|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$12,793.31
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$5,805.98 |
| Max. Negotiated Rate |
$12,793.31 |
| Rate for Payer: Aetna Medicare |
$6,356.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,639.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,639.45
|
| Rate for Payer: BCBS MAPPO |
$6,111.56
|
| Rate for Payer: BCBS Trust/PPO |
$12,793.31
|
| Rate for Payer: BCN Medicare Advantage |
$6,111.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,111.56
|
| Rate for Payer: Mclaren Medicare |
$6,111.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,417.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,028.29
|
| Rate for Payer: PACE Medicare |
$5,805.98
|
| Rate for Payer: PACE SWMI |
$6,111.56
|
| Rate for Payer: PHP Medicare Advantage |
$6,111.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,195.81
|
| Rate for Payer: Priority Health Medicare |
$6,111.56
|
| Rate for Payer: Priority Health Narrow Network |
$8,956.65
|
| Rate for Payer: Railroad Medicare Medicare |
$6,111.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,901.17
|
| Rate for Payer: UHC Core |
$7,302.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,111.56
|
| Rate for Payer: UHC Exchange |
$7,821.51
|
| Rate for Payer: UHC Medicare Advantage |
$6,294.91
|
| Rate for Payer: VA VA |
$6,111.56
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
IP
|
$15,804.67
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$7,807.87 |
| Max. Negotiated Rate |
$15,804.67 |
| Rate for Payer: Aetna Medicare |
$8,547.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,273.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,273.51
|
| Rate for Payer: BCBS MAPPO |
$8,218.81
|
| Rate for Payer: BCBS Trust/PPO |
$15,250.53
|
| Rate for Payer: BCN Medicare Advantage |
$8,218.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,218.81
|
| Rate for Payer: Mclaren Medicare |
$8,218.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,629.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,451.63
|
| Rate for Payer: PACE Medicare |
$7,807.87
|
| Rate for Payer: PACE SWMI |
$8,218.81
|
| Rate for Payer: PHP Medicare Advantage |
$8,218.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,867.95
|
| Rate for Payer: Priority Health Medicare |
$8,218.81
|
| Rate for Payer: Priority Health Narrow Network |
$11,894.36
|
| Rate for Payer: Railroad Medicare Medicare |
$8,218.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,804.67
|
| Rate for Payer: UHC Core |
$9,697.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,218.81
|
| Rate for Payer: UHC Exchange |
$10,386.90
|
| Rate for Payer: UHC Medicare Advantage |
$8,465.37
|
| Rate for Payer: VA VA |
$8,218.81
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$9,582.56
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$4,837.21 |
| Max. Negotiated Rate |
$9,582.56 |
| Rate for Payer: Aetna Medicare |
$5,295.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,364.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,364.75
|
| Rate for Payer: BCBS MAPPO |
$5,091.80
|
| Rate for Payer: BCBS Trust/PPO |
$9,246.93
|
| Rate for Payer: BCN Medicare Advantage |
$5,091.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,091.80
|
| Rate for Payer: Mclaren Medicare |
$5,091.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,346.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,855.57
|
| Rate for Payer: PACE Medicare |
$4,837.21
|
| Rate for Payer: PACE SWMI |
$5,091.80
|
| Rate for Payer: PHP Medicare Advantage |
$5,091.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,014.62
|
| Rate for Payer: Priority Health Medicare |
$5,091.80
|
| Rate for Payer: Priority Health Narrow Network |
$7,211.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5,091.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,582.56
|
| Rate for Payer: UHC Core |
$5,879.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,091.80
|
| Rate for Payer: UHC Exchange |
$6,297.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,244.55
|
| Rate for Payer: VA VA |
$5,091.80
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
IP
|
$80,398.49
|
|
|
Service Code
|
MS-DRG 245
|
| Min. Negotiated Rate |
$31,470.58 |
| Max. Negotiated Rate |
$80,398.49 |
| Rate for Payer: Aetna Medicare |
$34,452.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,408.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,408.66
|
| Rate for Payer: BCBS MAPPO |
$33,126.93
|
| Rate for Payer: BCBS Trust/PPO |
$80,398.49
|
| Rate for Payer: BCN Medicare Advantage |
$33,126.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,126.93
|
| Rate for Payer: Mclaren Medicare |
$33,126.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,783.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,095.97
|
| Rate for Payer: PACE Medicare |
$31,470.58
|
| Rate for Payer: PACE SWMI |
$33,126.93
|
| Rate for Payer: PHP Medicare Advantage |
$33,126.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,025.23
|
| Rate for Payer: Priority Health Medicare |
$33,126.93
|
| Rate for Payer: Priority Health Narrow Network |
$52,020.18
|
| Rate for Payer: Railroad Medicare Medicare |
$33,126.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,121.98
|
| Rate for Payer: UHC Core |
$42,413.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$33,126.93
|
| Rate for Payer: UHC Exchange |
$45,427.29
|
| Rate for Payer: UHC Medicare Advantage |
$34,120.74
|
| Rate for Payer: VA VA |
$33,126.93
|
|
|
AICD LEAD PROCEDURES
|
Facility
IP
|
$66,526.99
|
|
|
Service Code
|
MS-DRG 265
|
| Min. Negotiated Rate |
$24,647.36 |
| Max. Negotiated Rate |
$66,526.99 |
| Rate for Payer: Aetna Medicare |
$26,982.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,430.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,430.74
|
| Rate for Payer: BCBS MAPPO |
$25,944.59
|
| Rate for Payer: BCBS Trust/PPO |
$66,526.99
|
| Rate for Payer: BCN Medicare Advantage |
$25,944.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,944.59
|
| Rate for Payer: Mclaren Medicare |
$25,944.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,241.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,836.28
|
| Rate for Payer: PACE Medicare |
$24,647.36
|
| Rate for Payer: PACE SWMI |
$25,944.59
|
| Rate for Payer: PHP Medicare Advantage |
$25,944.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,714.05
|
| Rate for Payer: Priority Health Medicare |
$25,944.59
|
| Rate for Payer: Priority Health Narrow Network |
$40,571.24
|
| Rate for Payer: Railroad Medicare Medicare |
$25,944.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,909.16
|
| Rate for Payer: UHC Core |
$33,079.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,944.59
|
| Rate for Payer: UHC Exchange |
$35,429.35
|
| Rate for Payer: UHC Medicare Advantage |
$26,722.93
|
| Rate for Payer: VA VA |
$25,944.59
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$276.55
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna Commercial |
$147.33
|
| Rate for Payer: Aetna Commercial |
$241.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cash Price |
$226.92
|
| Rate for Payer: Cash Price |
$138.66
|
| Rate for Payer: Cofinity Commercial |
$121.33
|
| Rate for Payer: Cofinity Commercial |
$193.58
|
| Rate for Payer: Cofinity Commercial |
$198.56
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Cofinity Commercial |
$243.94
|
| Rate for Payer: Cofinity Commercial |
$149.06
|
| Rate for Payer: Healthscope Commercial |
$156.00
|
| Rate for Payer: Healthscope Commercial |
$255.28
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.33
|
| Rate for Payer: PHP Commercial |
$147.33
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: PHP Commercial |
$241.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.56
|
| Rate for Payer: Priority Health SBD |
$174.23
|
| Rate for Payer: Priority Health SBD |
$109.20
|
| Rate for Payer: Priority Health SBD |
$178.70
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION 100 ML
|
Facility
IP
|
$276.55
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
180336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$235.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.76
|
| Rate for Payer: Cash Price |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$193.58
|
| Rate for Payer: Cofinity Commercial |
$237.83
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.07
|
| Rate for Payer: PHP Commercial |
$235.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.58
|
| Rate for Payer: Priority Health SBD |
$174.23
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$177.48
|
|
|
Service Code
|
HCPCS P9041
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Commercial |
$153.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.64
|
| Rate for Payer: Cash Price |
$148.48
|
| Rate for Payer: Cash Price |
$144.77
|
| Rate for Payer: Cash Price |
$141.98
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$124.24
|
| Rate for Payer: Cofinity Commercial |
$152.63
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Cofinity Commercial |
$155.63
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Healthscope Commercial |
$162.86
|
| Rate for Payer: Healthscope Commercial |
$167.04
|
| Rate for Payer: Healthscope Commercial |
$159.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.82
|
| Rate for Payer: PHP Commercial |
$150.86
|
| Rate for Payer: PHP Commercial |
$153.82
|
| Rate for Payer: PHP Commercial |
$157.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.92
|
| Rate for Payer: Priority Health SBD |
$116.93
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: Priority Health SBD |
$111.81
|
|
|
ALBUMIN, HUMAN 5 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$187.92
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.39 |
| Max. Negotiated Rate |
$169.13 |
| Rate for Payer: Aetna Commercial |
$159.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.15
|
| Rate for Payer: Cash Price |
$150.34
|
| Rate for Payer: Cofinity Commercial |
$131.54
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Healthscope Commercial |
$169.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.73
|
| Rate for Payer: PHP Commercial |
$159.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.54
|
| Rate for Payer: Priority Health SBD |
$118.39
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$3.53
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.68
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health SBD |
$2.76
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: Priority Health SBD |
$2.22
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Cofinity Commercial |
$2.89
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.86
|
| Rate for Payer: PHP Commercial |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.35
|
| Rate for Payer: Priority Health SBD |
$2.12
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$37.00
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Aetna Commercial |
$31.45
|
| Rate for Payer: Aetna Commercial |
$140.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Cash Price |
$132.14
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$25.90
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Cofinity Commercial |
$142.05
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Healthscope Commercial |
$148.65
|
| Rate for Payer: Healthscope Commercial |
$33.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.45
|
| Rate for Payer: PHP Commercial |
$31.45
|
| Rate for Payer: PHP Commercial |
$140.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.62
|
| Rate for Payer: Priority Health SBD |
$104.06
|
| Rate for Payer: Priority Health SBD |
$23.31
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097-142-60
|
| Hospital Charge Code |
17837
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.84
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.28
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
IP
|
$8,763.42
|
|
|
Service Code
|
MS-DRG 894
|
| Min. Negotiated Rate |
$4,398.65 |
| Max. Negotiated Rate |
$8,763.42 |
| Rate for Payer: Aetna Medicare |
$4,815.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,787.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,787.70
|
| Rate for Payer: BCBS MAPPO |
$4,630.16
|
| Rate for Payer: BCBS Trust/PPO |
$8,627.69
|
| Rate for Payer: BCN Medicare Advantage |
$4,630.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,630.16
|
| Rate for Payer: Mclaren Medicare |
$4,630.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,861.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,324.68
|
| Rate for Payer: PACE Medicare |
$4,398.65
|
| Rate for Payer: PACE SWMI |
$4,630.16
|
| Rate for Payer: PHP Medicare Advantage |
$4,630.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,244.03
|
| Rate for Payer: Priority Health Medicare |
$4,630.16
|
| Rate for Payer: Priority Health Narrow Network |
$6,595.22
|
| Rate for Payer: Railroad Medicare Medicare |
$4,630.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,763.42
|
| Rate for Payer: UHC Core |
$5,377.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,630.16
|
| Rate for Payer: UHC Exchange |
$5,759.36
|
| Rate for Payer: UHC Medicare Advantage |
$4,769.06
|
| Rate for Payer: VA VA |
$4,630.16
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
IP
|
$27,123.14
|
|
|
Service Code
|
MS-DRG 896
|
| Min. Negotiated Rate |
$12,633.33 |
| Max. Negotiated Rate |
$27,123.14 |
| Rate for Payer: Aetna Medicare |
$13,830.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,622.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,622.80
|
| Rate for Payer: BCBS MAPPO |
$13,298.24
|
| Rate for Payer: BCBS Trust/PPO |
$22,626.55
|
| Rate for Payer: BCN Medicare Advantage |
$13,298.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,298.24
|
| Rate for Payer: Mclaren Medicare |
$13,298.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,963.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,292.98
|
| Rate for Payer: PACE Medicare |
$12,633.33
|
| Rate for Payer: PACE SWMI |
$13,298.24
|
| Rate for Payer: PHP Medicare Advantage |
$13,298.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,515.59
|
| Rate for Payer: Priority Health Medicare |
$13,298.24
|
| Rate for Payer: Priority Health Narrow Network |
$20,412.47
|
| Rate for Payer: Railroad Medicare Medicare |
$13,298.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,123.14
|
| Rate for Payer: UHC Core |
$16,643.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,298.24
|
| Rate for Payer: UHC Exchange |
$17,825.45
|
| Rate for Payer: UHC Medicare Advantage |
$13,697.19
|
| Rate for Payer: VA VA |
$13,298.24
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
IP
|
$13,051.32
|
|
|
Service Code
|
MS-DRG 897
|
| Min. Negotiated Rate |
$6,321.85 |
| Max. Negotiated Rate |
$13,051.32 |
| Rate for Payer: Aetna Medicare |
$6,920.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,318.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,318.22
|
| Rate for Payer: BCBS MAPPO |
$6,654.58
|
| Rate for Payer: BCBS Trust/PPO |
$10,770.89
|
| Rate for Payer: BCN Medicare Advantage |
$6,654.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,654.58
|
| Rate for Payer: Mclaren Medicare |
$6,654.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,987.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,652.77
|
| Rate for Payer: PACE Medicare |
$6,321.85
|
| Rate for Payer: PACE SWMI |
$6,654.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,654.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,277.79
|
| Rate for Payer: Priority Health Medicare |
$6,654.58
|
| Rate for Payer: Priority Health Narrow Network |
$9,822.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6,654.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,051.32
|
| Rate for Payer: UHC Core |
$8,008.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,654.58
|
| Rate for Payer: UHC Exchange |
$8,577.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,854.22
|
| Rate for Payer: VA VA |
$6,654.58
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
IP
|
$24,540.64
|
|
|
Service Code
|
MS-DRG 895
|
| Min. Negotiated Rate |
$11,475.02 |
| Max. Negotiated Rate |
$24,540.64 |
| Rate for Payer: Aetna Medicare |
$12,562.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,098.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,098.71
|
| Rate for Payer: BCBS MAPPO |
$12,078.97
|
| Rate for Payer: BCBS Trust/PPO |
$20,503.12
|
| Rate for Payer: BCN Medicare Advantage |
$12,078.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,078.97
|
| Rate for Payer: Mclaren Medicare |
$12,078.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,682.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,890.82
|
| Rate for Payer: PACE Medicare |
$11,475.02
|
| Rate for Payer: PACE SWMI |
$12,078.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,078.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,086.15
|
| Rate for Payer: Priority Health Medicare |
$12,078.97
|
| Rate for Payer: Priority Health Narrow Network |
$18,468.92
|
| Rate for Payer: Railroad Medicare Medicare |
$12,078.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,540.64
|
| Rate for Payer: UHC Core |
$15,058.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,078.97
|
| Rate for Payer: UHC Exchange |
$16,128.22
|
| Rate for Payer: UHC Medicare Advantage |
$12,441.34
|
| Rate for Payer: VA VA |
$12,078.97
|
|
|
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION
|
Facility
IP
|
$24,302.94
|
|
|
Service Code
|
HCPCS J9015
|
| Hospital Charge Code |
8993
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,310.85 |
| Max. Negotiated Rate |
$21,872.65 |
| Rate for Payer: Aetna Commercial |
$20,657.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,796.91
|
| Rate for Payer: Cash Price |
$19,442.35
|
| Rate for Payer: Cofinity Commercial |
$20,900.53
|
| Rate for Payer: Cofinity Commercial |
$17,012.06
|
| Rate for Payer: Healthscope Commercial |
$21,872.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,657.50
|
| Rate for Payer: PHP Commercial |
$20,657.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,012.06
|
| Rate for Payer: Priority Health SBD |
$15,310.85
|
|
|
ALLERGIC REACTIONS WITH MCC
|
Facility
IP
|
$28,397.38
|
|
|
Service Code
|
MS-DRG 915
|
| Min. Negotiated Rate |
$12,605.26 |
| Max. Negotiated Rate |
$28,397.38 |
| Rate for Payer: Aetna Medicare |
$13,799.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,585.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,585.88
|
| Rate for Payer: BCBS MAPPO |
$13,268.70
|
| Rate for Payer: BCBS Trust/PPO |
$28,397.38
|
| Rate for Payer: BCN Medicare Advantage |
$13,268.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,268.70
|
| Rate for Payer: Mclaren Medicare |
$13,268.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,932.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,259.00
|
| Rate for Payer: PACE Medicare |
$12,605.26
|
| Rate for Payer: PACE SWMI |
$13,268.70
|
| Rate for Payer: PHP Medicare Advantage |
$13,268.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,456.76
|
| Rate for Payer: Priority Health Medicare |
$13,268.70
|
| Rate for Payer: Priority Health Narrow Network |
$20,365.41
|
| Rate for Payer: Railroad Medicare Medicare |
$13,268.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,060.60
|
| Rate for Payer: UHC Core |
$16,604.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,268.70
|
| Rate for Payer: UHC Exchange |
$17,784.35
|
| Rate for Payer: UHC Medicare Advantage |
$13,666.76
|
| Rate for Payer: VA VA |
$13,268.70
|
|
|
ALLERGIC REACTIONS WITHOUT MCC
|
Facility
IP
|
$10,112.12
|
|
|
Service Code
|
MS-DRG 916
|
| Min. Negotiated Rate |
$4,975.41 |
| Max. Negotiated Rate |
$10,112.12 |
| Rate for Payer: Aetna Medicare |
$5,446.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,546.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,546.59
|
| Rate for Payer: BCBS MAPPO |
$5,237.27
|
| Rate for Payer: BCBS Trust/PPO |
$10,112.12
|
| Rate for Payer: BCN Medicare Advantage |
$5,237.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,237.27
|
| Rate for Payer: Mclaren Medicare |
$5,237.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,499.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,022.86
|
| Rate for Payer: PACE Medicare |
$4,975.41
|
| Rate for Payer: PACE SWMI |
$5,237.27
|
| Rate for Payer: PHP Medicare Advantage |
$5,237.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,453.73
|
| Rate for Payer: Priority Health Medicare |
$5,237.27
|
| Rate for Payer: Priority Health Narrow Network |
$7,562.98
|
| Rate for Payer: Railroad Medicare Medicare |
$5,237.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,049.34
|
| Rate for Payer: UHC Core |
$6,166.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,237.27
|
| Rate for Payer: UHC Exchange |
$6,604.47
|
| Rate for Payer: UHC Medicare Advantage |
$5,394.39
|
| Rate for Payer: VA VA |
$5,237.27
|
|
|
ALLOGENEIC BONE MARROW TRANSPLANT
|
Facility
IP
|
$307,103.20
|
|
|
Service Code
|
MS-DRG 014
|
| Min. Negotiated Rate |
$78,880.15 |
| Max. Negotiated Rate |
$307,103.20 |
| Rate for Payer: Aetna Medicare |
$86,353.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103,789.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103,789.68
|
| Rate for Payer: BCBS MAPPO |
$83,031.74
|
| Rate for Payer: BCBS Trust/PPO |
$307,103.20
|
| Rate for Payer: BCN Medicare Advantage |
$83,031.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83,031.74
|
| Rate for Payer: Mclaren Medicare |
$83,031.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87,183.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95,486.50
|
| Rate for Payer: PACE Medicare |
$78,880.15
|
| Rate for Payer: PACE SWMI |
$83,031.74
|
| Rate for Payer: PHP Medicare Advantage |
$83,031.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164,463.00
|
| Rate for Payer: Priority Health Medicare |
$83,031.74
|
| Rate for Payer: Priority Health Narrow Network |
$131,570.40
|
| Rate for Payer: Railroad Medicare Medicare |
$83,031.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174,824.57
|
| Rate for Payer: UHC Core |
$107,274.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$83,031.74
|
| Rate for Payer: UHC Exchange |
$114,895.52
|
| Rate for Payer: UHC Medicare Advantage |
$85,522.69
|
| Rate for Payer: VA VA |
$83,031.74
|
|
|
ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 20930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.92 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$176.92
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$277.40
|
|
|
Service Code
|
NDC 51079-205-20
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.18
|
| Rate for Payer: Priority Health SBD |
$174.76
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$2.78
|
|
|
Service Code
|
NDC 51079-205-01
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.81
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cofinity Commercial |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.36
|
| Rate for Payer: PHP Commercial |
$2.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health SBD |
$1.75
|
|
|
ALLOPURINOL 100 MG TABLET
|
Facility
IP
|
$277.40
|
|
|
Service Code
|
NDC 0591-5543-01
|
| Hospital Charge Code |
310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$249.66 |
| Rate for Payer: Aetna Commercial |
$235.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.31
|
| Rate for Payer: Cash Price |
$221.92
|
| Rate for Payer: Cofinity Commercial |
$194.18
|
| Rate for Payer: Cofinity Commercial |
$238.56
|
| Rate for Payer: Healthscope Commercial |
$249.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.79
|
| Rate for Payer: PHP Commercial |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.18
|
| Rate for Payer: Priority Health SBD |
$174.76
|
|
