|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$456.00
|
|
|
Service Code
|
NDC 50268-054-15
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.20 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: ASR ASR |
$442.32
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$353.54
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$428.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.80
|
| Rate for Payer: Healthscope Commercial |
$456.00
|
| Rate for Payer: Healthscope Whirlpool |
$442.32
|
| Rate for Payer: Mclaren Commercial |
$410.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$387.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$401.28
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$254.60
|
|
|
Service Code
|
NDC 23155-288-01
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.22 |
| Max. Negotiated Rate |
$254.60 |
| Rate for Payer: Aetna Commercial |
$229.14
|
| Rate for Payer: ASR ASR |
$246.96
|
| Rate for Payer: BCBS Trust/PPO |
$197.39
|
| Rate for Payer: BCN Commercial |
$197.39
|
| Rate for Payer: Cash Price |
$203.68
|
| Rate for Payer: Cofinity Commercial |
$239.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.68
|
| Rate for Payer: Healthscope Commercial |
$254.60
|
| Rate for Payer: Healthscope Whirlpool |
$246.96
|
| Rate for Payer: Mclaren Commercial |
$229.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$224.05
|
|
|
ACETAZOLAMIDE 250 MG TABLET
|
Facility
IP
|
$9.12
|
|
|
Service Code
|
NDC 50268-054-11
|
| Hospital Charge Code |
113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.21
|
| Rate for Payer: ASR ASR |
$8.85
|
| Rate for Payer: BCBS Trust/PPO |
$7.07
|
| Rate for Payer: BCN Commercial |
$7.07
|
| Rate for Payer: Cash Price |
$7.30
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.30
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Healthscope Whirlpool |
$8.85
|
| Rate for Payer: Mclaren Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.03
|
|
|
ACETIC ACID (BULK) 3 % LIQUID
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
NDC 5155200516
|
| Hospital Charge Code |
15091
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: ASR ASR |
$180.42
|
| Rate for Payer: BCBS Trust/PPO |
$144.21
|
| Rate for Payer: BCN Commercial |
$144.21
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.80
|
| Rate for Payer: Healthscope Commercial |
$186.00
|
| Rate for Payer: Healthscope Whirlpool |
$180.42
|
| Rate for Payer: Mclaren Commercial |
$167.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.68
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) INTRAVENOUS SOLUTION
|
Facility
IP
|
$677.02
|
|
|
Service Code
|
HCPCS J0132
|
| Hospital Charge Code |
38303
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$473.91 |
| Max. Negotiated Rate |
$677.02 |
| Rate for Payer: Aetna Commercial |
$609.32
|
| Rate for Payer: Aetna Commercial |
$154.64
|
| Rate for Payer: Aetna Commercial |
$121.11
|
| Rate for Payer: Aetna Commercial |
$553.44
|
| Rate for Payer: ASR ASR |
$596.48
|
| Rate for Payer: ASR ASR |
$166.67
|
| Rate for Payer: ASR ASR |
$656.71
|
| Rate for Payer: ASR ASR |
$130.53
|
| Rate for Payer: BCBS Trust/PPO |
$104.33
|
| Rate for Payer: BCBS Trust/PPO |
$476.76
|
| Rate for Payer: BCBS Trust/PPO |
$133.21
|
| Rate for Payer: BCBS Trust/PPO |
$524.89
|
| Rate for Payer: BCN Commercial |
$476.76
|
| Rate for Payer: BCN Commercial |
$104.33
|
| Rate for Payer: BCN Commercial |
$524.89
|
| Rate for Payer: BCN Commercial |
$133.21
|
| Rate for Payer: Cash Price |
$107.65
|
| Rate for Payer: Cash Price |
$137.45
|
| Rate for Payer: Cash Price |
$491.94
|
| Rate for Payer: Cash Price |
$541.62
|
| Rate for Payer: Cofinity Commercial |
$126.50
|
| Rate for Payer: Cofinity Commercial |
$578.03
|
| Rate for Payer: Cofinity Commercial |
$161.51
|
| Rate for Payer: Cofinity Commercial |
$636.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$491.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$137.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.62
|
| Rate for Payer: Healthscope Commercial |
$171.82
|
| Rate for Payer: Healthscope Commercial |
$614.93
|
| Rate for Payer: Healthscope Commercial |
$677.02
|
| Rate for Payer: Healthscope Commercial |
$134.57
|
| Rate for Payer: Healthscope Whirlpool |
$130.53
|
| Rate for Payer: Healthscope Whirlpool |
$656.71
|
| Rate for Payer: Healthscope Whirlpool |
$166.67
|
| Rate for Payer: Healthscope Whirlpool |
$596.48
|
| Rate for Payer: Mclaren Commercial |
$553.44
|
| Rate for Payer: Mclaren Commercial |
$609.32
|
| Rate for Payer: Mclaren Commercial |
$154.64
|
| Rate for Payer: Mclaren Commercial |
$121.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$522.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$575.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$430.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.20
|
|
|
ACETYLCYSTEINE 200 MG/ML (20 %) SOLUTION
|
Facility
IP
|
$117.70
|
|
|
Service Code
|
HCPCS J7608
|
| Hospital Charge Code |
123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.39 |
| Max. Negotiated Rate |
$117.70 |
| Rate for Payer: Aetna Commercial |
$105.93
|
| Rate for Payer: Aetna Commercial |
$91.63
|
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Commercial |
$38.92
|
| Rate for Payer: ASR ASR |
$98.76
|
| Rate for Payer: ASR ASR |
$41.95
|
| Rate for Payer: ASR ASR |
$114.17
|
| Rate for Payer: ASR ASR |
$86.25
|
| Rate for Payer: BCBS Trust/PPO |
$91.25
|
| Rate for Payer: BCBS Trust/PPO |
$78.93
|
| Rate for Payer: BCBS Trust/PPO |
$33.53
|
| Rate for Payer: BCBS Trust/PPO |
$68.94
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: BCN Commercial |
$68.94
|
| Rate for Payer: BCN Commercial |
$91.25
|
| Rate for Payer: BCN Commercial |
$33.53
|
| Rate for Payer: Cash Price |
$34.60
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cash Price |
$94.16
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cofinity Commercial |
$95.70
|
| Rate for Payer: Cofinity Commercial |
$110.64
|
| Rate for Payer: Cofinity Commercial |
$83.58
|
| Rate for Payer: Cofinity Commercial |
$40.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.16
|
| Rate for Payer: Healthscope Commercial |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$101.81
|
| Rate for Payer: Healthscope Commercial |
$117.70
|
| Rate for Payer: Healthscope Commercial |
$88.92
|
| Rate for Payer: Healthscope Whirlpool |
$98.76
|
| Rate for Payer: Healthscope Whirlpool |
$86.25
|
| Rate for Payer: Healthscope Whirlpool |
$41.95
|
| Rate for Payer: Healthscope Whirlpool |
$114.17
|
| Rate for Payer: Mclaren Commercial |
$80.03
|
| Rate for Payer: Mclaren Commercial |
$91.63
|
| Rate for Payer: Mclaren Commercial |
$105.93
|
| Rate for Payer: Mclaren Commercial |
$38.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.25
|
|
|
ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION
|
Facility
IP
|
$366.60
|
|
|
Service Code
|
NDC 0574-0521-04
|
| Hospital Charge Code |
115332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.62 |
| Max. Negotiated Rate |
$366.60 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: ASR ASR |
$355.60
|
| Rate for Payer: BCBS Trust/PPO |
$284.22
|
| Rate for Payer: BCN Commercial |
$284.22
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$344.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$366.60
|
| Rate for Payer: Healthscope Whirlpool |
$355.60
|
| Rate for Payer: Mclaren Commercial |
$329.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$322.61
|
|
|
ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION
|
Facility
IP
|
$479.40
|
|
|
Service Code
|
NDC 66689-202-04
|
| Hospital Charge Code |
115332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$335.58 |
| Max. Negotiated Rate |
$479.40 |
| Rate for Payer: Aetna Commercial |
$431.46
|
| Rate for Payer: ASR ASR |
$465.02
|
| Rate for Payer: BCBS Trust/PPO |
$371.68
|
| Rate for Payer: BCN Commercial |
$371.68
|
| Rate for Payer: Cash Price |
$383.52
|
| Rate for Payer: Cofinity Commercial |
$450.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.52
|
| Rate for Payer: Healthscope Commercial |
$479.40
|
| Rate for Payer: Healthscope Whirlpool |
$465.02
|
| Rate for Payer: Mclaren Commercial |
$431.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$407.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.87
|
|
|
ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSPENSION
|
Facility
IP
|
$273.54
|
|
|
Service Code
|
NDC 0574-0121-04
|
| Hospital Charge Code |
115332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.48 |
| Max. Negotiated Rate |
$273.54 |
| Rate for Payer: Aetna Commercial |
$246.19
|
| Rate for Payer: ASR ASR |
$265.33
|
| Rate for Payer: BCBS Trust/PPO |
$212.08
|
| Rate for Payer: BCN Commercial |
$212.08
|
| Rate for Payer: Cash Price |
$218.83
|
| Rate for Payer: Cofinity Commercial |
$257.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.83
|
| Rate for Payer: Healthscope Commercial |
$273.54
|
| Rate for Payer: Healthscope Whirlpool |
$265.33
|
| Rate for Payer: Mclaren Commercial |
$246.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$232.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$240.72
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$57.96
|
|
|
Service Code
|
NDC 0574-0121-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$52.16
|
| Rate for Payer: ASR ASR |
$56.22
|
| Rate for Payer: BCBS Trust/PPO |
$44.94
|
| Rate for Payer: BCN Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$46.37
|
| Rate for Payer: Cofinity Commercial |
$54.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.37
|
| Rate for Payer: Healthscope Commercial |
$57.96
|
| Rate for Payer: Healthscope Whirlpool |
$56.22
|
| Rate for Payer: Mclaren Commercial |
$52.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.00
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689-201-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Aetna Commercial |
$87.70
|
| Rate for Payer: ASR ASR |
$94.52
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$75.55
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$91.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$97.44
|
| Rate for Payer: Healthscope Whirlpool |
$94.52
|
| Rate for Payer: Mclaren Commercial |
$87.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.75
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$61.32
|
|
|
Service Code
|
NDC 0574-0521-76
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$61.32 |
| Rate for Payer: Aetna Commercial |
$55.19
|
| Rate for Payer: ASR ASR |
$59.48
|
| Rate for Payer: BCBS Trust/PPO |
$47.54
|
| Rate for Payer: BCN Commercial |
$47.54
|
| Rate for Payer: Cash Price |
$49.06
|
| Rate for Payer: Cofinity Commercial |
$57.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.06
|
| Rate for Payer: Healthscope Commercial |
$61.32
|
| Rate for Payer: Healthscope Whirlpool |
$59.48
|
| Rate for Payer: Mclaren Commercial |
$55.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.96
|
|
|
ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSPENSION
|
Facility
IP
|
$97.44
|
|
|
Service Code
|
NDC 66689-202-08
|
| Hospital Charge Code |
115331
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.21 |
| Max. Negotiated Rate |
$97.44 |
| Rate for Payer: Aetna Commercial |
$87.70
|
| Rate for Payer: ASR ASR |
$94.52
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$75.55
|
| Rate for Payer: Cash Price |
$77.95
|
| Rate for Payer: Cofinity Commercial |
$91.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$97.44
|
| Rate for Payer: Healthscope Whirlpool |
$94.52
|
| Rate for Payer: Mclaren Commercial |
$87.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.75
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
IP
|
$12,257.06
|
|
|
Service Code
|
MS-DRG 880
|
| Min. Negotiated Rate |
$9,274.81 |
| Max. Negotiated Rate |
$12,257.06 |
| Rate for Payer: Aetna Medicare |
$9,762.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,203.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,203.70
|
| Rate for Payer: BCBS MAPPO |
$9,762.96
|
| Rate for Payer: BCN Medicare Advantage |
$9,762.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,762.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,762.96
|
| Rate for Payer: Mclaren Medicare |
$9,762.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,251.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,227.40
|
| Rate for Payer: PACE Medicare |
$9,274.81
|
| Rate for Payer: PACE SWMI |
$9,762.96
|
| Rate for Payer: PHP Commercial |
$10,739.26
|
| Rate for Payer: PHP Medicare Advantage |
$9,762.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,257.06
|
| Rate for Payer: Priority Health Medicare |
$9,762.96
|
| Rate for Payer: Priority Health Narrow Network |
$9,805.65
|
| Rate for Payer: Railroad Medicare Medicare |
$9,762.96
|
| Rate for Payer: UHC Medicare Advantage |
$10,055.85
|
| Rate for Payer: VA VA |
$9,762.96
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
IP
|
$18,973.67
|
|
|
Service Code
|
MS-DRG 289
|
| Min. Negotiated Rate |
$13,482.15 |
| Max. Negotiated Rate |
$18,973.67 |
| Rate for Payer: Aetna Medicare |
$14,191.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,739.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,739.68
|
| Rate for Payer: BCBS MAPPO |
$14,191.74
|
| Rate for Payer: BCN Medicare Advantage |
$14,191.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,191.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,191.74
|
| Rate for Payer: Mclaren Medicare |
$14,191.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,901.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,320.50
|
| Rate for Payer: PACE Medicare |
$13,482.15
|
| Rate for Payer: PACE SWMI |
$14,191.74
|
| Rate for Payer: PHP Commercial |
$15,610.91
|
| Rate for Payer: PHP Medicare Advantage |
$14,191.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,973.67
|
| Rate for Payer: Priority Health Medicare |
$14,191.74
|
| Rate for Payer: Priority Health Narrow Network |
$15,178.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14,191.74
|
| Rate for Payer: UHC Medicare Advantage |
$14,617.49
|
| Rate for Payer: VA VA |
$14,191.74
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
IP
|
$33,294.12
|
|
|
Service Code
|
MS-DRG 288
|
| Min. Negotiated Rate |
$22,452.58 |
| Max. Negotiated Rate |
$33,294.12 |
| Rate for Payer: Aetna Medicare |
$23,634.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,542.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,542.88
|
| Rate for Payer: BCBS MAPPO |
$23,634.30
|
| Rate for Payer: BCN Medicare Advantage |
$23,634.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,634.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,634.30
|
| Rate for Payer: Mclaren Medicare |
$23,634.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,816.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,179.44
|
| Rate for Payer: PACE Medicare |
$22,452.58
|
| Rate for Payer: PACE SWMI |
$23,634.30
|
| Rate for Payer: PHP Commercial |
$25,997.73
|
| Rate for Payer: PHP Medicare Advantage |
$23,634.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,294.12
|
| Rate for Payer: Priority Health Medicare |
$23,634.30
|
| Rate for Payer: Priority Health Narrow Network |
$26,635.30
|
| Rate for Payer: Railroad Medicare Medicare |
$23,634.30
|
| Rate for Payer: UHC Medicare Advantage |
$24,343.33
|
| Rate for Payer: VA VA |
$23,634.30
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
IP
|
$13,584.79
|
|
|
Service Code
|
MS-DRG 290
|
| Min. Negotiated Rate |
$10,324.44 |
| Max. Negotiated Rate |
$13,584.79 |
| Rate for Payer: Aetna Medicare |
$10,867.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,584.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,584.79
|
| Rate for Payer: BCBS MAPPO |
$10,867.83
|
| Rate for Payer: BCN Medicare Advantage |
$10,867.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,867.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,867.83
|
| Rate for Payer: Mclaren Medicare |
$10,867.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,411.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,498.00
|
| Rate for Payer: PACE Medicare |
$10,324.44
|
| Rate for Payer: PACE SWMI |
$10,867.83
|
| Rate for Payer: PHP Commercial |
$11,954.61
|
| Rate for Payer: PHP Medicare Advantage |
$10,867.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,163.57
|
| Rate for Payer: Priority Health Medicare |
$10,867.83
|
| Rate for Payer: Priority Health Narrow Network |
$10,530.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,867.83
|
| Rate for Payer: UHC Medicare Advantage |
$11,193.86
|
| Rate for Payer: VA VA |
$10,867.83
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
IP
|
$28,703.82
|
|
|
Service Code
|
MS-DRG 835
|
| Min. Negotiated Rate |
$19,577.18 |
| Max. Negotiated Rate |
$28,703.82 |
| Rate for Payer: Aetna Medicare |
$20,607.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,759.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,759.45
|
| Rate for Payer: BCBS MAPPO |
$20,607.56
|
| Rate for Payer: BCN Medicare Advantage |
$20,607.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,607.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,607.56
|
| Rate for Payer: Mclaren Medicare |
$20,607.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,637.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,698.69
|
| Rate for Payer: PACE Medicare |
$19,577.18
|
| Rate for Payer: PACE SWMI |
$20,607.56
|
| Rate for Payer: PHP Commercial |
$22,668.32
|
| Rate for Payer: PHP Medicare Advantage |
$20,607.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,703.82
|
| Rate for Payer: Priority Health Medicare |
$20,607.56
|
| Rate for Payer: Priority Health Narrow Network |
$22,963.06
|
| Rate for Payer: Railroad Medicare Medicare |
$20,607.56
|
| Rate for Payer: UHC Medicare Advantage |
$21,225.79
|
| Rate for Payer: VA VA |
$20,607.56
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
IP
|
$71,891.16
|
|
|
Service Code
|
MS-DRG 834
|
| Min. Negotiated Rate |
$46,630.08 |
| Max. Negotiated Rate |
$71,891.16 |
| Rate for Payer: Aetna Medicare |
$49,084.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61,355.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61,355.36
|
| Rate for Payer: BCBS MAPPO |
$49,084.29
|
| Rate for Payer: BCN Medicare Advantage |
$49,084.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,084.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,084.29
|
| Rate for Payer: Mclaren Medicare |
$49,084.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51,538.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56,446.93
|
| Rate for Payer: PACE Medicare |
$46,630.08
|
| Rate for Payer: PACE SWMI |
$49,084.29
|
| Rate for Payer: PHP Commercial |
$53,992.72
|
| Rate for Payer: PHP Medicare Advantage |
$49,084.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71,891.16
|
| Rate for Payer: Priority Health Medicare |
$49,084.29
|
| Rate for Payer: Priority Health Narrow Network |
$57,512.93
|
| Rate for Payer: Railroad Medicare Medicare |
$49,084.29
|
| Rate for Payer: UHC Medicare Advantage |
$50,556.82
|
| Rate for Payer: VA VA |
$49,084.29
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$17,043.31
|
|
|
Service Code
|
MS-DRG 836
|
| Min. Negotiated Rate |
$12,298.66 |
| Max. Negotiated Rate |
$17,043.31 |
| Rate for Payer: Aetna Medicare |
$13,634.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,043.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,043.31
|
| Rate for Payer: BCBS MAPPO |
$13,634.65
|
| Rate for Payer: BCN Medicare Advantage |
$13,634.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,634.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,634.65
|
| Rate for Payer: Mclaren Medicare |
$13,634.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,316.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,679.85
|
| Rate for Payer: PACE Medicare |
$12,952.92
|
| Rate for Payer: PACE SWMI |
$13,634.65
|
| Rate for Payer: PHP Commercial |
$14,998.12
|
| Rate for Payer: PHP Medicare Advantage |
$13,634.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,373.33
|
| Rate for Payer: Priority Health Medicare |
$13,634.65
|
| Rate for Payer: Priority Health Narrow Network |
$12,298.66
|
| Rate for Payer: Railroad Medicare Medicare |
$13,634.65
|
| Rate for Payer: UHC Medicare Advantage |
$14,043.69
|
| Rate for Payer: VA VA |
$13,634.65
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
IP
|
$16,450.61
|
|
|
Service Code
|
MS-DRG 121
|
| Min. Negotiated Rate |
$11,901.69 |
| Max. Negotiated Rate |
$16,450.61 |
| Rate for Payer: Aetna Medicare |
$12,528.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,660.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,660.11
|
| Rate for Payer: BCBS MAPPO |
$12,528.09
|
| Rate for Payer: BCN Medicare Advantage |
$12,528.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,528.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,528.09
|
| Rate for Payer: Mclaren Medicare |
$12,528.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,154.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,407.30
|
| Rate for Payer: PACE Medicare |
$11,901.69
|
| Rate for Payer: PACE SWMI |
$12,528.09
|
| Rate for Payer: PHP Commercial |
$13,780.90
|
| Rate for Payer: PHP Medicare Advantage |
$12,528.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,450.61
|
| Rate for Payer: Priority Health Medicare |
$12,528.09
|
| Rate for Payer: Priority Health Narrow Network |
$13,160.49
|
| Rate for Payer: Railroad Medicare Medicare |
$12,528.09
|
| Rate for Payer: UHC Medicare Advantage |
$12,903.93
|
| Rate for Payer: VA VA |
$12,528.09
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
IP
|
$9,980.20
|
|
|
Service Code
|
MS-DRG 122
|
| Min. Negotiated Rate |
$7,584.95 |
| Max. Negotiated Rate |
$9,980.20 |
| Rate for Payer: Aetna Medicare |
$7,984.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,980.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,980.20
|
| Rate for Payer: BCBS MAPPO |
$7,984.16
|
| Rate for Payer: BCN Medicare Advantage |
$7,984.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,984.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,984.16
|
| Rate for Payer: Mclaren Medicare |
$7,984.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,383.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,181.78
|
| Rate for Payer: PACE Medicare |
$7,584.95
|
| Rate for Payer: PACE SWMI |
$7,984.16
|
| Rate for Payer: PHP Commercial |
$8,782.58
|
| Rate for Payer: PHP Medicare Advantage |
$7,984.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,559.38
|
| Rate for Payer: Priority Health Medicare |
$7,984.16
|
| Rate for Payer: Priority Health Narrow Network |
$7,647.50
|
| Rate for Payer: Railroad Medicare Medicare |
$7,984.16
|
| Rate for Payer: UHC Medicare Advantage |
$8,223.68
|
| Rate for Payer: VA VA |
$7,984.16
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
IP
|
$11,763.44
|
|
|
Service Code
|
MS-DRG 281
|
| Min. Negotiated Rate |
$8,940.21 |
| Max. Negotiated Rate |
$11,763.44 |
| Rate for Payer: Aetna Medicare |
$9,410.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,763.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,763.44
|
| Rate for Payer: BCBS MAPPO |
$9,410.75
|
| Rate for Payer: BCN Medicare Advantage |
$9,410.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,410.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,410.75
|
| Rate for Payer: Mclaren Medicare |
$9,410.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,881.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,822.36
|
| Rate for Payer: PACE Medicare |
$8,940.21
|
| Rate for Payer: PACE SWMI |
$9,410.75
|
| Rate for Payer: PHP Commercial |
$10,351.82
|
| Rate for Payer: PHP Medicare Advantage |
$9,410.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,722.92
|
| Rate for Payer: Priority Health Medicare |
$9,410.75
|
| Rate for Payer: Priority Health Narrow Network |
$9,378.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,410.75
|
| Rate for Payer: UHC Medicare Advantage |
$9,693.07
|
| Rate for Payer: VA VA |
$9,410.75
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
IP
|
$20,370.66
|
|
|
Service Code
|
MS-DRG 280
|
| Min. Negotiated Rate |
$14,357.24 |
| Max. Negotiated Rate |
$20,370.66 |
| Rate for Payer: Aetna Medicare |
$15,112.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,891.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,891.10
|
| Rate for Payer: BCBS MAPPO |
$15,112.88
|
| Rate for Payer: BCN Medicare Advantage |
$15,112.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,112.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,112.88
|
| Rate for Payer: Mclaren Medicare |
$15,112.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,868.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,379.81
|
| Rate for Payer: PACE Medicare |
$14,357.24
|
| Rate for Payer: PACE SWMI |
$15,112.88
|
| Rate for Payer: PHP Commercial |
$16,624.17
|
| Rate for Payer: PHP Medicare Advantage |
$15,112.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,370.66
|
| Rate for Payer: Priority Health Medicare |
$15,112.88
|
| Rate for Payer: Priority Health Narrow Network |
$16,296.53
|
| Rate for Payer: Railroad Medicare Medicare |
$15,112.88
|
| Rate for Payer: UHC Medicare Advantage |
$15,566.27
|
| Rate for Payer: VA VA |
$15,112.88
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
IP
|
$9,700.81
|
|
|
Service Code
|
MS-DRG 282
|
| Min. Negotiated Rate |
$7,372.62 |
| Max. Negotiated Rate |
$9,700.81 |
| Rate for Payer: Aetna Medicare |
$7,760.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,700.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,700.81
|
| Rate for Payer: BCBS MAPPO |
$7,760.65
|
| Rate for Payer: BCN Medicare Advantage |
$7,760.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,760.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,760.65
|
| Rate for Payer: Mclaren Medicare |
$7,760.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,148.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,924.75
|
| Rate for Payer: PACE Medicare |
$7,372.62
|
| Rate for Payer: PACE SWMI |
$7,760.65
|
| Rate for Payer: PHP Commercial |
$8,536.72
|
| Rate for Payer: PHP Medicare Advantage |
$7,760.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,220.40
|
| Rate for Payer: Priority Health Medicare |
$7,760.65
|
| Rate for Payer: Priority Health Narrow Network |
$7,376.32
|
| Rate for Payer: Railroad Medicare Medicare |
$7,760.65
|
| Rate for Payer: UHC Medicare Advantage |
$7,993.47
|
| Rate for Payer: VA VA |
$7,760.65
|
|
