|
CARBIDOPA ER 25 MG-LEVODOPA 100 MG TABLET,EXTENDED RELEASE
|
Facility
IP
|
$3.38
|
|
|
Service Code
|
NDC 68084-281-11
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna Commercial |
$3.04
|
| Rate for Payer: ASR ASR |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Healthscope Whirlpool |
$3.28
|
| Rate for Payer: Mclaren Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 1 % EYE LIQUID GEL DROPS
|
Facility
IP
|
$28.25
|
|
|
Service Code
|
NDC 0023-9205-15
|
| Hospital Charge Code |
27992
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$28.25 |
| Rate for Payer: Aetna Commercial |
$25.42
|
| Rate for Payer: ASR ASR |
$27.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.90
|
| Rate for Payer: BCN Commercial |
$21.90
|
| Rate for Payer: Cash Price |
$22.60
|
| Rate for Payer: Cofinity Commercial |
$26.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.60
|
| Rate for Payer: Healthscope Commercial |
$28.25
|
| Rate for Payer: Healthscope Whirlpool |
$27.40
|
| Rate for Payer: Mclaren Commercial |
$25.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.86
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH CC
|
Facility
IP
|
$9,811.94
|
|
|
Service Code
|
MS-DRG 297
|
| Min. Negotiated Rate |
$7,457.07 |
| Max. Negotiated Rate |
$9,811.94 |
| Rate for Payer: Aetna Medicare |
$7,849.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,811.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,811.94
|
| Rate for Payer: BCBS MAPPO |
$7,849.55
|
| Rate for Payer: BCN Medicare Advantage |
$7,849.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,849.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,849.55
|
| Rate for Payer: Mclaren Medicare |
$7,849.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,242.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,026.98
|
| Rate for Payer: PACE Medicare |
$7,457.07
|
| Rate for Payer: PACE SWMI |
$7,849.55
|
| Rate for Payer: PHP Commercial |
$8,634.50
|
| Rate for Payer: PHP Medicare Advantage |
$7,849.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,355.22
|
| Rate for Payer: Priority Health Medicare |
$7,849.55
|
| Rate for Payer: Priority Health Narrow Network |
$7,484.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,849.55
|
| Rate for Payer: UHC Medicare Advantage |
$8,085.04
|
| Rate for Payer: VA VA |
$7,849.55
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
IP
|
$20,585.09
|
|
|
Service Code
|
MS-DRG 296
|
| Min. Negotiated Rate |
$14,491.54 |
| Max. Negotiated Rate |
$20,585.09 |
| Rate for Payer: Aetna Medicare |
$15,254.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,067.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,067.81
|
| Rate for Payer: BCBS MAPPO |
$15,254.25
|
| Rate for Payer: BCN Medicare Advantage |
$15,254.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,254.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,254.25
|
| Rate for Payer: Mclaren Medicare |
$15,254.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,016.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,542.39
|
| Rate for Payer: PACE Medicare |
$14,491.54
|
| Rate for Payer: PACE SWMI |
$15,254.25
|
| Rate for Payer: PHP Commercial |
$16,779.68
|
| Rate for Payer: PHP Medicare Advantage |
$15,254.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,585.09
|
| Rate for Payer: Priority Health Medicare |
$15,254.25
|
| Rate for Payer: Priority Health Narrow Network |
$16,468.07
|
| Rate for Payer: Railroad Medicare Medicare |
$15,254.25
|
| Rate for Payer: UHC Medicare Advantage |
$15,711.88
|
| Rate for Payer: VA VA |
$15,254.25
|
|
|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
IP
|
$6,754.51
|
|
|
Service Code
|
MS-DRG 298
|
| Min. Negotiated Rate |
$4,508.38 |
| Max. Negotiated Rate |
$6,754.51 |
| Rate for Payer: Aetna Medicare |
$5,403.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,754.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,754.51
|
| Rate for Payer: BCBS MAPPO |
$5,403.61
|
| Rate for Payer: BCN Medicare Advantage |
$5,403.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,403.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,403.61
|
| Rate for Payer: Mclaren Medicare |
$5,403.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,673.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,214.15
|
| Rate for Payer: PACE Medicare |
$5,133.43
|
| Rate for Payer: PACE SWMI |
$5,403.61
|
| Rate for Payer: PHP Commercial |
$5,943.97
|
| Rate for Payer: PHP Medicare Advantage |
$5,403.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,635.48
|
| Rate for Payer: Priority Health Medicare |
$5,403.61
|
| Rate for Payer: Priority Health Narrow Network |
$4,508.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5,403.61
|
| Rate for Payer: UHC Medicare Advantage |
$5,565.72
|
| Rate for Payer: VA VA |
$5,403.61
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
IP
|
$9,982.32
|
|
|
Service Code
|
MS-DRG 309
|
| Min. Negotiated Rate |
$7,586.57 |
| Max. Negotiated Rate |
$9,982.32 |
| Rate for Payer: Aetna Medicare |
$7,985.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,982.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,982.32
|
| Rate for Payer: BCBS MAPPO |
$7,985.86
|
| Rate for Payer: BCN Medicare Advantage |
$7,985.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,985.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,985.86
|
| Rate for Payer: Mclaren Medicare |
$7,985.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,385.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,183.74
|
| Rate for Payer: PACE Medicare |
$7,586.57
|
| Rate for Payer: PACE SWMI |
$7,985.86
|
| Rate for Payer: PHP Commercial |
$8,784.45
|
| Rate for Payer: PHP Medicare Advantage |
$7,985.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,561.95
|
| Rate for Payer: Priority Health Medicare |
$7,985.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,649.56
|
| Rate for Payer: Railroad Medicare Medicare |
$7,985.86
|
| Rate for Payer: UHC Medicare Advantage |
$8,225.44
|
| Rate for Payer: VA VA |
$7,985.86
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
IP
|
$15,436.25
|
|
|
Service Code
|
MS-DRG 308
|
| Min. Negotiated Rate |
$11,266.28 |
| Max. Negotiated Rate |
$15,436.25 |
| Rate for Payer: Aetna Medicare |
$11,859.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,824.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,824.05
|
| Rate for Payer: BCBS MAPPO |
$11,859.24
|
| Rate for Payer: BCN Medicare Advantage |
$11,859.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,859.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,859.24
|
| Rate for Payer: Mclaren Medicare |
$11,859.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,452.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,638.13
|
| Rate for Payer: PACE Medicare |
$11,266.28
|
| Rate for Payer: PACE SWMI |
$11,859.24
|
| Rate for Payer: PHP Commercial |
$13,045.16
|
| Rate for Payer: PHP Medicare Advantage |
$11,859.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,436.25
|
| Rate for Payer: Priority Health Medicare |
$11,859.24
|
| Rate for Payer: Priority Health Narrow Network |
$12,349.00
|
| Rate for Payer: Railroad Medicare Medicare |
$11,859.24
|
| Rate for Payer: UHC Medicare Advantage |
$12,215.02
|
| Rate for Payer: VA VA |
$11,859.24
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$7,953.58
|
|
|
Service Code
|
MS-DRG 310
|
| Min. Negotiated Rate |
$5,680.42 |
| Max. Negotiated Rate |
$7,953.58 |
| Rate for Payer: Aetna Medicare |
$6,362.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,953.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,953.58
|
| Rate for Payer: BCBS MAPPO |
$6,362.86
|
| Rate for Payer: BCN Medicare Advantage |
$6,362.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,362.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,362.86
|
| Rate for Payer: Mclaren Medicare |
$6,362.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,681.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,317.29
|
| Rate for Payer: PACE Medicare |
$6,044.72
|
| Rate for Payer: PACE SWMI |
$6,362.86
|
| Rate for Payer: PHP Commercial |
$6,999.15
|
| Rate for Payer: PHP Medicare Advantage |
$6,362.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,100.52
|
| Rate for Payer: Priority Health Medicare |
$6,362.86
|
| Rate for Payer: Priority Health Narrow Network |
$5,680.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6,362.86
|
| Rate for Payer: UHC Medicare Advantage |
$6,553.75
|
| Rate for Payer: VA VA |
$6,362.86
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
IP
|
$19,732.51
|
|
|
Service Code
|
MS-DRG 306
|
| Min. Negotiated Rate |
$13,957.50 |
| Max. Negotiated Rate |
$19,732.51 |
| Rate for Payer: Aetna Medicare |
$14,692.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,365.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,365.12
|
| Rate for Payer: BCBS MAPPO |
$14,692.10
|
| Rate for Payer: BCN Medicare Advantage |
$14,692.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,692.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,692.10
|
| Rate for Payer: Mclaren Medicare |
$14,692.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,426.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,895.92
|
| Rate for Payer: PACE Medicare |
$13,957.50
|
| Rate for Payer: PACE SWMI |
$14,692.10
|
| Rate for Payer: PHP Commercial |
$16,161.31
|
| Rate for Payer: PHP Medicare Advantage |
$14,692.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,732.51
|
| Rate for Payer: Priority Health Medicare |
$14,692.10
|
| Rate for Payer: Priority Health Narrow Network |
$15,786.01
|
| Rate for Payer: Railroad Medicare Medicare |
$14,692.10
|
| Rate for Payer: UHC Medicare Advantage |
$15,132.86
|
| Rate for Payer: VA VA |
$14,692.10
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
IP
|
$12,102.98
|
|
|
Service Code
|
MS-DRG 307
|
| Min. Negotiated Rate |
$9,178.28 |
| Max. Negotiated Rate |
$12,102.98 |
| Rate for Payer: Aetna Medicare |
$9,661.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,076.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,076.69
|
| Rate for Payer: BCBS MAPPO |
$9,661.35
|
| Rate for Payer: BCN Medicare Advantage |
$9,661.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,661.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,661.35
|
| Rate for Payer: Mclaren Medicare |
$9,661.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,144.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,110.55
|
| Rate for Payer: PACE Medicare |
$9,178.28
|
| Rate for Payer: PACE SWMI |
$9,661.35
|
| Rate for Payer: PHP Commercial |
$10,627.48
|
| Rate for Payer: PHP Medicare Advantage |
$9,661.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,102.98
|
| Rate for Payer: Priority Health Medicare |
$9,661.35
|
| Rate for Payer: Priority Health Narrow Network |
$9,682.38
|
| Rate for Payer: Railroad Medicare Medicare |
$9,661.35
|
| Rate for Payer: UHC Medicare Advantage |
$9,951.19
|
| Rate for Payer: VA VA |
$9,661.35
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
IP
|
$90,339.67
|
|
|
Service Code
|
MS-DRG 275
|
| Min. Negotiated Rate |
$58,186.37 |
| Max. Negotiated Rate |
$90,339.67 |
| Rate for Payer: Aetna Medicare |
$61,248.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76,561.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76,561.01
|
| Rate for Payer: BCBS MAPPO |
$61,248.81
|
| Rate for Payer: BCN Medicare Advantage |
$61,248.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61,248.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$61,248.81
|
| Rate for Payer: Mclaren Medicare |
$61,248.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64,311.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70,436.13
|
| Rate for Payer: PACE Medicare |
$58,186.37
|
| Rate for Payer: PACE SWMI |
$61,248.81
|
| Rate for Payer: PHP Commercial |
$67,373.69
|
| Rate for Payer: PHP Medicare Advantage |
$61,248.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90,339.67
|
| Rate for Payer: Priority Health Medicare |
$61,248.81
|
| Rate for Payer: Priority Health Narrow Network |
$72,271.74
|
| Rate for Payer: Railroad Medicare Medicare |
$61,248.81
|
| Rate for Payer: UHC Medicare Advantage |
$63,086.27
|
| Rate for Payer: VA VA |
$61,248.81
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
IP
|
$79,738.97
|
|
|
Service Code
|
MS-DRG 276
|
| Min. Negotiated Rate |
$51,546.01 |
| Max. Negotiated Rate |
$79,738.97 |
| Rate for Payer: Aetna Medicare |
$54,258.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,823.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,823.70
|
| Rate for Payer: BCBS MAPPO |
$54,258.96
|
| Rate for Payer: BCN Medicare Advantage |
$54,258.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54,258.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$54,258.96
|
| Rate for Payer: Mclaren Medicare |
$54,258.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,971.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,397.80
|
| Rate for Payer: PACE Medicare |
$51,546.01
|
| Rate for Payer: PACE SWMI |
$54,258.96
|
| Rate for Payer: PHP Commercial |
$59,684.86
|
| Rate for Payer: PHP Medicare Advantage |
$54,258.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79,738.97
|
| Rate for Payer: Priority Health Medicare |
$54,258.96
|
| Rate for Payer: Priority Health Narrow Network |
$63,791.18
|
| Rate for Payer: Railroad Medicare Medicare |
$54,258.96
|
| Rate for Payer: UHC Medicare Advantage |
$55,886.73
|
| Rate for Payer: VA VA |
$54,258.96
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
IP
|
$61,406.02
|
|
|
Service Code
|
MS-DRG 277
|
| Min. Negotiated Rate |
$40,062.11 |
| Max. Negotiated Rate |
$61,406.02 |
| Rate for Payer: Aetna Medicare |
$42,170.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,713.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,713.30
|
| Rate for Payer: BCBS MAPPO |
$42,170.64
|
| Rate for Payer: BCN Medicare Advantage |
$42,170.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,170.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,170.64
|
| Rate for Payer: Mclaren Medicare |
$42,170.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,279.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,496.24
|
| Rate for Payer: PACE Medicare |
$40,062.11
|
| Rate for Payer: PACE SWMI |
$42,170.64
|
| Rate for Payer: PHP Commercial |
$46,387.70
|
| Rate for Payer: PHP Medicare Advantage |
$42,170.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,406.02
|
| Rate for Payer: Priority Health Medicare |
$42,170.64
|
| Rate for Payer: Priority Health Narrow Network |
$49,124.82
|
| Rate for Payer: Railroad Medicare Medicare |
$42,170.64
|
| Rate for Payer: UHC Medicare Advantage |
$43,435.76
|
| Rate for Payer: VA VA |
$42,170.64
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
IP
|
$34,778.42
|
|
|
Service Code
|
MS-DRG 258
|
| Min. Negotiated Rate |
$23,382.38 |
| Max. Negotiated Rate |
$34,778.42 |
| Rate for Payer: Aetna Medicare |
$24,613.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,766.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,766.29
|
| Rate for Payer: BCBS MAPPO |
$24,613.03
|
| Rate for Payer: BCN Medicare Advantage |
$24,613.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,613.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,613.03
|
| Rate for Payer: Mclaren Medicare |
$24,613.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,843.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,304.98
|
| Rate for Payer: PACE Medicare |
$23,382.38
|
| Rate for Payer: PACE SWMI |
$24,613.03
|
| Rate for Payer: PHP Commercial |
$27,074.33
|
| Rate for Payer: PHP Medicare Advantage |
$24,613.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,778.42
|
| Rate for Payer: Priority Health Medicare |
$24,613.03
|
| Rate for Payer: Priority Health Narrow Network |
$27,822.74
|
| Rate for Payer: Railroad Medicare Medicare |
$24,613.03
|
| Rate for Payer: UHC Medicare Advantage |
$25,351.42
|
| Rate for Payer: VA VA |
$24,613.03
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
IP
|
$23,967.14
|
|
|
Service Code
|
MS-DRG 259
|
| Min. Negotiated Rate |
$16,610.08 |
| Max. Negotiated Rate |
$23,967.14 |
| Rate for Payer: Aetna Medicare |
$17,484.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,855.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,855.38
|
| Rate for Payer: BCBS MAPPO |
$17,484.30
|
| Rate for Payer: BCN Medicare Advantage |
$17,484.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,484.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,484.30
|
| Rate for Payer: Mclaren Medicare |
$17,484.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,358.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,106.94
|
| Rate for Payer: PACE Medicare |
$16,610.08
|
| Rate for Payer: PACE SWMI |
$17,484.30
|
| Rate for Payer: PHP Commercial |
$19,232.73
|
| Rate for Payer: PHP Medicare Advantage |
$17,484.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,967.14
|
| Rate for Payer: Priority Health Medicare |
$17,484.30
|
| Rate for Payer: Priority Health Narrow Network |
$19,173.71
|
| Rate for Payer: Railroad Medicare Medicare |
$17,484.30
|
| Rate for Payer: UHC Medicare Advantage |
$18,008.83
|
| Rate for Payer: VA VA |
$17,484.30
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
IP
|
$24,162.31
|
|
|
Service Code
|
MS-DRG 261
|
| Min. Negotiated Rate |
$16,732.35 |
| Max. Negotiated Rate |
$24,162.31 |
| Rate for Payer: Aetna Medicare |
$17,613.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,016.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,016.25
|
| Rate for Payer: BCBS MAPPO |
$17,613.00
|
| Rate for Payer: BCN Medicare Advantage |
$17,613.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,613.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,613.00
|
| Rate for Payer: Mclaren Medicare |
$17,613.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,493.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,254.95
|
| Rate for Payer: PACE Medicare |
$16,732.35
|
| Rate for Payer: PACE SWMI |
$17,613.00
|
| Rate for Payer: PHP Commercial |
$19,374.30
|
| Rate for Payer: PHP Medicare Advantage |
$17,613.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,162.31
|
| Rate for Payer: Priority Health Medicare |
$17,613.00
|
| Rate for Payer: Priority Health Narrow Network |
$19,329.85
|
| Rate for Payer: Railroad Medicare Medicare |
$17,613.00
|
| Rate for Payer: UHC Medicare Advantage |
$18,141.39
|
| Rate for Payer: VA VA |
$17,613.00
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
IP
|
$42,567.17
|
|
|
Service Code
|
MS-DRG 260
|
| Min. Negotiated Rate |
$28,261.30 |
| Max. Negotiated Rate |
$42,567.17 |
| Rate for Payer: Aetna Medicare |
$29,748.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,185.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,185.92
|
| Rate for Payer: BCBS MAPPO |
$29,748.74
|
| Rate for Payer: BCN Medicare Advantage |
$29,748.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,748.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,748.74
|
| Rate for Payer: Mclaren Medicare |
$29,748.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,236.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,211.05
|
| Rate for Payer: PACE Medicare |
$28,261.30
|
| Rate for Payer: PACE SWMI |
$29,748.74
|
| Rate for Payer: PHP Commercial |
$32,723.61
|
| Rate for Payer: PHP Medicare Advantage |
$29,748.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,567.17
|
| Rate for Payer: Priority Health Medicare |
$29,748.74
|
| Rate for Payer: Priority Health Narrow Network |
$34,053.74
|
| Rate for Payer: Railroad Medicare Medicare |
$29,748.74
|
| Rate for Payer: UHC Medicare Advantage |
$30,641.20
|
| Rate for Payer: VA VA |
$29,748.74
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC
|
Facility
IP
|
$21,125.65
|
|
|
Service Code
|
MS-DRG 262
|
| Min. Negotiated Rate |
$14,830.16 |
| Max. Negotiated Rate |
$21,125.65 |
| Rate for Payer: Aetna Medicare |
$15,610.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,513.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,513.38
|
| Rate for Payer: BCBS MAPPO |
$15,610.70
|
| Rate for Payer: BCN Medicare Advantage |
$15,610.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,610.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,610.70
|
| Rate for Payer: Mclaren Medicare |
$15,610.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,391.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,952.30
|
| Rate for Payer: PACE Medicare |
$14,830.16
|
| Rate for Payer: PACE SWMI |
$15,610.70
|
| Rate for Payer: PHP Commercial |
$17,171.77
|
| Rate for Payer: PHP Medicare Advantage |
$15,610.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,125.65
|
| Rate for Payer: Priority Health Medicare |
$15,610.70
|
| Rate for Payer: Priority Health Narrow Network |
$16,900.52
|
| Rate for Payer: Railroad Medicare Medicare |
$15,610.70
|
| Rate for Payer: UHC Medicare Advantage |
$16,079.02
|
| Rate for Payer: VA VA |
$15,610.70
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC
|
Facility
IP
|
$81,730.45
|
|
|
Service Code
|
MS-DRG 217
|
| Min. Negotiated Rate |
$52,793.49 |
| Max. Negotiated Rate |
$81,730.45 |
| Rate for Payer: Aetna Medicare |
$55,572.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69,465.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69,465.11
|
| Rate for Payer: BCBS MAPPO |
$55,572.09
|
| Rate for Payer: BCN Medicare Advantage |
$55,572.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55,572.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$55,572.09
|
| Rate for Payer: Mclaren Medicare |
$55,572.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58,350.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63,907.90
|
| Rate for Payer: PACE Medicare |
$52,793.49
|
| Rate for Payer: PACE SWMI |
$55,572.09
|
| Rate for Payer: PHP Commercial |
$61,129.30
|
| Rate for Payer: PHP Medicare Advantage |
$55,572.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,730.45
|
| Rate for Payer: Priority Health Medicare |
$55,572.09
|
| Rate for Payer: Priority Health Narrow Network |
$65,384.36
|
| Rate for Payer: Railroad Medicare Medicare |
$55,572.09
|
| Rate for Payer: UHC Medicare Advantage |
$57,239.25
|
| Rate for Payer: VA VA |
$55,572.09
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC
|
Facility
IP
|
$124,616.05
|
|
|
Service Code
|
MS-DRG 216
|
| Min. Negotiated Rate |
$79,657.36 |
| Max. Negotiated Rate |
$124,616.05 |
| Rate for Payer: Aetna Medicare |
$83,849.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104,812.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104,812.31
|
| Rate for Payer: BCBS MAPPO |
$83,849.85
|
| Rate for Payer: BCN Medicare Advantage |
$83,849.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83,849.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$83,849.85
|
| Rate for Payer: Mclaren Medicare |
$83,849.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$88,042.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96,427.33
|
| Rate for Payer: PACE Medicare |
$79,657.36
|
| Rate for Payer: PACE SWMI |
$83,849.85
|
| Rate for Payer: PHP Commercial |
$92,234.84
|
| Rate for Payer: PHP Medicare Advantage |
$83,849.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124,616.05
|
| Rate for Payer: Priority Health Medicare |
$83,849.85
|
| Rate for Payer: Priority Health Narrow Network |
$99,692.84
|
| Rate for Payer: Railroad Medicare Medicare |
$83,849.85
|
| Rate for Payer: UHC Medicare Advantage |
$86,365.35
|
| Rate for Payer: VA VA |
$83,849.85
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
IP
|
$73,145.63
|
|
|
Service Code
|
MS-DRG 218
|
| Min. Negotiated Rate |
$47,415.89 |
| Max. Negotiated Rate |
$73,145.63 |
| Rate for Payer: Aetna Medicare |
$49,911.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,389.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,389.32
|
| Rate for Payer: BCBS MAPPO |
$49,911.46
|
| Rate for Payer: BCN Medicare Advantage |
$49,911.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,911.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,911.46
|
| Rate for Payer: Mclaren Medicare |
$49,911.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,407.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,398.18
|
| Rate for Payer: PACE Medicare |
$47,415.89
|
| Rate for Payer: PACE SWMI |
$49,911.46
|
| Rate for Payer: PHP Commercial |
$54,902.61
|
| Rate for Payer: PHP Medicare Advantage |
$49,911.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73,145.63
|
| Rate for Payer: Priority Health Medicare |
$49,911.46
|
| Rate for Payer: Priority Health Narrow Network |
$58,516.50
|
| Rate for Payer: Railroad Medicare Medicare |
$49,911.46
|
| Rate for Payer: UHC Medicare Advantage |
$51,408.80
|
| Rate for Payer: VA VA |
$49,911.46
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC
|
Facility
IP
|
$67,340.66
|
|
|
Service Code
|
MS-DRG 220
|
| Min. Negotiated Rate |
$43,779.61 |
| Max. Negotiated Rate |
$67,340.66 |
| Rate for Payer: Aetna Medicare |
$46,083.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,604.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,604.75
|
| Rate for Payer: BCBS MAPPO |
$46,083.80
|
| Rate for Payer: BCN Medicare Advantage |
$46,083.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,083.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$46,083.80
|
| Rate for Payer: Mclaren Medicare |
$46,083.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48,387.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,996.37
|
| Rate for Payer: PACE Medicare |
$43,779.61
|
| Rate for Payer: PACE SWMI |
$46,083.80
|
| Rate for Payer: PHP Commercial |
$50,692.18
|
| Rate for Payer: PHP Medicare Advantage |
$46,083.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67,340.66
|
| Rate for Payer: Priority Health Medicare |
$46,083.80
|
| Rate for Payer: Priority Health Narrow Network |
$53,872.53
|
| Rate for Payer: Railroad Medicare Medicare |
$46,083.80
|
| Rate for Payer: UHC Medicare Advantage |
$47,466.31
|
| Rate for Payer: VA VA |
$46,083.80
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
IP
|
$99,011.81
|
|
|
Service Code
|
MS-DRG 219
|
| Min. Negotiated Rate |
$63,618.66 |
| Max. Negotiated Rate |
$99,011.81 |
| Rate for Payer: Aetna Medicare |
$66,967.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83,708.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83,708.76
|
| Rate for Payer: BCBS MAPPO |
$66,967.01
|
| Rate for Payer: BCN Medicare Advantage |
$66,967.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66,967.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$66,967.01
|
| Rate for Payer: Mclaren Medicare |
$66,967.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70,315.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77,012.06
|
| Rate for Payer: PACE Medicare |
$63,618.66
|
| Rate for Payer: PACE SWMI |
$66,967.01
|
| Rate for Payer: PHP Commercial |
$73,663.71
|
| Rate for Payer: PHP Medicare Advantage |
$66,967.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99,011.81
|
| Rate for Payer: Priority Health Medicare |
$66,967.01
|
| Rate for Payer: Priority Health Narrow Network |
$79,209.45
|
| Rate for Payer: Railroad Medicare Medicare |
$66,967.01
|
| Rate for Payer: UHC Medicare Advantage |
$68,976.02
|
| Rate for Payer: VA VA |
$66,967.01
|
|
|
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC
|
Facility
IP
|
$59,688.02
|
|
|
Service Code
|
MS-DRG 221
|
| Min. Negotiated Rate |
$38,985.94 |
| Max. Negotiated Rate |
$59,688.02 |
| Rate for Payer: Aetna Medicare |
$41,037.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,297.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,297.29
|
| Rate for Payer: BCBS MAPPO |
$41,037.83
|
| Rate for Payer: BCN Medicare Advantage |
$41,037.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,037.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,037.83
|
| Rate for Payer: Mclaren Medicare |
$41,037.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,089.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,193.50
|
| Rate for Payer: PACE Medicare |
$38,985.94
|
| Rate for Payer: PACE SWMI |
$41,037.83
|
| Rate for Payer: PHP Commercial |
$45,141.61
|
| Rate for Payer: PHP Medicare Advantage |
$41,037.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59,688.02
|
| Rate for Payer: Priority Health Medicare |
$41,037.83
|
| Rate for Payer: Priority Health Narrow Network |
$47,750.42
|
| Rate for Payer: Railroad Medicare Medicare |
$41,037.83
|
| Rate for Payer: UHC Medicare Advantage |
$42,268.96
|
| Rate for Payer: VA VA |
$41,037.83
|
|
|
CAROTID ARTERY STENT PROCEDURES WITH CC
|
Facility
IP
|
$29,525.58
|
|
|
Service Code
|
MS-DRG 035
|
| Min. Negotiated Rate |
$20,091.96 |
| Max. Negotiated Rate |
$29,525.58 |
| Rate for Payer: Aetna Medicare |
$21,149.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,436.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,436.79
|
| Rate for Payer: BCBS MAPPO |
$21,149.43
|
| Rate for Payer: BCN Medicare Advantage |
$21,149.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,149.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,149.43
|
| Rate for Payer: Mclaren Medicare |
$21,149.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,206.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,321.84
|
| Rate for Payer: PACE Medicare |
$20,091.96
|
| Rate for Payer: PACE SWMI |
$21,149.43
|
| Rate for Payer: PHP Commercial |
$23,264.37
|
| Rate for Payer: PHP Medicare Advantage |
$21,149.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,525.58
|
| Rate for Payer: Priority Health Medicare |
$21,149.43
|
| Rate for Payer: Priority Health Narrow Network |
$23,620.46
|
| Rate for Payer: Railroad Medicare Medicare |
$21,149.43
|
| Rate for Payer: UHC Medicare Advantage |
$21,783.91
|
| Rate for Payer: VA VA |
$21,149.43
|
|
