exchange |
$7,254.09
|
| Rate for Payer: UHC Medicare Advantage |
$5,875.06
|
| Rate for Payer: VA VA |
$5,703.94
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,346.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$192.72 |
| Max. Negotiated Rate |
$942.20 |
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: BCBS Complete |
$685.60
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,199.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.15
|
| Rate for Payer: Priority Health Narrow Network |
$343.15
|
| Rate for Payer: Priority Health Narrow Network |
$343.15
|
| Rate for Payer: Priority Health SBD |
$731.89
|
| Rate for Payer: Priority Health SBD |
$731.89
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$87.24
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.36
|
| Rate for Payer: Priority Health Narrow Network |
$57.36
|
| Rate for Payer: Priority Health SBD |
$116.26
|
|
