|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$33,323.57
|
|
|
Service Code
|
MS-DRG 099
|
| Min. Negotiated Rate |
$10,151.57 |
| Max. Negotiated Rate |
$33,323.57 |
| Rate for Payer: Aetna Medicare |
$11,113.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,357.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,357.32
|
| Rate for Payer: BCBS MAPPO |
$10,685.86
|
| Rate for Payer: BCBS Trust/PPO |
$33,323.57
|
| Rate for Payer: BCN Medicare Advantage |
$10,685.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,685.86
|
| Rate for Payer: Mclaren Medicare |
$10,685.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,220.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,288.74
|
| Rate for Payer: PACE Medicare |
$10,151.57
|
| Rate for Payer: PACE SWMI |
$10,685.86
|
| Rate for Payer: PHP Medicare Advantage |
$10,685.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,944.76
|
| Rate for Payer: Priority Health Medicare |
$10,685.86
|
| Rate for Payer: Priority Health Narrow Network |
$15,155.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10,685.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,138.33
|
| Rate for Payer: UHC Core |
$16,513.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,685.86
|
| Rate for Payer: UHC Exchange |
$13,128.07
|
| Rate for Payer: UHC Medicare Advantage |
$11,006.44
|
| Rate for Payer: VA VA |
$10,685.86
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$31,134.94
|
|
|
Service Code
|
MS-DRG 935
|
| Min. Negotiated Rate |
$15,429.07 |
| Max. Negotiated Rate |
$31,134.94 |
| Rate for Payer: Aetna Medicare |
$16,890.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,301.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,301.41
|
| Rate for Payer: BCBS MAPPO |
$16,241.13
|
| Rate for Payer: BCBS Trust/PPO |
$17,771.23
|
| Rate for Payer: BCN Medicare Advantage |
$16,241.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,241.13
|
| Rate for Payer: Mclaren Medicare |
$16,241.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,053.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,677.30
|
| Rate for Payer: PACE Medicare |
$15,429.07
|
| Rate for Payer: PACE SWMI |
$16,241.13
|
| Rate for Payer: PHP Medicare Advantage |
$16,241.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,289.62
|
| Rate for Payer: Priority Health Medicare |
$16,241.13
|
| Rate for Payer: Priority Health Narrow Network |
$23,431.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,241.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,134.94
|
| Rate for Payer: UHC Core |
$25,530.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,241.13
|
| Rate for Payer: UHC Exchange |
$20,296.70
|
| Rate for Payer: UHC Medicare Advantage |
$16,728.36
|
| Rate for Payer: VA VA |
$16,241.13
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$32,202.81
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$12,910.02 |
| Max. Negotiated Rate |
$32,202.81 |
| Rate for Payer: Aetna Medicare |
$14,133.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,986.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,986.86
|
| Rate for Payer: BCBS MAPPO |
$13,589.49
|
| Rate for Payer: BCBS Trust/PPO |
$32,202.81
|
| Rate for Payer: BCN Medicare Advantage |
$13,589.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,589.49
|
| Rate for Payer: Mclaren Medicare |
$13,589.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,268.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,627.91
|
| Rate for Payer: PACE Medicare |
$12,910.02
|
| Rate for Payer: PACE SWMI |
$13,589.49
|
| Rate for Payer: PHP Medicare Advantage |
$13,589.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,351.81
|
| Rate for Payer: Priority Health Medicare |
$13,589.49
|
| Rate for Payer: Priority Health Narrow Network |
$19,481.45
|
| Rate for Payer: Railroad Medicare Medicare |
$13,589.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,886.04
|
| Rate for Payer: UHC Core |
$21,226.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,589.49
|
| Rate for Payer: UHC Exchange |
$16,874.97
|
| Rate for Payer: UHC Medicare Advantage |
$13,997.17
|
| Rate for Payer: VA VA |
$13,589.49
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$83,264.94
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$25,206.65 |
| Max. Negotiated Rate |
$83,264.94 |
| Rate for Payer: Aetna Medicare |
$27,594.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,166.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,166.65
|
| Rate for Payer: BCBS MAPPO |
$26,533.32
|
| Rate for Payer: BCBS Trust/PPO |
$83,264.94
|
| Rate for Payer: BCN Medicare Advantage |
$26,533.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,533.32
|
| Rate for Payer: Mclaren Medicare |
$26,533.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,859.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,513.32
|
| Rate for Payer: PACE Medicare |
$25,206.65
|
| Rate for Payer: PACE SWMI |
$26,533.32
|
| Rate for Payer: PHP Medicare Advantage |
$26,533.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,455.37
|
| Rate for Payer: Priority Health Medicare |
$26,533.32
|
| Rate for Payer: Priority Health Narrow Network |
$38,764.30
|
| Rate for Payer: Railroad Medicare Medicare |
$26,533.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,508.18
|
| Rate for Payer: UHC Core |
$42,235.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,533.32
|
| Rate for Payer: UHC Exchange |
$33,577.90
|
| Rate for Payer: UHC Medicare Advantage |
$27,329.32
|
| Rate for Payer: VA VA |
$26,533.32
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,731.69
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$8,395.32 |
| Max. Negotiated Rate |
$22,731.69 |
| Rate for Payer: Aetna Medicare |
$9,190.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,046.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,046.48
|
| Rate for Payer: BCBS MAPPO |
$8,837.18
|
| Rate for Payer: BCBS Trust/PPO |
$22,731.69
|
| Rate for Payer: BCN Medicare Advantage |
$8,837.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,837.18
|
| Rate for Payer: Mclaren Medicare |
$8,837.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,279.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,162.76
|
| Rate for Payer: PACE Medicare |
$8,395.32
|
| Rate for Payer: PACE SWMI |
$8,837.18
|
| Rate for Payer: PHP Medicare Advantage |
$8,837.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,502.22
|
| Rate for Payer: Priority Health Medicare |
$8,837.18
|
| Rate for Payer: Priority Health Narrow Network |
$12,401.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8,837.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,478.90
|
| Rate for Payer: UHC Core |
$13,512.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,837.18
|
| Rate for Payer: UHC Exchange |
$10,742.50
|
| Rate for Payer: UHC Medicare Advantage |
$9,102.30
|
| Rate for Payer: VA VA |
$8,837.18
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$15,642.98
|
|
|
Service Code
|
MS-DRG 600
|
| Min. Negotiated Rate |
$7,994.15 |
| Max. Negotiated Rate |
$15,642.98 |
| Rate for Payer: Aetna Medicare |
$8,751.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,518.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,518.61
|
| Rate for Payer: BCBS MAPPO |
$8,414.89
|
| Rate for Payer: BCBS Trust/PPO |
$14,617.54
|
| Rate for Payer: BCN Medicare Advantage |
$8,414.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,414.89
|
| Rate for Payer: Mclaren Medicare |
$8,414.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,835.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,677.12
|
| Rate for Payer: PACE Medicare |
$7,994.15
|
| Rate for Payer: PACE SWMI |
$8,414.89
|
| Rate for Payer: PHP Medicare Advantage |
$8,414.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,715.84
|
| Rate for Payer: Priority Health Medicare |
$8,414.89
|
| Rate for Payer: Priority Health Narrow Network |
$11,772.67
|
| Rate for Payer: Railroad Medicare Medicare |
$8,414.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,642.98
|
| Rate for Payer: UHC Core |
$12,826.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,414.89
|
| Rate for Payer: UHC Exchange |
$10,197.57
|
| Rate for Payer: UHC Medicare Advantage |
$8,667.34
|
| Rate for Payer: VA VA |
$8,414.89
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,497.14
|
|
|
Service Code
|
MS-DRG 601
|
| Min. Negotiated Rate |
$5,124.41 |
| Max. Negotiated Rate |
$9,497.14 |
| Rate for Payer: Aetna Medicare |
$5,609.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,742.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,742.65
|
| Rate for Payer: BCBS MAPPO |
$5,394.12
|
| Rate for Payer: BCBS Trust/PPO |
$8,129.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,394.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,394.12
|
| Rate for Payer: Mclaren Medicare |
$5,394.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,663.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,203.24
|
| Rate for Payer: PACE Medicare |
$5,124.41
|
| Rate for Payer: PACE SWMI |
$5,394.12
|
| Rate for Payer: PHP Medicare Advantage |
$5,394.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,934.26
|
| Rate for Payer: Priority Health Medicare |
$5,394.12
|
| Rate for Payer: Priority Health Narrow Network |
$7,147.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5,394.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,497.14
|
| Rate for Payer: UHC Core |
$7,787.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,394.12
|
| Rate for Payer: UHC Exchange |
$6,191.13
|
| Rate for Payer: UHC Medicare Advantage |
$5,555.94
|
| Rate for Payer: VA VA |
$5,394.12
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$19,286.51
|
|
|
Service Code
|
MS-DRG 071
|
| Min. Negotiated Rate |
$8,259.89 |
| Max. Negotiated Rate |
$19,286.51 |
| Rate for Payer: Aetna Medicare |
$9,042.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,868.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,868.28
|
| Rate for Payer: BCBS MAPPO |
$8,694.62
|
| Rate for Payer: BCBS Trust/PPO |
$19,286.51
|
| Rate for Payer: BCN Medicare Advantage |
$8,694.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,694.62
|
| Rate for Payer: Mclaren Medicare |
$8,694.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,129.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,998.81
|
| Rate for Payer: PACE Medicare |
$8,259.89
|
| Rate for Payer: PACE SWMI |
$8,694.62
|
| Rate for Payer: PHP Medicare Advantage |
$8,694.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,236.75
|
| Rate for Payer: Priority Health Medicare |
$8,694.62
|
| Rate for Payer: Priority Health Narrow Network |
$12,189.40
|
| Rate for Payer: Railroad Medicare Medicare |
$8,694.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,196.70
|
| Rate for Payer: UHC Core |
$13,280.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,694.62
|
| Rate for Payer: UHC Exchange |
$10,558.54
|
| Rate for Payer: UHC Medicare Advantage |
$8,955.46
|
| Rate for Payer: VA VA |
$8,694.62
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$35,341.43
|
|
|
Service Code
|
MS-DRG 070
|
| Min. Negotiated Rate |
$13,587.18 |
| Max. Negotiated Rate |
$35,341.43 |
| Rate for Payer: Aetna Medicare |
$14,874.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,877.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,877.88
|
| Rate for Payer: BCBS MAPPO |
$14,302.30
|
| Rate for Payer: BCBS Trust/PPO |
$35,341.43
|
| Rate for Payer: BCN Medicare Advantage |
$14,302.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,302.30
|
| Rate for Payer: Mclaren Medicare |
$14,302.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,017.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,447.64
|
| Rate for Payer: PACE Medicare |
$13,587.18
|
| Rate for Payer: PACE SWMI |
$14,302.30
|
| Rate for Payer: PHP Medicare Advantage |
$14,302.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,679.18
|
| Rate for Payer: Priority Health Medicare |
$14,302.30
|
| Rate for Payer: Priority Health Narrow Network |
$20,543.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14,302.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,297.03
|
| Rate for Payer: UHC Core |
$22,383.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,302.30
|
| Rate for Payer: UHC Exchange |
$17,794.79
|
| Rate for Payer: UHC Medicare Advantage |
$14,731.37
|
| Rate for Payer: VA VA |
$14,302.30
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,527.21
|
|
|
Service Code
|
MS-DRG 072
|
| Min. Negotiated Rate |
$6,218.86 |
| Max. Negotiated Rate |
$15,527.21 |
| Rate for Payer: Aetna Medicare |
$6,808.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,182.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,182.71
|
| Rate for Payer: BCBS MAPPO |
$6,546.17
|
| Rate for Payer: BCBS Trust/PPO |
$15,527.21
|
| Rate for Payer: BCN Medicare Advantage |
$6,546.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,546.17
|
| Rate for Payer: Mclaren Medicare |
$6,546.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,873.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,528.10
|
| Rate for Payer: PACE Medicare |
$6,218.86
|
| Rate for Payer: PACE SWMI |
$6,546.17
|
| Rate for Payer: PHP Medicare Advantage |
$6,546.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,235.99
|
| Rate for Payer: Priority Health Medicare |
$6,546.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,988.79
|
| Rate for Payer: Railroad Medicare Medicare |
$6,546.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,943.88
|
| Rate for Payer: UHC Core |
$9,793.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,546.17
|
| Rate for Payer: UHC Exchange |
$7,786.15
|
| Rate for Payer: UHC Medicare Advantage |
$6,742.56
|
| Rate for Payer: VA VA |
$6,546.17
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$30,772.97
|
|
|
Service Code
|
MS-DRG 067
|
| Min. Negotiated Rate |
$10,859.47 |
| Max. Negotiated Rate |
$30,772.97 |
| Rate for Payer: Aetna Medicare |
$11,888.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,288.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,288.78
|
| Rate for Payer: BCBS MAPPO |
$11,431.02
|
| Rate for Payer: BCBS Trust/PPO |
$30,772.97
|
| Rate for Payer: BCN Medicare Advantage |
$11,431.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,431.02
|
| Rate for Payer: Mclaren Medicare |
$11,431.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,002.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,145.67
|
| Rate for Payer: PACE Medicare |
$10,859.47
|
| Rate for Payer: PACE SWMI |
$11,431.02
|
| Rate for Payer: PHP Medicare Advantage |
$11,431.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,332.40
|
| Rate for Payer: Priority Health Medicare |
$11,431.02
|
| Rate for Payer: Priority Health Narrow Network |
$16,265.92
|
| Rate for Payer: Railroad Medicare Medicare |
$11,431.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,613.39
|
| Rate for Payer: UHC Core |
$17,722.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,431.02
|
| Rate for Payer: UHC Exchange |
$14,089.65
|
| Rate for Payer: UHC Medicare Advantage |
$11,773.95
|
| Rate for Payer: VA VA |
$11,431.02
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$18,288.89
|
|
|
Service Code
|
MS-DRG 068
|
| Min. Negotiated Rate |
$6,863.10 |
| Max. Negotiated Rate |
$18,288.89 |
| Rate for Payer: Aetna Medicare |
$7,513.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,030.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,030.40
|
| Rate for Payer: BCBS MAPPO |
$7,224.32
|
| Rate for Payer: BCBS Trust/PPO |
$18,288.89
|
| Rate for Payer: BCN Medicare Advantage |
$7,224.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,224.32
|
| Rate for Payer: Mclaren Medicare |
$7,224.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,585.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,307.97
|
| Rate for Payer: PACE Medicare |
$6,863.10
|
| Rate for Payer: PACE SWMI |
$7,224.32
|
| Rate for Payer: PHP Medicare Advantage |
$7,224.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,498.78
|
| Rate for Payer: Priority Health Medicare |
$7,224.32
|
| Rate for Payer: Priority Health Narrow Network |
$9,999.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7,224.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,286.23
|
| Rate for Payer: UHC Core |
$10,894.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,224.32
|
| Rate for Payer: UHC Exchange |
$8,661.22
|
| Rate for Payer: UHC Medicare Advantage |
$7,441.05
|
| Rate for Payer: VA VA |
$7,224.32
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$33,691.51
|
|
|
Service Code
|
MS-DRG 080
|
| Min. Negotiated Rate |
$16,656.03 |
| Max. Negotiated Rate |
$33,691.51 |
| Rate for Payer: Aetna Medicare |
$18,233.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,915.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,915.82
|
| Rate for Payer: BCBS MAPPO |
$17,532.66
|
| Rate for Payer: BCBS Trust/PPO |
$27,342.86
|
| Rate for Payer: BCN Medicare Advantage |
$17,532.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,532.66
|
| Rate for Payer: Mclaren Medicare |
$17,532.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,409.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,162.56
|
| Rate for Payer: PACE Medicare |
$16,656.03
|
| Rate for Payer: PACE SWMI |
$17,532.66
|
| Rate for Payer: PHP Medicare Advantage |
$17,532.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,694.67
|
| Rate for Payer: Priority Health Medicare |
$17,532.66
|
| Rate for Payer: Priority Health Narrow Network |
$25,355.74
|
| Rate for Payer: Railroad Medicare Medicare |
$17,532.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,691.51
|
| Rate for Payer: UHC Core |
$27,626.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,532.66
|
| Rate for Payer: UHC Exchange |
$21,963.31
|
| Rate for Payer: UHC Medicare Advantage |
$18,058.64
|
| Rate for Payer: VA VA |
$17,532.66
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$22,917.65
|
|
|
Service Code
|
MS-DRG 081
|
| Min. Negotiated Rate |
$7,144.95 |
| Max. Negotiated Rate |
$22,917.65 |
| Rate for Payer: Aetna Medicare |
$7,821.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,401.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,401.25
|
| Rate for Payer: BCBS MAPPO |
$7,521.00
|
| Rate for Payer: BCBS Trust/PPO |
$22,917.65
|
| Rate for Payer: BCN Medicare Advantage |
$7,521.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,521.00
|
| Rate for Payer: Mclaren Medicare |
$7,521.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,897.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,649.15
|
| Rate for Payer: PACE Medicare |
$7,144.95
|
| Rate for Payer: PACE SWMI |
$7,521.00
|
| Rate for Payer: PHP Medicare Advantage |
$7,521.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,051.25
|
| Rate for Payer: Priority Health Medicare |
$7,521.00
|
| Rate for Payer: Priority Health Narrow Network |
$10,441.00
|
| Rate for Payer: Railroad Medicare Medicare |
$7,521.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,873.51
|
| Rate for Payer: UHC Core |
$11,376.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,521.00
|
| Rate for Payer: UHC Exchange |
$9,044.07
|
| Rate for Payer: UHC Medicare Advantage |
$7,746.63
|
| Rate for Payer: VA VA |
$7,521.00
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$143.65
|
|
|
Service Code
|
NDC 0378-3340-16
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$129.28 |
| Rate for Payer: Aetna American Axle |
$93.37
|
| Rate for Payer: Aetna Commercial |
$122.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.37
|
| Rate for Payer: Cash Price |
$114.92
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Cofinity Commercial |
$123.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.92
|
| Rate for Payer: Healthscope Commercial |
$129.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.10
|
| Rate for Payer: PHP Commercial |
$122.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.56
|
| Rate for Payer: Priority Health SBD |
$90.50
|
| Rate for Payer: UMR Bronson Commercial |
$63.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.74
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$430.94
|
|
|
Service Code
|
NDC 0378-3340-53
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.61 |
| Max. Negotiated Rate |
$387.85 |
| Rate for Payer: Aetna American Axle |
$280.11
|
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.11
|
| Rate for Payer: Cash Price |
$344.75
|
| Rate for Payer: Cofinity Commercial |
$301.66
|
| Rate for Payer: Cofinity Commercial |
$370.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.75
|
| Rate for Payer: Healthscope Commercial |
$387.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.30
|
| Rate for Payer: PHP Commercial |
$366.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.66
|
| Rate for Payer: Priority Health SBD |
$271.49
|
| Rate for Payer: UMR Bronson Commercial |
$189.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.20
|
|
|
NOREPINEPHRINE 8 MG/250 ML (IV PREMIX)
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
NDC 9900-0003-69
|
| Hospital Charge Code |
161520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna American Axle |
$22.10
|
| Rate for Payer: Aetna Commercial |
$28.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$29.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$30.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.90
|
| Rate for Payer: PHP Commercial |
$28.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: Priority Health SBD |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.50
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 36000-162-01
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.18
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
NDC 63323-940-21
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.58
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.17
|
|
|
Service Code
|
NDC 47335-615-40
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna American Axle |
$23.51
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.51
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$25.32
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.74
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.32
|
| Rate for Payer: Priority Health SBD |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$15.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.37
|
|
|
Service Code
|
NDC 67457-852-00
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Aetna American Axle |
$11.94
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.94
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$16.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.78
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.36
|
|
|
Service Code
|
NDC 70121-1576-1
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$20.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.52
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.37
|
|
|
Service Code
|
NDC 67457-852-04
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$16.53 |
| Rate for Payer: Aetna American Axle |
$11.94
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.94
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.70
|
| Rate for Payer: Healthscope Commercial |
$16.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.61
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.86
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.78
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.36
|
|
|
Service Code
|
NDC 70121-1576-7
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna American Axle |
$15.18
|
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.18
|
| Rate for Payer: Cash Price |
$18.69
|
| Rate for Payer: Cofinity Commercial |
$16.35
|
| Rate for Payer: Cofinity Commercial |
$20.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.86
|
| Rate for Payer: PHP Commercial |
$19.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.35
|
| Rate for Payer: Priority Health SBD |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$10.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.52
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 0703-1153-03
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna American Axle |
$48.48
|
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
