|
USTEKINUMAB 90 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
IP
|
$64,118.11
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40,394.41 |
| Max. Negotiated Rate |
$57,706.30 |
| Rate for Payer: Aetna Commercial |
$54,500.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41,676.77
|
| Rate for Payer: Cash Price |
$51,294.49
|
| Rate for Payer: Cofinity Commercial |
$44,882.68
|
| Rate for Payer: Cofinity Commercial |
$55,141.57
|
| Rate for Payer: Healthscope Commercial |
$57,706.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54,500.39
|
| Rate for Payer: PHP Commercial |
$54,500.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44,882.68
|
| Rate for Payer: Priority Health SBD |
$40,394.41
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC
|
Facility
IP
|
$28,522.55
|
|
|
Service Code
|
MS-DRG 742
|
| Min. Negotiated Rate |
$12,659.32 |
| Max. Negotiated Rate |
$28,522.55 |
| Rate for Payer: Aetna Medicare |
$13,858.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,657.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,657.00
|
| Rate for Payer: BCBS MAPPO |
$13,325.60
|
| Rate for Payer: BCBS Trust/PPO |
$28,522.55
|
| Rate for Payer: BCN Medicare Advantage |
$13,325.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,325.60
|
| Rate for Payer: Mclaren Medicare |
$13,325.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,991.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,324.44
|
| Rate for Payer: PACE Medicare |
$12,659.32
|
| Rate for Payer: PACE SWMI |
$13,325.60
|
| Rate for Payer: PHP Medicare Advantage |
$13,325.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,570.12
|
| Rate for Payer: Priority Health Medicare |
$13,325.60
|
| Rate for Payer: Priority Health Narrow Network |
$20,456.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13,325.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,181.10
|
| Rate for Payer: UHC Core |
$16,678.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,325.60
|
| Rate for Payer: UHC Exchange |
$17,863.55
|
| Rate for Payer: UHC Medicare Advantage |
$13,725.37
|
| Rate for Payer: VA VA |
$13,325.60
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$20,667.81
|
|
|
Service Code
|
MS-DRG 743
|
| Min. Negotiated Rate |
$8,418.14 |
| Max. Negotiated Rate |
$20,667.81 |
| Rate for Payer: Aetna Medicare |
$9,215.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,076.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,076.50
|
| Rate for Payer: BCBS MAPPO |
$8,861.20
|
| Rate for Payer: BCBS Trust/PPO |
$20,667.81
|
| Rate for Payer: BCN Medicare Advantage |
$8,861.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,861.20
|
| Rate for Payer: Mclaren Medicare |
$8,861.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,304.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,190.38
|
| Rate for Payer: PACE Medicare |
$8,418.14
|
| Rate for Payer: PACE SWMI |
$8,861.20
|
| Rate for Payer: PHP Medicare Advantage |
$8,861.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,674.61
|
| Rate for Payer: Priority Health Medicare |
$8,861.20
|
| Rate for Payer: Priority Health Narrow Network |
$13,339.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8,861.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,725.15
|
| Rate for Payer: UHC Core |
$10,876.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,861.20
|
| Rate for Payer: UHC Exchange |
$11,649.05
|
| Rate for Payer: UHC Medicare Advantage |
$9,127.04
|
| Rate for Payer: VA VA |
$8,861.20
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$34,906.03
|
|
|
Service Code
|
MS-DRG 740
|
| Min. Negotiated Rate |
$12,694.21 |
| Max. Negotiated Rate |
$34,906.03 |
| Rate for Payer: Aetna Medicare |
$13,896.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,702.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,702.91
|
| Rate for Payer: BCBS MAPPO |
$13,362.33
|
| Rate for Payer: BCBS Trust/PPO |
$34,906.03
|
| Rate for Payer: BCN Medicare Advantage |
$13,362.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,362.33
|
| Rate for Payer: Mclaren Medicare |
$13,362.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,030.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,366.68
|
| Rate for Payer: PACE Medicare |
$12,694.21
|
| Rate for Payer: PACE SWMI |
$13,362.33
|
| Rate for Payer: PHP Medicare Advantage |
$13,362.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,643.31
|
| Rate for Payer: Priority Health Medicare |
$13,362.33
|
| Rate for Payer: Priority Health Narrow Network |
$20,514.65
|
| Rate for Payer: Railroad Medicare Medicare |
$13,362.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,258.90
|
| Rate for Payer: UHC Core |
$16,726.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,362.33
|
| Rate for Payer: UHC Exchange |
$17,914.68
|
| Rate for Payer: UHC Medicare Advantage |
$13,763.20
|
| Rate for Payer: VA VA |
$13,362.33
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$55,224.69
|
|
|
Service Code
|
MS-DRG 739
|
| Min. Negotiated Rate |
$25,209.74 |
| Max. Negotiated Rate |
$55,224.69 |
| Rate for Payer: Aetna Medicare |
$27,598.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,170.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,170.71
|
| Rate for Payer: BCBS MAPPO |
$26,536.57
|
| Rate for Payer: BCBS Trust/PPO |
$55,224.69
|
| Rate for Payer: BCN Medicare Advantage |
$26,536.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,536.57
|
| Rate for Payer: Mclaren Medicare |
$26,536.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,863.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,517.06
|
| Rate for Payer: PACE Medicare |
$25,209.74
|
| Rate for Payer: PACE SWMI |
$26,536.57
|
| Rate for Payer: PHP Medicare Advantage |
$26,536.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,893.62
|
| Rate for Payer: Priority Health Medicare |
$26,536.57
|
| Rate for Payer: Priority Health Narrow Network |
$41,514.90
|
| Rate for Payer: Railroad Medicare Medicare |
$26,536.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,163.04
|
| Rate for Payer: UHC Core |
$33,848.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,536.57
|
| Rate for Payer: UHC Exchange |
$36,253.41
|
| Rate for Payer: UHC Medicare Advantage |
$27,332.67
|
| Rate for Payer: VA VA |
$26,536.57
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$26,014.83
|
|
|
Service Code
|
MS-DRG 741
|
| Min. Negotiated Rate |
$9,357.52 |
| Max. Negotiated Rate |
$26,014.83 |
| Rate for Payer: Aetna Medicare |
$10,244.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,312.52
|
| Rate for Payer: BCBS MAPPO |
$9,850.02
|
| Rate for Payer: BCBS Trust/PPO |
$26,014.83
|
| Rate for Payer: BCN Medicare Advantage |
$9,850.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,850.02
|
| Rate for Payer: Mclaren Medicare |
$9,850.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,342.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,327.52
|
| Rate for Payer: PACE Medicare |
$9,357.52
|
| Rate for Payer: PACE SWMI |
$9,850.02
|
| Rate for Payer: PHP Medicare Advantage |
$9,850.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,644.85
|
| Rate for Payer: Priority Health Medicare |
$9,850.02
|
| Rate for Payer: Priority Health Narrow Network |
$14,915.88
|
| Rate for Payer: Railroad Medicare Medicare |
$9,850.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,819.52
|
| Rate for Payer: UHC Core |
$12,161.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,850.02
|
| Rate for Payer: UHC Exchange |
$13,025.48
|
| Rate for Payer: UHC Medicare Advantage |
$10,145.52
|
| Rate for Payer: VA VA |
$9,850.02
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$34,756.71
|
|
|
Service Code
|
MS-DRG 737
|
| Min. Negotiated Rate |
$13,972.25 |
| Max. Negotiated Rate |
$34,756.71 |
| Rate for Payer: Aetna Medicare |
$15,295.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,384.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,384.54
|
| Rate for Payer: BCBS MAPPO |
$14,707.63
|
| Rate for Payer: BCBS Trust/PPO |
$34,756.71
|
| Rate for Payer: BCN Medicare Advantage |
$14,707.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,707.63
|
| Rate for Payer: Mclaren Medicare |
$14,707.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,443.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,913.77
|
| Rate for Payer: PACE Medicare |
$13,972.25
|
| Rate for Payer: PACE SWMI |
$14,707.63
|
| Rate for Payer: PHP Medicare Advantage |
$14,707.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,323.87
|
| Rate for Payer: Priority Health Medicare |
$14,707.63
|
| Rate for Payer: Priority Health Narrow Network |
$22,659.10
|
| Rate for Payer: Railroad Medicare Medicare |
$14,707.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,108.35
|
| Rate for Payer: UHC Core |
$18,474.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,707.63
|
| Rate for Payer: UHC Exchange |
$19,787.35
|
| Rate for Payer: UHC Medicare Advantage |
$15,148.86
|
| Rate for Payer: VA VA |
$14,707.63
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$65,995.58
|
|
|
Service Code
|
MS-DRG 736
|
| Min. Negotiated Rate |
$27,063.16 |
| Max. Negotiated Rate |
$65,995.58 |
| Rate for Payer: Aetna Medicare |
$29,627.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,609.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,609.42
|
| Rate for Payer: BCBS MAPPO |
$28,487.54
|
| Rate for Payer: BCBS Trust/PPO |
$65,995.58
|
| Rate for Payer: BCN Medicare Advantage |
$28,487.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,487.54
|
| Rate for Payer: Mclaren Medicare |
$28,487.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,911.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,760.67
|
| Rate for Payer: PACE Medicare |
$27,063.16
|
| Rate for Payer: PACE SWMI |
$28,487.54
|
| Rate for Payer: PHP Medicare Advantage |
$28,487.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,781.01
|
| Rate for Payer: Priority Health Medicare |
$28,487.54
|
| Rate for Payer: Priority Health Narrow Network |
$44,624.81
|
| Rate for Payer: Railroad Medicare Medicare |
$28,487.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,295.35
|
| Rate for Payer: UHC Core |
$36,384.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,487.54
|
| Rate for Payer: UHC Exchange |
$38,969.18
|
| Rate for Payer: UHC Medicare Advantage |
$29,342.17
|
| Rate for Payer: VA VA |
$28,487.54
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$25,096.94
|
|
|
Service Code
|
MS-DRG 738
|
| Min. Negotiated Rate |
$9,804.28 |
| Max. Negotiated Rate |
$25,096.94 |
| Rate for Payer: Aetna Medicare |
$10,733.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,900.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,900.38
|
| Rate for Payer: BCBS MAPPO |
$10,320.30
|
| Rate for Payer: BCBS Trust/PPO |
$25,096.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,320.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,320.30
|
| Rate for Payer: Mclaren Medicare |
$10,320.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,836.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,868.34
|
| Rate for Payer: PACE Medicare |
$9,804.28
|
| Rate for Payer: PACE SWMI |
$10,320.30
|
| Rate for Payer: PHP Medicare Advantage |
$10,320.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,581.90
|
| Rate for Payer: Priority Health Medicare |
$10,320.30
|
| Rate for Payer: Priority Health Narrow Network |
$15,665.52
|
| Rate for Payer: Railroad Medicare Medicare |
$10,320.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,815.61
|
| Rate for Payer: UHC Core |
$12,772.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,320.30
|
| Rate for Payer: UHC Exchange |
$13,680.12
|
| Rate for Payer: UHC Medicare Advantage |
$10,629.91
|
| Rate for Payer: VA VA |
$10,320.30
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
IP
|
$26,177.32
|
|
|
Service Code
|
MS-DRG 746
|
| Min. Negotiated Rate |
$11,935.47 |
| Max. Negotiated Rate |
$26,177.32 |
| Rate for Payer: Aetna Medicare |
$13,066.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,704.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,704.56
|
| Rate for Payer: BCBS MAPPO |
$12,563.65
|
| Rate for Payer: BCBS Trust/PPO |
$26,177.32
|
| Rate for Payer: BCN Medicare Advantage |
$12,563.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,563.65
|
| Rate for Payer: Mclaren Medicare |
$12,563.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,191.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,448.20
|
| Rate for Payer: PACE Medicare |
$11,935.47
|
| Rate for Payer: PACE SWMI |
$12,563.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,563.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,051.90
|
| Rate for Payer: Priority Health Medicare |
$12,563.65
|
| Rate for Payer: Priority Health Narrow Network |
$19,241.52
|
| Rate for Payer: Railroad Medicare Medicare |
$12,563.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,567.23
|
| Rate for Payer: UHC Core |
$15,688.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,563.65
|
| Rate for Payer: UHC Exchange |
$16,802.90
|
| Rate for Payer: UHC Medicare Advantage |
$12,940.56
|
| Rate for Payer: VA VA |
$12,563.65
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,695.49
|
|
|
Service Code
|
MS-DRG 747
|
| Min. Negotiated Rate |
$6,538.06 |
| Max. Negotiated Rate |
$21,695.49 |
| Rate for Payer: Aetna Medicare |
$7,157.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,602.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,602.71
|
| Rate for Payer: BCBS MAPPO |
$6,882.17
|
| Rate for Payer: BCBS Trust/PPO |
$21,695.49
|
| Rate for Payer: BCN Medicare Advantage |
$6,882.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,882.17
|
| Rate for Payer: Mclaren Medicare |
$6,882.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,226.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,914.50
|
| Rate for Payer: PACE Medicare |
$6,538.06
|
| Rate for Payer: PACE SWMI |
$6,882.17
|
| Rate for Payer: PHP Medicare Advantage |
$6,882.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,731.25
|
| Rate for Payer: Priority Health Medicare |
$6,882.17
|
| Rate for Payer: Priority Health Narrow Network |
$10,185.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,882.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,533.35
|
| Rate for Payer: UHC Core |
$8,304.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,882.17
|
| Rate for Payer: UHC Exchange |
$8,894.18
|
| Rate for Payer: UHC Medicare Advantage |
$7,088.64
|
| Rate for Payer: VA VA |
$6,882.17
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
IP
|
$18,580.90
|
|
|
Service Code
|
MS-DRG 768
|
| Min. Negotiated Rate |
$2,100.00 |
| Max. Negotiated Rate |
$18,580.90 |
| Rate for Payer: Aetna Medicare |
$9,635.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,581.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,581.55
|
| Rate for Payer: BCBS MAPPO |
$9,265.24
|
| Rate for Payer: BCBS Trust/PPO |
$10,259.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,265.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,265.24
|
| Rate for Payer: Mclaren Medicare |
$9,265.24
|
| Rate for Payer: Meridian Medicaid |
$2,100.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,728.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,655.03
|
| Rate for Payer: PACE Medicare |
$8,801.98
|
| Rate for Payer: PACE SWMI |
$9,265.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,265.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,479.64
|
| Rate for Payer: Priority Health Medicare |
$9,265.24
|
| Rate for Payer: Priority Health Narrow Network |
$13,983.71
|
| Rate for Payer: Railroad Medicare Medicare |
$9,265.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,580.90
|
| Rate for Payer: UHC Core |
$4,452.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,265.24
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$9,543.20
|
| Rate for Payer: VA VA |
$9,265.24
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
IP
|
$11,390.16
|
|
|
Service Code
|
MS-DRG 806
|
| Min. Negotiated Rate |
$5,576.79 |
| Max. Negotiated Rate |
$11,390.16 |
| Rate for Payer: Aetna Medicare |
$6,105.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,337.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,337.89
|
| Rate for Payer: BCBS MAPPO |
$5,870.31
|
| Rate for Payer: BCBS Trust/PPO |
$8,632.08
|
| Rate for Payer: BCN Medicare Advantage |
$5,870.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,870.31
|
| Rate for Payer: Mclaren Medicare |
$5,870.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,163.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,750.86
|
| Rate for Payer: PACE Medicare |
$5,576.79
|
| Rate for Payer: PACE SWMI |
$5,870.31
|
| Rate for Payer: PHP Medicare Advantage |
$5,870.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,715.09
|
| Rate for Payer: Priority Health Medicare |
$5,870.31
|
| Rate for Payer: Priority Health Narrow Network |
$8,572.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,870.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,390.16
|
| Rate for Payer: UHC Core |
$6,989.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,870.31
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,046.42
|
| Rate for Payer: VA VA |
$5,870.31
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
IP
|
$15,379.08
|
|
|
Service Code
|
MS-DRG 805
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$15,379.08 |
| Rate for Payer: Aetna Medicare |
$8,063.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,691.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,691.98
|
| Rate for Payer: BCBS MAPPO |
$7,753.58
|
| Rate for Payer: BCBS Trust/PPO |
$10,327.32
|
| Rate for Payer: BCN Medicare Advantage |
$7,753.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,753.58
|
| Rate for Payer: Mclaren Medicare |
$7,753.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,141.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,916.62
|
| Rate for Payer: PACE Medicare |
$7,365.90
|
| Rate for Payer: PACE SWMI |
$7,753.58
|
| Rate for Payer: PHP Medicare Advantage |
$7,753.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,467.59
|
| Rate for Payer: Priority Health Medicare |
$7,753.58
|
| Rate for Payer: Priority Health Narrow Network |
$11,574.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7,753.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,379.08
|
| Rate for Payer: UHC Core |
$9,436.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,753.58
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,986.19
|
| Rate for Payer: VA VA |
$7,753.58
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$9,980.69
|
|
|
Service Code
|
MS-DRG 807
|
| Min. Negotiated Rate |
$4,944.61 |
| Max. Negotiated Rate |
$9,980.69 |
| Rate for Payer: Aetna Medicare |
$5,413.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.06
|
| Rate for Payer: BCBS MAPPO |
$5,204.85
|
| Rate for Payer: BCBS Trust/PPO |
$7,672.47
|
| Rate for Payer: BCN Medicare Advantage |
$5,204.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,204.85
|
| Rate for Payer: Mclaren Medicare |
$5,204.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,985.58
|
| Rate for Payer: PACE Medicare |
$4,944.61
|
| Rate for Payer: PACE SWMI |
$5,204.85
|
| Rate for Payer: PHP Medicare Advantage |
$5,204.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,389.15
|
| Rate for Payer: Priority Health Medicare |
$5,204.85
|
| Rate for Payer: Priority Health Narrow Network |
$7,511.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,204.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,980.69
|
| Rate for Payer: UHC Core |
$6,124.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,204.85
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.00
|
| Rate for Payer: VA VA |
$5,204.85
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
IP
|
$15,191.46
|
|
|
Service Code
|
MS-DRG 797
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$15,191.46 |
| Rate for Payer: Aetna Medicare |
$7,971.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,581.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,581.24
|
| Rate for Payer: BCBS MAPPO |
$7,664.99
|
| Rate for Payer: BCBS Trust/PPO |
$13,586.03
|
| Rate for Payer: BCN Medicare Advantage |
$7,664.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,664.99
|
| Rate for Payer: Mclaren Medicare |
$7,664.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,048.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,814.74
|
| Rate for Payer: PACE Medicare |
$7,281.74
|
| Rate for Payer: PACE SWMI |
$7,664.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,664.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,291.09
|
| Rate for Payer: Priority Health Medicare |
$7,664.99
|
| Rate for Payer: Priority Health Narrow Network |
$11,432.87
|
| Rate for Payer: Railroad Medicare Medicare |
$7,664.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,191.46
|
| Rate for Payer: UHC Core |
$9,321.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,664.99
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$7,894.94
|
| Rate for Payer: VA VA |
$7,664.99
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
IP
|
$21,636.27
|
|
|
Service Code
|
MS-DRG 796
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$21,636.27 |
| Rate for Payer: Aetna Medicare |
$11,136.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,384.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,384.70
|
| Rate for Payer: BCBS MAPPO |
$10,707.76
|
| Rate for Payer: BCBS Trust/PPO |
$16,407.76
|
| Rate for Payer: BCN Medicare Advantage |
$10,707.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,707.76
|
| Rate for Payer: Mclaren Medicare |
$10,707.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,243.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,313.92
|
| Rate for Payer: PACE Medicare |
$10,172.37
|
| Rate for Payer: PACE SWMI |
$10,707.76
|
| Rate for Payer: PHP Medicare Advantage |
$10,707.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,353.93
|
| Rate for Payer: Priority Health Medicare |
$10,707.76
|
| Rate for Payer: Priority Health Narrow Network |
$16,283.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10,707.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,636.27
|
| Rate for Payer: UHC Core |
$13,276.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,707.76
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,028.99
|
| Rate for Payer: VA VA |
$10,707.76
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
IP
|
$12,374.04
|
|
|
Service Code
|
MS-DRG 798
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$12,374.04 |
| Rate for Payer: Aetna Medicare |
$6,767.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,133.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,133.69
|
| Rate for Payer: BCBS MAPPO |
$6,506.95
|
| Rate for Payer: BCBS Trust/PPO |
$12,189.44
|
| Rate for Payer: BCN Medicare Advantage |
$6,506.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,506.95
|
| Rate for Payer: Mclaren Medicare |
$6,506.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,832.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,482.99
|
| Rate for Payer: PACE Medicare |
$6,181.60
|
| Rate for Payer: PACE SWMI |
$6,506.95
|
| Rate for Payer: PHP Medicare Advantage |
$6,506.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,640.66
|
| Rate for Payer: Priority Health Medicare |
$6,506.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,312.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,506.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,374.04
|
| Rate for Payer: UHC Core |
$7,592.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,506.95
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,702.16
|
| Rate for Payer: VA VA |
$6,506.95
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
OP
|
$5,532.19
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.76 |
| Max. Negotiated Rate |
$5,532.19 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,724.54
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.64
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$828.76
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S)
|
Facility
OP
|
$5,532.19
|
|
|
Service Code
|
CPT 58262
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$915.53 |
| Max. Negotiated Rate |
$5,532.19 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,755.00
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.08
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$915.53
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$1,101.12
|
|
|
Service Code
|
NDC 63739-525-10
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$693.71 |
| Max. Negotiated Rate |
$991.01 |
| Rate for Payer: Aetna Commercial |
$935.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$715.73
|
| Rate for Payer: Cash Price |
$880.90
|
| Rate for Payer: Cofinity Commercial |
$770.78
|
| Rate for Payer: Cofinity Commercial |
$946.96
|
| Rate for Payer: Healthscope Commercial |
$991.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$935.95
|
| Rate for Payer: PHP Commercial |
$935.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.78
|
| Rate for Payer: Priority Health SBD |
$693.71
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$487.20
|
|
|
Service Code
|
NDC 0904-6565-61
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.94 |
| Max. Negotiated Rate |
$438.48 |
| Rate for Payer: Aetna Commercial |
$414.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.68
|
| Rate for Payer: Cash Price |
$389.76
|
| Rate for Payer: Cofinity Commercial |
$341.04
|
| Rate for Payer: Cofinity Commercial |
$418.99
|
| Rate for Payer: Healthscope Commercial |
$438.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$414.12
|
| Rate for Payer: PHP Commercial |
$414.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.04
|
| Rate for Payer: Priority Health SBD |
$306.94
|
|
|
VALACYCLOVIR 500 MG TABLET
|
Facility
IP
|
$315.13
|
|
|
Service Code
|
NDC 51079-093-03
|
| Hospital Charge Code |
13133
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.53 |
| Max. Negotiated Rate |
$283.62 |
| Rate for Payer: Aetna Commercial |
$267.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.83
|
| Rate for Payer: Cash Price |
$252.10
|
| Rate for Payer: Cofinity Commercial |
$220.59
|
| Rate for Payer: Cofinity Commercial |
$271.01
|
| Rate for Payer: Healthscope Commercial |
$283.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.86
|
| Rate for Payer: PHP Commercial |
$267.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.59
|
| Rate for Payer: Priority Health SBD |
$198.53
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$3,363.86
|
|
|
Service Code
|
NDC 68084-965-25
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,119.23 |
| Max. Negotiated Rate |
$3,027.47 |
| Rate for Payer: Aetna Commercial |
$2,859.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,186.51
|
| Rate for Payer: Cash Price |
$2,691.09
|
| Rate for Payer: Cofinity Commercial |
$2,354.70
|
| Rate for Payer: Cofinity Commercial |
$2,892.92
|
| Rate for Payer: Healthscope Commercial |
$3,027.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,859.28
|
| Rate for Payer: PHP Commercial |
$2,859.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,354.70
|
| Rate for Payer: Priority Health SBD |
$2,119.23
|
|
|
VALGANCICLOVIR 450 MG TABLET
|
Facility
IP
|
$18,251.51
|
|
|
Service Code
|
NDC 0004-0038-22
|
| Hospital Charge Code |
30148
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,498.45 |
| Max. Negotiated Rate |
$16,426.36 |
| Rate for Payer: Aetna Commercial |
$15,513.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,863.48
|
| Rate for Payer: Cash Price |
$14,601.21
|
| Rate for Payer: Cofinity Commercial |
$12,776.06
|
| Rate for Payer: Cofinity Commercial |
$15,696.30
|
| Rate for Payer: Healthscope Commercial |
$16,426.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,513.78
|
| Rate for Payer: PHP Commercial |
$15,513.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,776.06
|
| Rate for Payer: Priority Health SBD |
$11,498.45
|
|
