|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$15,141.12
|
|
|
Service Code
|
MS-DRG 758
|
| Min. Negotiated Rate |
$7,259.17 |
| Max. Negotiated Rate |
$15,141.12 |
| Rate for Payer: Aetna Medicare |
$7,946.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,551.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,551.54
|
| Rate for Payer: BCBS MAPPO |
$7,641.23
|
| Rate for Payer: BCBS Trust/PPO |
$12,485.89
|
| Rate for Payer: BCN Medicare Advantage |
$7,641.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,641.23
|
| Rate for Payer: Mclaren Medicare |
$7,641.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,023.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,787.41
|
| Rate for Payer: PACE Medicare |
$7,259.17
|
| Rate for Payer: PACE SWMI |
$7,641.23
|
| Rate for Payer: PHP Medicare Advantage |
$7,641.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,243.73
|
| Rate for Payer: Priority Health Medicare |
$7,641.23
|
| Rate for Payer: Priority Health Narrow Network |
$11,394.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,641.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,141.12
|
| Rate for Payer: UHC Core |
$9,290.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,641.23
|
| Rate for Payer: UHC Exchange |
$9,950.82
|
| Rate for Payer: UHC Medicare Advantage |
$7,870.47
|
| Rate for Payer: VA VA |
$7,641.23
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$22,752.87
|
|
|
Service Code
|
MS-DRG 757
|
| Min. Negotiated Rate |
$10,673.17 |
| Max. Negotiated Rate |
$22,752.87 |
| Rate for Payer: Aetna Medicare |
$11,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,043.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,043.65
|
| Rate for Payer: BCBS MAPPO |
$11,234.92
|
| Rate for Payer: BCBS Trust/PPO |
$18,280.87
|
| Rate for Payer: BCN Medicare Advantage |
$11,234.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,234.92
|
| Rate for Payer: Mclaren Medicare |
$11,234.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,796.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,920.16
|
| Rate for Payer: PACE Medicare |
$10,673.17
|
| Rate for Payer: PACE SWMI |
$11,234.92
|
| Rate for Payer: PHP Medicare Advantage |
$11,234.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,404.34
|
| Rate for Payer: Priority Health Medicare |
$11,234.92
|
| Rate for Payer: Priority Health Narrow Network |
$17,123.47
|
| Rate for Payer: Railroad Medicare Medicare |
$11,234.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,752.87
|
| Rate for Payer: UHC Core |
$13,961.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,234.92
|
| Rate for Payer: UHC Exchange |
$14,953.29
|
| Rate for Payer: UHC Medicare Advantage |
$11,571.97
|
| Rate for Payer: VA VA |
$11,234.92
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$11,658.03
|
|
|
Service Code
|
MS-DRG 759
|
| Min. Negotiated Rate |
$4,889.19 |
| Max. Negotiated Rate |
$11,658.03 |
| Rate for Payer: Aetna Medicare |
$5,352.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,433.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,433.15
|
| Rate for Payer: BCBS MAPPO |
$5,146.52
|
| Rate for Payer: BCBS Trust/PPO |
$11,658.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,146.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,146.52
|
| Rate for Payer: Mclaren Medicare |
$5,146.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,403.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,918.50
|
| Rate for Payer: PACE Medicare |
$4,889.19
|
| Rate for Payer: PACE SWMI |
$5,146.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,146.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,272.92
|
| Rate for Payer: Priority Health Medicare |
$5,146.52
|
| Rate for Payer: Priority Health Narrow Network |
$7,418.34
|
| Rate for Payer: Railroad Medicare Medicare |
$5,146.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,857.13
|
| Rate for Payer: UHC Core |
$6,048.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,146.52
|
| Rate for Payer: UHC Exchange |
$6,478.16
|
| Rate for Payer: UHC Medicare Advantage |
$5,300.92
|
| Rate for Payer: VA VA |
$5,146.52
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$31,090.70
|
|
|
Service Code
|
MS-DRG 854
|
| Min. Negotiated Rate |
$14,412.85 |
| Max. Negotiated Rate |
$31,090.70 |
| Rate for Payer: Aetna Medicare |
$15,778.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,964.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,964.28
|
| Rate for Payer: BCBS MAPPO |
$15,171.42
|
| Rate for Payer: BCBS Trust/PPO |
$24,249.32
|
| Rate for Payer: BCN Medicare Advantage |
$15,171.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,171.42
|
| Rate for Payer: Mclaren Medicare |
$15,171.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,929.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,447.13
|
| Rate for Payer: PACE Medicare |
$14,412.85
|
| Rate for Payer: PACE SWMI |
$15,171.42
|
| Rate for Payer: PHP Medicare Advantage |
$15,171.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,248.01
|
| Rate for Payer: Priority Health Medicare |
$15,171.42
|
| Rate for Payer: Priority Health Narrow Network |
$23,398.41
|
| Rate for Payer: Railroad Medicare Medicare |
$15,171.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,090.70
|
| Rate for Payer: UHC Core |
$19,077.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,171.42
|
| Rate for Payer: UHC Exchange |
$20,432.96
|
| Rate for Payer: UHC Medicare Advantage |
$15,626.56
|
| Rate for Payer: VA VA |
$15,171.42
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,259.32
|
|
|
Service Code
|
MS-DRG 853
|
| Min. Negotiated Rate |
$34,671.83 |
| Max. Negotiated Rate |
$76,259.32 |
| Rate for Payer: Aetna Medicare |
$37,956.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,620.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,620.82
|
| Rate for Payer: BCBS MAPPO |
$36,496.66
|
| Rate for Payer: BCBS Trust/PPO |
$70,721.16
|
| Rate for Payer: BCN Medicare Advantage |
$36,496.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,496.66
|
| Rate for Payer: Mclaren Medicare |
$36,496.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38,321.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,971.16
|
| Rate for Payer: PACE Medicare |
$34,671.83
|
| Rate for Payer: PACE SWMI |
$36,496.66
|
| Rate for Payer: PHP Medicare Advantage |
$36,496.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71,739.56
|
| Rate for Payer: Priority Health Medicare |
$36,496.66
|
| Rate for Payer: Priority Health Narrow Network |
$57,391.65
|
| Rate for Payer: Railroad Medicare Medicare |
$36,496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76,259.32
|
| Rate for Payer: UHC Core |
$46,793.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$36,496.66
|
| Rate for Payer: UHC Exchange |
$50,117.98
|
| Rate for Payer: UHC Medicare Advantage |
$37,591.56
|
| Rate for Payer: VA VA |
$36,496.66
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,959.26
|
|
|
Service Code
|
MS-DRG 855
|
| Min. Negotiated Rate |
$12,111.30 |
| Max. Negotiated Rate |
$25,959.26 |
| Rate for Payer: Aetna Medicare |
$13,258.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,935.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,935.92
|
| Rate for Payer: BCBS MAPPO |
$12,748.74
|
| Rate for Payer: BCBS Trust/PPO |
$19,194.36
|
| Rate for Payer: BCN Medicare Advantage |
$12,748.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,748.74
|
| Rate for Payer: Mclaren Medicare |
$12,748.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,386.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,661.05
|
| Rate for Payer: PACE Medicare |
$12,111.30
|
| Rate for Payer: PACE SWMI |
$12,748.74
|
| Rate for Payer: PHP Medicare Advantage |
$12,748.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,420.69
|
| Rate for Payer: Priority Health Medicare |
$12,748.74
|
| Rate for Payer: Priority Health Narrow Network |
$19,536.55
|
| Rate for Payer: Railroad Medicare Medicare |
$12,748.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,959.26
|
| Rate for Payer: UHC Core |
$15,928.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,748.74
|
| Rate for Payer: UHC Exchange |
$17,060.55
|
| Rate for Payer: UHC Medicare Advantage |
$13,131.20
|
| Rate for Payer: VA VA |
$12,748.74
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$24,726.73
|
|
|
Service Code
|
MS-DRG 727
|
| Min. Negotiated Rate |
$11,558.49 |
| Max. Negotiated Rate |
$24,726.73 |
| Rate for Payer: Aetna Medicare |
$12,653.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,208.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,208.54
|
| Rate for Payer: BCBS MAPPO |
$12,166.83
|
| Rate for Payer: BCBS Trust/PPO |
$21,715.26
|
| Rate for Payer: BCN Medicare Advantage |
$12,166.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,166.83
|
| Rate for Payer: Mclaren Medicare |
$12,166.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,775.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,991.85
|
| Rate for Payer: PACE Medicare |
$11,558.49
|
| Rate for Payer: PACE SWMI |
$12,166.83
|
| Rate for Payer: PHP Medicare Advantage |
$12,166.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,261.22
|
| Rate for Payer: Priority Health Medicare |
$12,166.83
|
| Rate for Payer: Priority Health Narrow Network |
$18,608.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12,166.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,726.73
|
| Rate for Payer: UHC Core |
$15,172.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,166.83
|
| Rate for Payer: UHC Exchange |
$16,250.53
|
| Rate for Payer: UHC Medicare Advantage |
$12,531.83
|
| Rate for Payer: VA VA |
$12,166.83
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$12,204.73
|
|
|
Service Code
|
MS-DRG 728
|
| Min. Negotiated Rate |
$5,942.14 |
| Max. Negotiated Rate |
$12,204.73 |
| Rate for Payer: Aetna Medicare |
$6,505.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,818.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,818.60
|
| Rate for Payer: BCBS MAPPO |
$6,254.88
|
| Rate for Payer: BCBS Trust/PPO |
$9,462.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,254.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,254.88
|
| Rate for Payer: Mclaren Medicare |
$6,254.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,567.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,193.11
|
| Rate for Payer: PACE Medicare |
$5,942.14
|
| Rate for Payer: PACE SWMI |
$6,254.88
|
| Rate for Payer: PHP Medicare Advantage |
$6,254.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,481.37
|
| Rate for Payer: Priority Health Medicare |
$6,254.88
|
| Rate for Payer: Priority Health Narrow Network |
$9,185.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6,254.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,204.73
|
| Rate for Payer: UHC Core |
$7,488.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,254.88
|
| Rate for Payer: UHC Exchange |
$8,021.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,442.53
|
| Rate for Payer: VA VA |
$6,254.88
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$17,143.39
|
|
|
Service Code
|
MS-DRG 386
|
| Min. Negotiated Rate |
$7,115.49 |
| Max. Negotiated Rate |
$17,143.39 |
| Rate for Payer: Aetna Medicare |
$7,789.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,362.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,362.49
|
| Rate for Payer: BCBS MAPPO |
$7,489.99
|
| Rate for Payer: BCBS Trust/PPO |
$17,143.39
|
| Rate for Payer: BCN Medicare Advantage |
$7,489.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,489.99
|
| Rate for Payer: Mclaren Medicare |
$7,489.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,864.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,613.49
|
| Rate for Payer: PACE Medicare |
$7,115.49
|
| Rate for Payer: PACE SWMI |
$7,489.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,489.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,942.38
|
| Rate for Payer: Priority Health Medicare |
$7,489.99
|
| Rate for Payer: Priority Health Narrow Network |
$11,153.90
|
| Rate for Payer: Railroad Medicare Medicare |
$7,489.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,820.79
|
| Rate for Payer: UHC Core |
$9,094.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,489.99
|
| Rate for Payer: UHC Exchange |
$9,740.29
|
| Rate for Payer: UHC Medicare Advantage |
$7,714.69
|
| Rate for Payer: VA VA |
$7,489.99
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$23,901.49
|
|
|
Service Code
|
MS-DRG 385
|
| Min. Negotiated Rate |
$11,188.36 |
| Max. Negotiated Rate |
$23,901.49 |
| Rate for Payer: Aetna Medicare |
$12,248.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,721.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,721.52
|
| Rate for Payer: BCBS MAPPO |
$11,777.22
|
| Rate for Payer: BCBS Trust/PPO |
$22,955.94
|
| Rate for Payer: BCN Medicare Advantage |
$11,777.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,777.22
|
| Rate for Payer: Mclaren Medicare |
$11,777.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,366.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,543.80
|
| Rate for Payer: PACE Medicare |
$11,188.36
|
| Rate for Payer: PACE SWMI |
$11,777.22
|
| Rate for Payer: PHP Medicare Advantage |
$11,777.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,484.89
|
| Rate for Payer: Priority Health Medicare |
$11,777.22
|
| Rate for Payer: Priority Health Narrow Network |
$17,987.91
|
| Rate for Payer: Railroad Medicare Medicare |
$11,777.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,901.49
|
| Rate for Payer: UHC Core |
$14,666.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,777.22
|
| Rate for Payer: UHC Exchange |
$15,708.17
|
| Rate for Payer: UHC Medicare Advantage |
$12,130.54
|
| Rate for Payer: VA VA |
$11,777.22
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$11,697.56
|
|
|
Service Code
|
MS-DRG 387
|
| Min. Negotiated Rate |
$5,148.50 |
| Max. Negotiated Rate |
$11,697.56 |
| Rate for Payer: Aetna Medicare |
$5,636.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,774.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,774.34
|
| Rate for Payer: BCBS MAPPO |
$5,419.47
|
| Rate for Payer: BCBS Trust/PPO |
$11,697.56
|
| Rate for Payer: BCN Medicare Advantage |
$5,419.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,419.47
|
| Rate for Payer: Mclaren Medicare |
$5,419.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,690.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,232.39
|
| Rate for Payer: PACE Medicare |
$5,148.50
|
| Rate for Payer: PACE SWMI |
$5,419.47
|
| Rate for Payer: PHP Medicare Advantage |
$5,419.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,816.78
|
| Rate for Payer: Priority Health Medicare |
$5,419.47
|
| Rate for Payer: Priority Health Narrow Network |
$7,853.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,419.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,435.26
|
| Rate for Payer: UHC Core |
$6,403.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,419.47
|
| Rate for Payer: UHC Exchange |
$6,858.10
|
| Rate for Payer: UHC Medicare Advantage |
$5,582.05
|
| Rate for Payer: VA VA |
$5,419.47
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,641.80
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$3,277.62 |
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna Medicare |
$33.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.20
|
| Rate for Payer: BCBS Complete |
$18.47
|
| Rate for Payer: BCBS MAPPO |
$32.16
|
| Rate for Payer: BCBS Trust/PPO |
$95.19
|
| Rate for Payer: BCN Medicare Advantage |
$32.16
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.16
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Mclaren Medicaid |
$17.59
|
| Rate for Payer: Mclaren Medicare |
$32.16
|
| Rate for Payer: Meridian Medicaid |
$18.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,095.53
|
| Rate for Payer: PACE Medicare |
$30.55
|
| Rate for Payer: PACE SWMI |
$32.16
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Medicare Advantage |
$32.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,549.26
|
| Rate for Payer: Priority Health Medicare |
$32.16
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
| Rate for Payer: Railroad Medicare Medicare |
$32.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.16
|
| Rate for Payer: UHC Medicare Advantage |
$33.13
|
| Rate for Payer: VA VA |
$32.16
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,481.25
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$933.19 |
| Max. Negotiated Rate |
$1,333.12 |
| Rate for Payer: Aetna Commercial |
$1,259.06
|
| Rate for Payer: Aetna Commercial |
$3,095.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$962.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.17
|
| Rate for Payer: Cash Price |
$2,913.44
|
| Rate for Payer: Cash Price |
$1,185.00
|
| Rate for Payer: Cofinity Commercial |
$1,036.88
|
| Rate for Payer: Cofinity Commercial |
$3,131.95
|
| Rate for Payer: Cofinity Commercial |
$2,549.26
|
| Rate for Payer: Cofinity Commercial |
$1,273.88
|
| Rate for Payer: Healthscope Commercial |
$3,277.62
|
| Rate for Payer: Healthscope Commercial |
$1,333.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,259.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,095.53
|
| Rate for Payer: PHP Commercial |
$3,095.53
|
| Rate for Payer: PHP Commercial |
$1,259.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,036.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,549.26
|
| Rate for Payer: Priority Health SBD |
$933.19
|
| Rate for Payer: Priority Health SBD |
$2,294.33
|
|
|
INFLIXIMAB-ABDA 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,482.02
|
|
|
Service Code
|
HCPCS Q5104
|
| Hospital Charge Code |
184064
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$933.67 |
| Max. Negotiated Rate |
$1,333.82 |
| Rate for Payer: Aetna Commercial |
$1,259.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.31
|
| Rate for Payer: Cash Price |
$1,185.62
|
| Rate for Payer: Cofinity Commercial |
$1,037.41
|
| Rate for Payer: Cofinity Commercial |
$1,274.54
|
| Rate for Payer: Healthscope Commercial |
$1,333.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,259.72
|
| Rate for Payer: PHP Commercial |
$1,259.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.41
|
| Rate for Payer: Priority Health SBD |
$933.67
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,653.60
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,041.77 |
| Max. Negotiated Rate |
$1,488.24 |
| Rate for Payer: Aetna Commercial |
$1,405.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.84
|
| Rate for Payer: Cash Price |
$1,322.88
|
| Rate for Payer: Cofinity Commercial |
$1,157.52
|
| Rate for Payer: Cofinity Commercial |
$1,422.10
|
| Rate for Payer: Healthscope Commercial |
$1,488.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,405.56
|
| Rate for Payer: PHP Commercial |
$1,405.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.52
|
| Rate for Payer: Priority Health SBD |
$1,041.77
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$26,144.39
|
|
|
Service Code
|
MS-DRG 351
|
| Min. Negotiated Rate |
$10,426.88 |
| Max. Negotiated Rate |
$26,144.39 |
| Rate for Payer: Aetna Medicare |
$11,414.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,719.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,719.58
|
| Rate for Payer: BCBS MAPPO |
$10,975.66
|
| Rate for Payer: BCBS Trust/PPO |
$26,144.39
|
| Rate for Payer: BCN Medicare Advantage |
$10,975.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,975.66
|
| Rate for Payer: Mclaren Medicare |
$10,975.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,524.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,622.01
|
| Rate for Payer: PACE Medicare |
$10,426.88
|
| Rate for Payer: PACE SWMI |
$10,975.66
|
| Rate for Payer: PHP Medicare Advantage |
$10,975.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,887.74
|
| Rate for Payer: Priority Health Medicare |
$10,975.66
|
| Rate for Payer: Priority Health Narrow Network |
$16,710.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,975.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,203.72
|
| Rate for Payer: UHC Core |
$13,624.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,975.66
|
| Rate for Payer: UHC Exchange |
$14,592.39
|
| Rate for Payer: UHC Medicare Advantage |
$11,304.93
|
| Rate for Payer: VA VA |
$10,975.66
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$36,609.60
|
|
|
Service Code
|
MS-DRG 350
|
| Min. Negotiated Rate |
$16,888.17 |
| Max. Negotiated Rate |
$36,609.60 |
| Rate for Payer: Aetna Medicare |
$18,488.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,221.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,221.28
|
| Rate for Payer: BCBS MAPPO |
$17,777.02
|
| Rate for Payer: BCBS Trust/PPO |
$30,426.39
|
| Rate for Payer: BCN Medicare Advantage |
$17,777.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,777.02
|
| Rate for Payer: Mclaren Medicare |
$17,777.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,665.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,443.57
|
| Rate for Payer: PACE Medicare |
$16,888.17
|
| Rate for Payer: PACE SWMI |
$17,777.02
|
| Rate for Payer: PHP Medicare Advantage |
$17,777.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,439.81
|
| Rate for Payer: Priority Health Medicare |
$17,777.02
|
| Rate for Payer: Priority Health Narrow Network |
$27,551.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17,777.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,609.60
|
| Rate for Payer: UHC Core |
$22,464.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,777.02
|
| Rate for Payer: UHC Exchange |
$24,060.00
|
| Rate for Payer: UHC Medicare Advantage |
$18,310.33
|
| Rate for Payer: VA VA |
$17,777.02
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,834.76
|
|
|
Service Code
|
MS-DRG 352
|
| Min. Negotiated Rate |
$8,055.54 |
| Max. Negotiated Rate |
$25,834.76 |
| Rate for Payer: Aetna Medicare |
$8,818.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,599.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,599.40
|
| Rate for Payer: BCBS MAPPO |
$8,479.52
|
| Rate for Payer: BCBS Trust/PPO |
$25,834.76
|
| Rate for Payer: BCN Medicare Advantage |
$8,479.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,479.52
|
| Rate for Payer: Mclaren Medicare |
$8,479.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,903.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,751.45
|
| Rate for Payer: PACE Medicare |
$8,055.54
|
| Rate for Payer: PACE SWMI |
$8,479.52
|
| Rate for Payer: PHP Medicare Advantage |
$8,479.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,914.06
|
| Rate for Payer: Priority Health Medicare |
$8,479.52
|
| Rate for Payer: Priority Health Narrow Network |
$12,731.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8,479.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,916.69
|
| Rate for Payer: UHC Core |
$10,380.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,479.52
|
| Rate for Payer: UHC Exchange |
$11,117.73
|
| Rate for Payer: UHC Medicare Advantage |
$8,733.91
|
| Rate for Payer: VA VA |
$8,479.52
|
|
|
INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 64510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.31 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$843.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,013.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,013.79
|
| Rate for Payer: BCBS Complete |
$465.86
|
| Rate for Payer: BCBS MAPPO |
$811.03
|
| Rate for Payer: BCBS Trust/PPO |
$366.28
|
| Rate for Payer: BCN Medicare Advantage |
$811.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.03
|
| Rate for Payer: Mclaren Medicaid |
$443.63
|
| Rate for Payer: Mclaren Medicare |
$811.03
|
| Rate for Payer: Meridian Medicaid |
$465.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$851.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$932.68
|
| Rate for Payer: PACE Medicare |
$770.48
|
| Rate for Payer: PACE SWMI |
$811.03
|
| Rate for Payer: PHP Medicare Advantage |
$811.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.63
|
| Rate for Payer: Priority Health Medicare |
$811.03
|
| Rate for Payer: Railroad Medicare Medicare |
$811.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.84
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.03
|
| Rate for Payer: UHC Exchange |
$75.31
|
| Rate for Payer: UHC Medicare Advantage |
$835.36
|
| Rate for Payer: VA VA |
$811.03
|
|
|
INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 51610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.54 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$276.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.79
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$62.54
|
|
|
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY
|
Facility
|
OP
|
$1,932.06
|
|
|
Service Code
|
CPT G0260
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$332.37 |
| Max. Negotiated Rate |
$1,932.06 |
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$332.37
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,932.06
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.65
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GENICULAR NERVE BRANCHES, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 64454
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$80.22 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.24
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$80.22
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 64450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$639.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$769.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$769.16
|
| Rate for Payer: BCBS Complete |
$353.45
|
| Rate for Payer: BCBS MAPPO |
$615.33
|
| Rate for Payer: BCBS Trust/PPO |
$402.78
|
| Rate for Payer: BCN Medicare Advantage |
$615.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.33
|
| Rate for Payer: Mclaren Medicaid |
$336.59
|
| Rate for Payer: Mclaren Medicare |
$615.33
|
| Rate for Payer: Meridian Medicaid |
$353.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$707.63
|
| Rate for Payer: PACE Medicare |
$584.56
|
| Rate for Payer: PACE SWMI |
$615.33
|
| Rate for Payer: PHP Medicare Advantage |
$615.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.59
|
| Rate for Payer: Priority Health Medicare |
$615.33
|
| Rate for Payer: Railroad Medicare Medicare |
$615.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.33
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$633.79
|
| Rate for Payer: VA VA |
$615.33
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NERVE, EACH BRANCH (IE, OPHTHALMIC, MAXILLARY, MANDIBULAR)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 64400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$50.75
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.78
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$37.98
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
