|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598-436-11
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.85 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health SBD |
$46.85
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 0071-0418-13
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.45 |
| Max. Negotiated Rate |
$119.21 |
| Rate for Payer: Aetna Commercial |
$112.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.10
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$92.72
|
| Rate for Payer: Healthscope Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.59
|
| Rate for Payer: PHP Commercial |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.72
|
| Rate for Payer: Priority Health SBD |
$83.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$74.37
|
|
|
Service Code
|
NDC 43598-436-35
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$66.93 |
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.34
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$63.96
|
| Rate for Payer: Healthscope Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.21
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: Priority Health SBD |
$46.85
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$102.10
|
|
|
Service Code
|
NDC 49730-113-30
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.32 |
| Max. Negotiated Rate |
$91.89 |
| Rate for Payer: Aetna Commercial |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.36
|
| Rate for Payer: Cash Price |
$81.68
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Healthscope Commercial |
$91.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.78
|
| Rate for Payer: PHP Commercial |
$86.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.47
|
| Rate for Payer: Priority Health SBD |
$64.32
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$126.87
|
|
|
Service Code
|
NDC 68382-311-30
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$114.18 |
| Rate for Payer: Aetna Commercial |
$107.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.47
|
| Rate for Payer: Cash Price |
$101.50
|
| Rate for Payer: Cofinity Commercial |
$109.11
|
| Rate for Payer: Cofinity Commercial |
$88.81
|
| Rate for Payer: Healthscope Commercial |
$114.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.84
|
| Rate for Payer: PHP Commercial |
$107.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.81
|
| Rate for Payer: Priority Health SBD |
$79.93
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 68382-311-01
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health SBD |
$2.66
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 0378-9116-16
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.10
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.56
|
| Rate for Payer: Priority Health SBD |
$2.30
|
|
|
NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
NDC 0378-9116-93
|
| Hospital Charge Code |
27475
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.95 |
| Max. Negotiated Rate |
$98.50 |
| Rate for Payer: Aetna Commercial |
$93.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.14
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$76.61
|
| Rate for Payer: Cofinity Commercial |
$94.12
|
| Rate for Payer: Healthscope Commercial |
$98.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.02
|
| Rate for Payer: PHP Commercial |
$93.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.61
|
| Rate for Payer: Priority Health SBD |
$68.95
|
|
|
NITROGLYCERIN 2 % TRANSDERMAL OINTMENT
|
Facility
|
IP
|
$100.91
|
|
|
Service Code
|
NDC 0281-0326-30
|
| Hospital Charge Code |
5606
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.57 |
| Max. Negotiated Rate |
$90.82 |
| Rate for Payer: Aetna Commercial |
$85.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.59
|
| Rate for Payer: Cash Price |
$80.73
|
| Rate for Payer: Cofinity Commercial |
$70.64
|
| Rate for Payer: Cofinity Commercial |
$86.78
|
| Rate for Payer: Healthscope Commercial |
$90.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.77
|
| Rate for Payer: PHP Commercial |
$85.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.64
|
| Rate for Payer: Priority Health SBD |
$63.57
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$87.21
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.94 |
| Max. Negotiated Rate |
$78.49 |
| Rate for Payer: Aetna Commercial |
$74.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.69
|
| Rate for Payer: Cash Price |
$69.77
|
| Rate for Payer: Cofinity Commercial |
$61.05
|
| Rate for Payer: Cofinity Commercial |
$75.00
|
| Rate for Payer: Healthscope Commercial |
$78.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.13
|
| Rate for Payer: PHP Commercial |
$74.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.05
|
| Rate for Payer: Priority Health SBD |
$54.94
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,003.06
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$12,602.75 |
| Rate for Payer: Aetna Commercial |
$11,902.60
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,101.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.02
|
| Rate for Payer: BCN Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$11,202.45
|
| Rate for Payer: Cash Price |
$11,202.45
|
| Rate for Payer: Cofinity Commercial |
$12,042.63
|
| Rate for Payer: Cofinity Commercial |
$9,802.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$12,602.75
|
| Rate for Payer: Mclaren Medicaid |
$17.01
|
| Rate for Payer: Mclaren Medicare |
$31.09
|
| Rate for Payer: Meridian Medicaid |
$17.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,902.60
|
| Rate for Payer: PACE Medicare |
$29.53
|
| Rate for Payer: PACE SWMI |
$31.09
|
| Rate for Payer: PHP Commercial |
$11,902.60
|
| Rate for Payer: PHP Medicare Advantage |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,802.14
|
| Rate for Payer: Priority Health Medicare |
$31.09
|
| Rate for Payer: Priority Health SBD |
$8,821.93
|
| Rate for Payer: Railroad Medicare Medicare |
$31.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.09
|
| Rate for Payer: UHC Medicare Advantage |
$32.02
|
| Rate for Payer: VA VA |
$31.09
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,003.06
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,821.93 |
| Max. Negotiated Rate |
$12,602.75 |
| Rate for Payer: Aetna Commercial |
$11,902.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,101.99
|
| Rate for Payer: Cash Price |
$11,202.45
|
| Rate for Payer: Cofinity Commercial |
$9,802.14
|
| Rate for Payer: Cofinity Commercial |
$12,042.63
|
| Rate for Payer: Healthscope Commercial |
$12,602.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,902.60
|
| Rate for Payer: PHP Commercial |
$11,902.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,802.14
|
| Rate for Payer: Priority Health SBD |
$8,821.93
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23,951.85
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$21,556.66 |
| Rate for Payer: Aetna Commercial |
$20,359.07
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15,568.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.02
|
| Rate for Payer: BCN Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$19,161.48
|
| Rate for Payer: Cash Price |
$19,161.48
|
| Rate for Payer: Cofinity Commercial |
$20,598.59
|
| Rate for Payer: Cofinity Commercial |
$16,766.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$21,556.66
|
| Rate for Payer: Mclaren Medicaid |
$17.01
|
| Rate for Payer: Mclaren Medicare |
$31.09
|
| Rate for Payer: Meridian Medicaid |
$17.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20,359.07
|
| Rate for Payer: PACE Medicare |
$29.53
|
| Rate for Payer: PACE SWMI |
$31.09
|
| Rate for Payer: PHP Commercial |
$20,359.07
|
| Rate for Payer: PHP Medicare Advantage |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,766.30
|
| Rate for Payer: Priority Health Medicare |
$31.09
|
| Rate for Payer: Priority Health SBD |
$15,089.67
|
| Rate for Payer: Railroad Medicare Medicare |
$31.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.09
|
| Rate for Payer: UHC Medicare Advantage |
$32.02
|
| Rate for Payer: VA VA |
$31.09
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,601.24
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$5,041.12 |
| Rate for Payer: Aetna Commercial |
$4,761.05
|
| Rate for Payer: Aetna Medicare |
$32.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,640.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.86
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: BCBS MAPPO |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$92.02
|
| Rate for Payer: BCN Medicare Advantage |
$31.09
|
| Rate for Payer: Cash Price |
$4,480.99
|
| Rate for Payer: Cash Price |
$4,480.99
|
| Rate for Payer: Cofinity Commercial |
$4,817.07
|
| Rate for Payer: Cofinity Commercial |
$3,920.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.09
|
| Rate for Payer: Healthscope Commercial |
$5,041.12
|
| Rate for Payer: Mclaren Medicaid |
$17.01
|
| Rate for Payer: Mclaren Medicare |
$31.09
|
| Rate for Payer: Meridian Medicaid |
$17.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,761.05
|
| Rate for Payer: PACE Medicare |
$29.53
|
| Rate for Payer: PACE SWMI |
$31.09
|
| Rate for Payer: PHP Commercial |
$4,761.05
|
| Rate for Payer: PHP Medicare Advantage |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,920.87
|
| Rate for Payer: Priority Health Medicare |
$31.09
|
| Rate for Payer: Priority Health SBD |
$3,528.78
|
| Rate for Payer: Railroad Medicare Medicare |
$31.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.09
|
| Rate for Payer: UHC Medicare Advantage |
$32.02
|
| Rate for Payer: VA VA |
$31.09
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$32,864.74
|
|
|
Service Code
|
MS-DRG 098
|
| Min. Negotiated Rate |
$15,208.54 |
| Max. Negotiated Rate |
$32,864.74 |
| Rate for Payer: Aetna Medicare |
$16,649.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,011.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,011.24
|
| Rate for Payer: BCBS MAPPO |
$16,008.99
|
| Rate for Payer: BCBS Trust/PPO |
$29,486.55
|
| Rate for Payer: BCN Medicare Advantage |
$16,008.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,008.99
|
| Rate for Payer: Mclaren Medicare |
$16,008.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,809.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,410.34
|
| Rate for Payer: PACE Medicare |
$15,208.54
|
| Rate for Payer: PACE SWMI |
$16,008.99
|
| Rate for Payer: PHP Medicare Advantage |
$16,008.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,916.90
|
| Rate for Payer: Priority Health Medicare |
$16,008.99
|
| Rate for Payer: Priority Health Narrow Network |
$24,733.52
|
| Rate for Payer: Railroad Medicare Medicare |
$16,008.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,864.74
|
| Rate for Payer: UHC Core |
$20,166.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,008.99
|
| Rate for Payer: UHC Exchange |
$21,598.86
|
| Rate for Payer: UHC Medicare Advantage |
$16,489.26
|
| Rate for Payer: VA VA |
$16,008.99
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$55,477.27
|
|
|
Service Code
|
MS-DRG 097
|
| Min. Negotiated Rate |
$25,350.68 |
| Max. Negotiated Rate |
$55,477.27 |
| Rate for Payer: Aetna Medicare |
$27,752.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,356.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,356.16
|
| Rate for Payer: BCBS MAPPO |
$26,684.93
|
| Rate for Payer: BCBS Trust/PPO |
$38,296.50
|
| Rate for Payer: BCN Medicare Advantage |
$26,684.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,684.93
|
| Rate for Payer: Mclaren Medicare |
$26,684.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,019.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,687.67
|
| Rate for Payer: PACE Medicare |
$25,350.68
|
| Rate for Payer: PACE SWMI |
$26,684.93
|
| Rate for Payer: PHP Medicare Advantage |
$26,684.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,189.22
|
| Rate for Payer: Priority Health Medicare |
$26,684.93
|
| Rate for Payer: Priority Health Narrow Network |
$41,751.38
|
| Rate for Payer: Railroad Medicare Medicare |
$26,684.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,477.27
|
| Rate for Payer: UHC Core |
$34,041.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,684.93
|
| Rate for Payer: UHC Exchange |
$36,459.92
|
| Rate for Payer: UHC Medicare Advantage |
$27,485.48
|
| Rate for Payer: VA VA |
$26,684.93
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,119.83
|
|
|
Service Code
|
MS-DRG 099
|
| Min. Negotiated Rate |
$9,500.50 |
| Max. Negotiated Rate |
$29,119.83 |
| Rate for Payer: Aetna Medicare |
$10,400.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,500.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,500.66
|
| Rate for Payer: BCBS MAPPO |
$10,000.53
|
| Rate for Payer: BCBS Trust/PPO |
$29,119.83
|
| Rate for Payer: BCN Medicare Advantage |
$10,000.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,000.53
|
| Rate for Payer: Mclaren Medicare |
$10,000.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,500.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,500.61
|
| Rate for Payer: PACE Medicare |
$9,500.50
|
| Rate for Payer: PACE SWMI |
$10,000.53
|
| Rate for Payer: PHP Medicare Advantage |
$10,000.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,944.76
|
| Rate for Payer: Priority Health Medicare |
$10,000.53
|
| Rate for Payer: Priority Health Narrow Network |
$15,155.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10,000.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,138.33
|
| Rate for Payer: UHC Core |
$12,357.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,000.53
|
| Rate for Payer: UHC Exchange |
$13,235.01
|
| Rate for Payer: UHC Medicare Advantage |
$10,300.55
|
| Rate for Payer: VA VA |
$10,000.53
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$31,134.94
|
|
|
Service Code
|
MS-DRG 935
|
| Min. Negotiated Rate |
$14,432.69 |
| Max. Negotiated Rate |
$31,134.94 |
| Rate for Payer: Aetna Medicare |
$15,800.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,990.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,990.39
|
| Rate for Payer: BCBS MAPPO |
$15,192.31
|
| Rate for Payer: BCBS Trust/PPO |
$15,529.40
|
| Rate for Payer: BCN Medicare Advantage |
$15,192.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,192.31
|
| Rate for Payer: Mclaren Medicare |
$15,192.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,951.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,471.16
|
| Rate for Payer: PACE Medicare |
$14,432.69
|
| Rate for Payer: PACE SWMI |
$15,192.31
|
| Rate for Payer: PHP Medicare Advantage |
$15,192.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,289.62
|
| Rate for Payer: Priority Health Medicare |
$15,192.31
|
| Rate for Payer: Priority Health Narrow Network |
$23,431.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,192.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,134.94
|
| Rate for Payer: UHC Core |
$19,104.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,192.31
|
| Rate for Payer: UHC Exchange |
$20,462.03
|
| Rate for Payer: UHC Medicare Advantage |
$15,648.08
|
| Rate for Payer: VA VA |
$15,192.31
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$28,140.46
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$12,078.46 |
| Max. Negotiated Rate |
$28,140.46 |
| Rate for Payer: Aetna Medicare |
$13,222.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,892.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,892.71
|
| Rate for Payer: BCBS MAPPO |
$12,714.17
|
| Rate for Payer: BCBS Trust/PPO |
$28,140.46
|
| Rate for Payer: BCN Medicare Advantage |
$12,714.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,714.17
|
| Rate for Payer: Mclaren Medicare |
$12,714.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,349.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,621.30
|
| Rate for Payer: PACE Medicare |
$12,078.46
|
| Rate for Payer: PACE SWMI |
$12,714.17
|
| Rate for Payer: PHP Medicare Advantage |
$12,714.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,351.81
|
| Rate for Payer: Priority Health Medicare |
$12,714.17
|
| Rate for Payer: Priority Health Narrow Network |
$19,481.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12,714.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,886.04
|
| Rate for Payer: UHC Core |
$15,883.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,714.17
|
| Rate for Payer: UHC Exchange |
$17,012.43
|
| Rate for Payer: UHC Medicare Advantage |
$13,095.60
|
| Rate for Payer: VA VA |
$12,714.17
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$72,761.15
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$23,570.47 |
| Max. Negotiated Rate |
$72,761.15 |
| Rate for Payer: Aetna Medicare |
$25,803.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,013.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,013.78
|
| Rate for Payer: BCBS MAPPO |
$24,811.02
|
| Rate for Payer: BCBS Trust/PPO |
$72,761.15
|
| Rate for Payer: BCN Medicare Advantage |
$24,811.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,811.02
|
| Rate for Payer: Mclaren Medicare |
$24,811.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,051.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,532.67
|
| Rate for Payer: PACE Medicare |
$23,570.47
|
| Rate for Payer: PACE SWMI |
$24,811.02
|
| Rate for Payer: PHP Medicare Advantage |
$24,811.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,455.37
|
| Rate for Payer: Priority Health Medicare |
$24,811.02
|
| Rate for Payer: Priority Health Narrow Network |
$38,764.30
|
| Rate for Payer: Railroad Medicare Medicare |
$24,811.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,508.18
|
| Rate for Payer: UHC Core |
$31,605.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,811.02
|
| Rate for Payer: UHC Exchange |
$33,851.42
|
| Rate for Payer: UHC Medicare Advantage |
$25,555.35
|
| Rate for Payer: VA VA |
$24,811.02
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,864.11
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$7,859.18 |
| Max. Negotiated Rate |
$19,864.11 |
| Rate for Payer: Aetna Medicare |
$8,603.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,341.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,341.02
|
| Rate for Payer: BCBS MAPPO |
$8,272.82
|
| Rate for Payer: BCBS Trust/PPO |
$19,864.11
|
| Rate for Payer: BCN Medicare Advantage |
$8,272.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,272.82
|
| Rate for Payer: Mclaren Medicare |
$8,272.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,686.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,513.74
|
| Rate for Payer: PACE Medicare |
$7,859.18
|
| Rate for Payer: PACE SWMI |
$8,272.82
|
| Rate for Payer: PHP Medicare Advantage |
$8,272.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,502.22
|
| Rate for Payer: Priority Health Medicare |
$8,272.82
|
| Rate for Payer: Priority Health Narrow Network |
$12,401.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8,272.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,478.90
|
| Rate for Payer: UHC Core |
$10,111.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,272.82
|
| Rate for Payer: UHC Exchange |
$10,830.01
|
| Rate for Payer: UHC Medicare Advantage |
$8,521.00
|
| Rate for Payer: VA VA |
$8,272.82
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$15,642.98
|
|
|
Service Code
|
MS-DRG 600
|
| Min. Negotiated Rate |
$7,484.25 |
| Max. Negotiated Rate |
$15,642.98 |
| Rate for Payer: Aetna Medicare |
$8,193.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,847.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,847.70
|
| Rate for Payer: BCBS MAPPO |
$7,878.16
|
| Rate for Payer: BCBS Trust/PPO |
$12,773.55
|
| Rate for Payer: BCN Medicare Advantage |
$7,878.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,878.16
|
| Rate for Payer: Mclaren Medicare |
$7,878.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,272.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,059.88
|
| Rate for Payer: PACE Medicare |
$7,484.25
|
| Rate for Payer: PACE SWMI |
$7,878.16
|
| Rate for Payer: PHP Medicare Advantage |
$7,878.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,715.84
|
| Rate for Payer: Priority Health Medicare |
$7,878.16
|
| Rate for Payer: Priority Health Narrow Network |
$11,772.67
|
| Rate for Payer: Railroad Medicare Medicare |
$7,878.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,642.98
|
| Rate for Payer: UHC Core |
$9,598.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,878.16
|
| Rate for Payer: UHC Exchange |
$10,280.64
|
| Rate for Payer: UHC Medicare Advantage |
$8,114.50
|
| Rate for Payer: VA VA |
$7,878.16
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,497.14
|
|
|
Service Code
|
MS-DRG 601
|
| Min. Negotiated Rate |
$4,802.31 |
| Max. Negotiated Rate |
$9,497.14 |
| Rate for Payer: Aetna Medicare |
$5,257.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,318.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,318.82
|
| Rate for Payer: BCBS MAPPO |
$5,055.06
|
| Rate for Payer: BCBS Trust/PPO |
$7,103.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,055.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,055.06
|
| Rate for Payer: Mclaren Medicare |
$5,055.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,307.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,813.32
|
| Rate for Payer: PACE Medicare |
$4,802.31
|
| Rate for Payer: PACE SWMI |
$5,055.06
|
| Rate for Payer: PHP Medicare Advantage |
$5,055.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,934.26
|
| Rate for Payer: Priority Health Medicare |
$5,055.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,147.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5,055.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,497.14
|
| Rate for Payer: UHC Core |
$5,827.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,055.06
|
| Rate for Payer: UHC Exchange |
$6,241.57
|
| Rate for Payer: UHC Medicare Advantage |
$5,206.71
|
| Rate for Payer: VA VA |
$5,055.06
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$16,853.53
|
|
|
Service Code
|
MS-DRG 071
|
| Min. Negotiated Rate |
$7,732.60 |
| Max. Negotiated Rate |
$16,853.53 |
| Rate for Payer: Aetna Medicare |
$8,465.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,174.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,174.48
|
| Rate for Payer: BCBS MAPPO |
$8,139.58
|
| Rate for Payer: BCBS Trust/PPO |
$16,853.53
|
| Rate for Payer: BCN Medicare Advantage |
$8,139.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,139.58
|
| Rate for Payer: Mclaren Medicare |
$8,139.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,546.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,360.52
|
| Rate for Payer: PACE Medicare |
$7,732.60
|
| Rate for Payer: PACE SWMI |
$8,139.58
|
| Rate for Payer: PHP Medicare Advantage |
$8,139.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,236.75
|
| Rate for Payer: Priority Health Medicare |
$8,139.58
|
| Rate for Payer: Priority Health Narrow Network |
$12,189.40
|
| Rate for Payer: Railroad Medicare Medicare |
$8,139.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,196.70
|
| Rate for Payer: UHC Core |
$9,938.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,139.58
|
| Rate for Payer: UHC Exchange |
$10,644.55
|
| Rate for Payer: UHC Medicare Advantage |
$8,383.77
|
| Rate for Payer: VA VA |
$8,139.58
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$30,883.14
|
|
|
Service Code
|
MS-DRG 070
|
| Min. Negotiated Rate |
$12,711.31 |
| Max. Negotiated Rate |
$30,883.14 |
| Rate for Payer: Aetna Medicare |
$13,915.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,725.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,725.41
|
| Rate for Payer: BCBS MAPPO |
$13,380.33
|
| Rate for Payer: BCBS Trust/PPO |
$30,883.14
|
| Rate for Payer: BCN Medicare Advantage |
$13,380.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,380.33
|
| Rate for Payer: Mclaren Medicare |
$13,380.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,049.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,387.38
|
| Rate for Payer: PACE Medicare |
$12,711.31
|
| Rate for Payer: PACE SWMI |
$13,380.33
|
| Rate for Payer: PHP Medicare Advantage |
$13,380.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,679.18
|
| Rate for Payer: Priority Health Medicare |
$13,380.33
|
| Rate for Payer: Priority Health Narrow Network |
$20,543.34
|
| Rate for Payer: Railroad Medicare Medicare |
$13,380.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,297.03
|
| Rate for Payer: UHC Core |
$16,749.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,380.33
|
| Rate for Payer: UHC Exchange |
$17,939.74
|
| Rate for Payer: UHC Medicare Advantage |
$13,781.74
|
| Rate for Payer: VA VA |
$13,380.33
|
|
