|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Commercial |
$66.95
|
| Rate for Payer: Aetna Commercial |
$131.18
|
| Rate for Payer: Aetna Commercial |
$72.97
|
| Rate for Payer: Aetna Commercial |
$87.49
|
| Rate for Payer: Aetna Medicare |
$51.47
|
| Rate for Payer: Aetna Medicare |
$77.17
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna Medicare |
$42.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.90
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: BCBS Complete |
$61.73
|
| Rate for Payer: BCBS Complete |
$31.51
|
| Rate for Payer: BCBS Complete |
$41.17
|
| Rate for Payer: BCBS Complete |
$34.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: BCN Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$123.46
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cash Price |
$82.34
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$123.46
|
| Rate for Payer: Cash Price |
$63.02
|
| Rate for Payer: Cash Price |
$68.68
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Advantage |
$60.09
|
| Rate for Payer: Cofinity Advantage |
$108.03
|
| Rate for Payer: Cofinity Advantage |
$72.05
|
| Rate for Payer: Cofinity Advantage |
$55.14
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Cofinity Commercial |
$132.72
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Commercial |
$88.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.46
|
| Rate for Payer: Healthscope Commercial |
$138.90
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Healthscope Commercial |
$77.27
|
| Rate for Payer: Healthscope Commercial |
$70.89
|
| Rate for Payer: Healthscope Commercial |
$92.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$115.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.39
|
| Rate for Payer: PHP Commercial |
$66.95
|
| Rate for Payer: PHP Commercial |
$131.18
|
| Rate for Payer: PHP Commercial |
$87.49
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$72.97
|
| Rate for Payer: Priority Health SBD |
$49.63
|
| Rate for Payer: Priority Health SBD |
$54.09
|
| Rate for Payer: Priority Health SBD |
$59.97
|
| Rate for Payer: Priority Health SBD |
$97.23
|
| Rate for Payer: Priority Health SBD |
$64.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Core |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
| Rate for Payer: UHC Exchange |
$0.61
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
IP
|
$39.54
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$35.59 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Advantage |
$17.19
|
| Rate for Payer: Cofinity Advantage |
$27.68
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.66
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: Priority Health SBD |
$24.91
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
|
OP
|
$24.56
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$19.77
|
| Rate for Payer: Aetna Medicare |
$12.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.70
|
| Rate for Payer: BCBS Complete |
$15.82
|
| Rate for Payer: BCBS Complete |
$9.82
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cofinity Advantage |
$27.68
|
| Rate for Payer: Cofinity Advantage |
$17.19
|
| Rate for Payer: Cofinity Commercial |
$21.12
|
| Rate for Payer: Cofinity Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Commercial |
$35.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.42
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$33.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.46
|
| Rate for Payer: Priority Health SBD |
$24.91
|
| Rate for Payer: Priority Health SBD |
$15.47
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: Priority Health Tiered Network |
$6.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.70
|
| Rate for Payer: UHC Core |
$12.80
|
| Rate for Payer: UHC Core |
$20.60
|
| Rate for Payer: UHC Exchange |
$9.65
|
| Rate for Payer: UHC Exchange |
$15.54
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna Medicare |
$48.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: BCBS Complete |
$38.98
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Advantage |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health SBD |
$61.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.34
|
| Rate for Payer: UHC Core |
$50.77
|
| Rate for Payer: UHC Exchange |
$38.29
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689020108
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| Max. Negotiated Rate |
$87.70 |
| Rate for Payer: Aetna Commercial |
$82.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.34
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Advantage |
$68.21
|
| Rate for Payer: Cofinity Commercial |
$83.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$87.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.08
|
| Rate for Payer: PHP Commercial |
$82.82
|
| Rate for Payer: Priority Health SBD |
$61.39
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Advantage |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health SBD |
$47.63
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
IP
|
$85.68
|
|
|
Service Code
|
NDC 66689020208
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.98 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Advantage |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.26
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health SBD |
$53.98
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$75.60
|
|
|
Service Code
|
NDC 00574052176
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.71 |
| Max. Negotiated Rate |
$68.04 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$37.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.14
|
| Rate for Payer: BCBS Complete |
$30.24
|
| Rate for Payer: Cash Price |
$60.48
|
| Rate for Payer: Cofinity Advantage |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.48
|
| Rate for Payer: Healthscope Commercial |
$68.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.70
|
| Rate for Payer: PHP Commercial |
$64.26
|
| Rate for Payer: Priority Health SBD |
$47.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.14
|
| Rate for Payer: UHC Core |
$39.39
|
| Rate for Payer: UHC Exchange |
$29.71
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
|
OP
|
$85.68
|
|
|
Service Code
|
NDC 66689020208
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.67 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$72.83
|
| Rate for Payer: Aetna Medicare |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.69
|
| Rate for Payer: BCBS Complete |
$34.27
|
| Rate for Payer: Cash Price |
$68.54
|
| Rate for Payer: Cofinity Advantage |
$59.98
|
| Rate for Payer: Cofinity Commercial |
$73.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.26
|
| Rate for Payer: PHP Commercial |
$72.83
|
| Rate for Payer: Priority Health SBD |
$53.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.69
|
| Rate for Payer: UHC Core |
$44.64
|
| Rate for Payer: UHC Exchange |
$33.67
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$17,043.36
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$17,043.36 |
| Rate for Payer: Aetna Medicare |
$8,319.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,999.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,999.56
|
| Rate for Payer: BCBS MAPPO |
$7,999.65
|
| Rate for Payer: BCBS Trust/PPO |
$17,043.36
|
| Rate for Payer: BCN Commercial |
$17,043.36
|
| Rate for Payer: BCN Medicare Advantage |
$7,999.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,999.65
|
| Rate for Payer: Mclaren Medicare |
$7,999.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,399.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,199.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,799.61
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE Medicare |
$7,599.67
|
| Rate for Payer: PACE SWMI |
$7,999.65
|
| Rate for Payer: PHP Medicare Advantage |
$7,999.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,480.48
|
| Rate for Payer: Priority Health Medicare |
$7,999.65
|
| Rate for Payer: Priority Health Tiered Network |
$12,384.38
|
| Rate for Payer: Railroad Medicare Medicare |
$7,999.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,651.26
|
| Rate for Payer: UHC Core |
$13,094.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,999.65
|
| Rate for Payer: UHC Exchange |
$10,693.75
|
| Rate for Payer: VA VA |
$7,999.65
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$7,771.65
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$7,401.58 |
| Max. Negotiated Rate |
$7,771.65 |
| Rate for Payer: BCBS Complete |
$7,771.65
|
| Rate for Payer: Mclaren Medicaid |
$7,401.58
|
| Rate for Payer: Meridian Medicaid |
$7,771.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,401.58
|
| Rate for Payer: UHC Medicaid |
$7,401.58
|
| Rate for Payer: UHCCP Medicaid |
$7,401.58
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$6,832.02
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$6,506.68 |
| Max. Negotiated Rate |
$6,832.02 |
| Rate for Payer: BCBS Complete |
$6,832.02
|
| Rate for Payer: Mclaren Medicaid |
$6,506.68
|
| Rate for Payer: Meridian Medicaid |
$6,832.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,506.68
|
| Rate for Payer: UHC Medicaid |
$6,506.68
|
| Rate for Payer: UHCCP Medicaid |
$6,506.68
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$12,539.79
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$11,942.66 |
| Max. Negotiated Rate |
$12,539.79 |
| Rate for Payer: BCBS Complete |
$12,539.79
|
| Rate for Payer: Mclaren Medicaid |
$11,942.66
|
| Rate for Payer: Meridian Medicaid |
$12,539.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,942.66
|
| Rate for Payer: UHC Medicaid |
$11,942.66
|
| Rate for Payer: UHCCP Medicaid |
$11,942.66
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$11,715.39
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$11,157.51 |
| Max. Negotiated Rate |
$11,715.39 |
| Rate for Payer: BCBS Complete |
$11,715.39
|
| Rate for Payer: Mclaren Medicaid |
$11,157.51
|
| Rate for Payer: Meridian Medicaid |
$11,715.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,157.51
|
| Rate for Payer: UHC Medicaid |
$11,157.51
|
| Rate for Payer: UHCCP Medicaid |
$11,157.51
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$27,822.47
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$13,081.80 |
| Max. Negotiated Rate |
$27,822.47 |
| Rate for Payer: Aetna Medicare |
$14,321.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,212.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,212.90
|
| Rate for Payer: BCBS MAPPO |
$13,770.32
|
| Rate for Payer: BCBS Trust/PPO |
$22,452.95
|
| Rate for Payer: BCN Commercial |
$22,452.95
|
| Rate for Payer: BCN Medicare Advantage |
$13,770.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,770.32
|
| Rate for Payer: Mclaren Medicare |
$13,770.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,458.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,835.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,147.35
|
| Rate for Payer: Nomi Health Commercial |
$22,019.01
|
| Rate for Payer: PACE Medicare |
$13,081.80
|
| Rate for Payer: PACE SWMI |
$13,770.32
|
| Rate for Payer: PHP Medicare Advantage |
$13,770.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,518.88
|
| Rate for Payer: Priority Health Medicare |
$13,770.32
|
| Rate for Payer: Priority Health Tiered Network |
$22,015.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13,770.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,822.47
|
| Rate for Payer: UHC Core |
$23,277.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,770.32
|
| Rate for Payer: UHC Exchange |
$19,009.75
|
| Rate for Payer: VA VA |
$13,770.32
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$63,290.55
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$20,418.47 |
| Max. Negotiated Rate |
$63,290.55 |
| Rate for Payer: Aetna Medicare |
$22,352.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,866.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,866.41
|
| Rate for Payer: BCBS MAPPO |
$21,493.13
|
| Rate for Payer: BCBS Trust/PPO |
$63,290.55
|
| Rate for Payer: BCN Commercial |
$63,290.55
|
| Rate for Payer: BCN Medicare Advantage |
$21,493.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,493.13
|
| Rate for Payer: Mclaren Medicare |
$21,493.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,567.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,717.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,642.44
|
| Rate for Payer: Nomi Health Commercial |
$34,909.98
|
| Rate for Payer: PACE Medicare |
$20,418.47
|
| Rate for Payer: PACE SWMI |
$21,493.13
|
| Rate for Payer: PHP Medicare Advantage |
$21,493.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,629.74
|
| Rate for Payer: Priority Health Medicare |
$21,493.13
|
| Rate for Payer: Priority Health Tiered Network |
$34,903.78
|
| Rate for Payer: Railroad Medicare Medicare |
$21,493.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,111.06
|
| Rate for Payer: UHC Core |
$36,904.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,493.13
|
| Rate for Payer: UHC Exchange |
$30,138.95
|
| Rate for Payer: VA VA |
$21,493.13
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,246.06
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$7,375.73 |
| Max. Negotiated Rate |
$19,246.06 |
| Rate for Payer: Aetna Medicare |
$8,074.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,704.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,704.91
|
| Rate for Payer: BCBS MAPPO |
$7,763.93
|
| Rate for Payer: BCBS Trust/PPO |
$19,246.06
|
| Rate for Payer: BCN Commercial |
$19,246.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,763.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,763.93
|
| Rate for Payer: Mclaren Medicare |
$7,763.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,152.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,928.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,540.32
|
| Rate for Payer: Nomi Health Commercial |
$11,993.13
|
| Rate for Payer: PACE Medicare |
$7,375.73
|
| Rate for Payer: PACE SWMI |
$7,763.93
|
| Rate for Payer: PHP Medicare Advantage |
$7,763.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,988.75
|
| Rate for Payer: Priority Health Medicare |
$7,763.93
|
| Rate for Payer: Priority Health Tiered Network |
$11,991.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,763.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,154.11
|
| Rate for Payer: UHC Core |
$12,678.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,763.93
|
| Rate for Payer: UHC Exchange |
$10,354.07
|
| Rate for Payer: VA VA |
$7,763.93
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$5,082.88
|
|
|
Service Code
|
APR-DRG 7562
|
| Min. Negotiated Rate |
$4,840.84 |
| Max. Negotiated Rate |
$5,082.88 |
| Rate for Payer: BCBS Complete |
$5,082.88
|
| Rate for Payer: Mclaren Medicaid |
$4,840.84
|
| Rate for Payer: Meridian Medicaid |
$5,082.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,840.84
|
| Rate for Payer: UHC Medicaid |
$4,840.84
|
| Rate for Payer: UHCCP Medicaid |
$4,840.84
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$13,430.13
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$12,790.60 |
| Max. Negotiated Rate |
$13,430.13 |
| Rate for Payer: BCBS Complete |
$13,430.13
|
| Rate for Payer: Mclaren Medicaid |
$12,790.60
|
| Rate for Payer: Meridian Medicaid |
$13,430.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,790.60
|
| Rate for Payer: UHC Medicaid |
$12,790.60
|
| Rate for Payer: UHCCP Medicaid |
$12,790.60
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$3,248.89
|
|
|
Service Code
|
APR-DRG 7561
|
| Min. Negotiated Rate |
$3,094.18 |
| Max. Negotiated Rate |
$3,248.89 |
| Rate for Payer: BCBS Complete |
$3,248.89
|
| Rate for Payer: Mclaren Medicaid |
$3,094.18
|
| Rate for Payer: Meridian Medicaid |
$3,248.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,094.18
|
| Rate for Payer: UHC Medicaid |
$3,094.18
|
| Rate for Payer: UHCCP Medicaid |
$3,094.18
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$8,230.87
|
|
|
Service Code
|
APR-DRG 7563
|
| Min. Negotiated Rate |
$7,838.92 |
| Max. Negotiated Rate |
$8,230.87 |
| Rate for Payer: BCBS Complete |
$8,230.87
|
| Rate for Payer: Mclaren Medicaid |
$7,838.92
|
| Rate for Payer: Meridian Medicaid |
$8,230.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,838.92
|
| Rate for Payer: UHC Medicaid |
$7,838.92
|
| Rate for Payer: UHCCP Medicaid |
$7,838.92
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$3,132.51
|
|
|
Service Code
|
APR-DRG 1451
|
| Min. Negotiated Rate |
$2,983.34 |
| Max. Negotiated Rate |
$3,132.51 |
| Rate for Payer: BCBS Complete |
$3,132.51
|
| Rate for Payer: Mclaren Medicaid |
$2,983.34
|
| Rate for Payer: Meridian Medicaid |
$3,132.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,983.34
|
| Rate for Payer: UHC Medicaid |
$2,983.34
|
| Rate for Payer: UHCCP Medicaid |
$2,983.34
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$3,920.80
|
|
|
Service Code
|
APR-DRG 1452
|
| Min. Negotiated Rate |
$3,734.09 |
| Max. Negotiated Rate |
$3,920.80 |
| Rate for Payer: BCBS Complete |
$3,920.80
|
| Rate for Payer: Mclaren Medicaid |
$3,734.09
|
| Rate for Payer: Meridian Medicaid |
$3,920.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.09
|
| Rate for Payer: UHC Medicaid |
$3,734.09
|
| Rate for Payer: UHCCP Medicaid |
$3,734.09
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$5,467.56
|
|
|
Service Code
|
APR-DRG 1453
|
| Min. Negotiated Rate |
$5,207.20 |
| Max. Negotiated Rate |
$5,467.56 |
| Rate for Payer: BCBS Complete |
$5,467.56
|
| Rate for Payer: Mclaren Medicaid |
$5,207.20
|
| Rate for Payer: Meridian Medicaid |
$5,467.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,207.20
|
| Rate for Payer: UHC Medicaid |
$5,207.20
|
| Rate for Payer: UHCCP Medicaid |
$5,207.20
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$9,035.78
|
|
|
Service Code
|
APR-DRG 1454
|
| Min. Negotiated Rate |
$8,605.51 |
| Max. Negotiated Rate |
$9,035.78 |
| Rate for Payer: BCBS Complete |
$9,035.78
|
| Rate for Payer: Mclaren Medicaid |
$8,605.51
|
| Rate for Payer: Meridian Medicaid |
$9,035.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,605.51
|
| Rate for Payer: UHC Medicaid |
$8,605.51
|
| Rate for Payer: UHCCP Medicaid |
$8,605.51
|
|
