|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
IP
|
$9,929.42
|
|
|
Service Code
|
MS-DRG 284
|
| Min. Negotiated Rate |
$7,546.36 |
| Max. Negotiated Rate |
$9,929.42 |
| Rate for Payer: Aetna Medicare |
$7,943.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,929.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,929.42
|
| Rate for Payer: BCBS MAPPO |
$7,943.54
|
| Rate for Payer: BCN Medicare Advantage |
$7,943.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,943.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,943.54
|
| Rate for Payer: Mclaren Medicare |
$7,943.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,340.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,135.07
|
| Rate for Payer: PACE Medicare |
$7,546.36
|
| Rate for Payer: PACE SWMI |
$7,943.54
|
| Rate for Payer: PHP Commercial |
$8,737.89
|
| Rate for Payer: PHP Medicare Advantage |
$7,943.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,497.75
|
| Rate for Payer: Priority Health Medicare |
$7,943.54
|
| Rate for Payer: Priority Health Narrow Network |
$7,598.20
|
| Rate for Payer: Railroad Medicare Medicare |
$7,943.54
|
| Rate for Payer: UHC Medicare Advantage |
$8,181.85
|
| Rate for Payer: VA VA |
$7,943.54
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
IP
|
$25,312.78
|
|
|
Service Code
|
MS-DRG 283
|
| Min. Negotiated Rate |
$17,453.01 |
| Max. Negotiated Rate |
$25,312.78 |
| Rate for Payer: Aetna Medicare |
$18,371.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,964.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,964.49
|
| Rate for Payer: BCBS MAPPO |
$18,371.59
|
| Rate for Payer: BCN Medicare Advantage |
$18,371.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,371.59
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,371.59
|
| Rate for Payer: Mclaren Medicare |
$18,371.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,290.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,127.33
|
| Rate for Payer: PACE Medicare |
$17,453.01
|
| Rate for Payer: PACE SWMI |
$18,371.59
|
| Rate for Payer: PHP Commercial |
$20,208.75
|
| Rate for Payer: PHP Medicare Advantage |
$18,371.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,312.78
|
| Rate for Payer: Priority Health Medicare |
$18,371.59
|
| Rate for Payer: Priority Health Narrow Network |
$20,250.22
|
| Rate for Payer: Railroad Medicare Medicare |
$18,371.59
|
| Rate for Payer: UHC Medicare Advantage |
$18,922.74
|
| Rate for Payer: VA VA |
$18,371.59
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
IP
|
$7,273.10
|
|
|
Service Code
|
MS-DRG 285
|
| Min. Negotiated Rate |
$5,019.93 |
| Max. Negotiated Rate |
$7,273.10 |
| Rate for Payer: Aetna Medicare |
$5,818.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,273.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,273.10
|
| Rate for Payer: BCBS MAPPO |
$5,818.48
|
| Rate for Payer: BCN Medicare Advantage |
$5,818.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,818.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,818.48
|
| Rate for Payer: Mclaren Medicare |
$5,818.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,109.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,691.25
|
| Rate for Payer: PACE Medicare |
$5,527.56
|
| Rate for Payer: PACE SWMI |
$5,818.48
|
| Rate for Payer: PHP Commercial |
$6,400.33
|
| Rate for Payer: PHP Medicare Advantage |
$5,818.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,274.91
|
| Rate for Payer: Priority Health Medicare |
$5,818.48
|
| Rate for Payer: Priority Health Narrow Network |
$5,019.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5,818.48
|
| Rate for Payer: UHC Medicare Advantage |
$5,993.03
|
| Rate for Payer: VA VA |
$5,818.48
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
IP
|
$293.75
|
|
|
Service Code
|
NDC 0904-5789-61
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$293.75 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: ASR ASR |
$284.94
|
| Rate for Payer: BCBS Trust/PPO |
$227.74
|
| Rate for Payer: BCN Commercial |
$227.74
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$276.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$293.75
|
| Rate for Payer: Healthscope Whirlpool |
$284.94
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.50
|
|
|
ACYCLOVIR SODIUM 500 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$26.29
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
8974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$26.29 |
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: ASR ASR |
$25.50
|
| Rate for Payer: BCBS Trust/PPO |
$20.38
|
| Rate for Payer: BCN Commercial |
$20.38
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.03
|
| Rate for Payer: Healthscope Commercial |
$26.29
|
| Rate for Payer: Healthscope Whirlpool |
$25.50
|
| Rate for Payer: Mclaren Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.14
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$17.17
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$17.17 |
| Rate for Payer: Aetna Commercial |
$15.45
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: ASR ASR |
$21.96
|
| Rate for Payer: ASR ASR |
$19.45
|
| Rate for Payer: ASR ASR |
$26.25
|
| Rate for Payer: ASR ASR |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$13.31
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: BCN Commercial |
$13.31
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Commercial |
$17.55
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.04
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$25.44
|
| Rate for Payer: Cofinity Commercial |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.04
|
| Rate for Payer: Healthscope Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Healthscope Commercial |
$27.06
|
| Rate for Payer: Healthscope Whirlpool |
$19.45
|
| Rate for Payer: Healthscope Whirlpool |
$21.96
|
| Rate for Payer: Healthscope Whirlpool |
$16.65
|
| Rate for Payer: Healthscope Whirlpool |
$26.25
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$24.35
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$15.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.81
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$17.26
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.08 |
| Max. Negotiated Rate |
$17.26 |
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$22.27
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$22.76
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$16.74
|
| Rate for Payer: ASR ASR |
$24.53
|
| Rate for Payer: ASR ASR |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Commercial |
$13.38
|
| Rate for Payer: BCN Commercial |
$19.18
|
| Rate for Payer: BCN Commercial |
$19.61
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$23.77
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Healthscope Commercial |
$25.29
|
| Rate for Payer: Healthscope Commercial |
$24.74
|
| Rate for Payer: Healthscope Commercial |
$17.26
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Whirlpool |
$16.74
|
| Rate for Payer: Healthscope Whirlpool |
$24.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$24.00
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Mclaren Commercial |
$22.27
|
| Rate for Payer: Mclaren Commercial |
$15.53
|
| Rate for Payer: Mclaren Commercial |
$22.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.19
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
IP
|
$22.75
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.92 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.48
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCN Commercial |
$17.64
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$18.04
|
| Rate for Payer: Healthscope Commercial |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$22.07
|
| Rate for Payer: Mclaren Commercial |
$20.48
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
IP
|
$28,920.82
|
|
|
Service Code
|
MS-DRG 614
|
| Min. Negotiated Rate |
$19,713.12 |
| Max. Negotiated Rate |
$28,920.82 |
| Rate for Payer: Aetna Medicare |
$20,750.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,938.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,938.31
|
| Rate for Payer: BCBS MAPPO |
$20,750.65
|
| Rate for Payer: BCN Medicare Advantage |
$20,750.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,750.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,750.65
|
| Rate for Payer: Mclaren Medicare |
$20,750.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,788.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,863.25
|
| Rate for Payer: PACE Medicare |
$19,713.12
|
| Rate for Payer: PACE SWMI |
$20,750.65
|
| Rate for Payer: PHP Commercial |
$22,825.72
|
| Rate for Payer: PHP Medicare Advantage |
$20,750.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,920.82
|
| Rate for Payer: Priority Health Medicare |
$20,750.65
|
| Rate for Payer: Priority Health Narrow Network |
$23,136.66
|
| Rate for Payer: Railroad Medicare Medicare |
$20,750.65
|
| Rate for Payer: UHC Medicare Advantage |
$21,373.17
|
| Rate for Payer: VA VA |
$20,750.65
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$18,888.92
|
|
|
Service Code
|
MS-DRG 615
|
| Min. Negotiated Rate |
$13,429.07 |
| Max. Negotiated Rate |
$18,888.92 |
| Rate for Payer: Aetna Medicare |
$14,135.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,669.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,669.82
|
| Rate for Payer: BCBS MAPPO |
$14,135.86
|
| Rate for Payer: BCN Medicare Advantage |
$14,135.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,135.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,135.86
|
| Rate for Payer: Mclaren Medicare |
$14,135.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,842.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,256.24
|
| Rate for Payer: PACE Medicare |
$13,429.07
|
| Rate for Payer: PACE SWMI |
$14,135.86
|
| Rate for Payer: PHP Commercial |
$15,549.45
|
| Rate for Payer: PHP Medicare Advantage |
$14,135.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,888.92
|
| Rate for Payer: Priority Health Medicare |
$14,135.86
|
| Rate for Payer: Priority Health Narrow Network |
$15,111.14
|
| Rate for Payer: Railroad Medicare Medicare |
$14,135.86
|
| Rate for Payer: UHC Medicare Advantage |
$14,559.94
|
| Rate for Payer: VA VA |
$14,135.86
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
IP
|
$14,536.16
|
|
|
Service Code
|
MS-DRG 560
|
| Min. Negotiated Rate |
$10,702.45 |
| Max. Negotiated Rate |
$14,536.16 |
| Rate for Payer: Aetna Medicare |
$11,265.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,082.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,082.18
|
| Rate for Payer: BCBS MAPPO |
$11,265.74
|
| Rate for Payer: BCN Medicare Advantage |
$11,265.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,265.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,265.74
|
| Rate for Payer: Mclaren Medicare |
$11,265.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,829.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,955.60
|
| Rate for Payer: PACE Medicare |
$10,702.45
|
| Rate for Payer: PACE SWMI |
$11,265.74
|
| Rate for Payer: PHP Commercial |
$12,392.31
|
| Rate for Payer: PHP Medicare Advantage |
$11,265.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,536.16
|
| Rate for Payer: Priority Health Medicare |
$11,265.74
|
| Rate for Payer: Priority Health Narrow Network |
$11,628.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11,265.74
|
| Rate for Payer: UHC Medicare Advantage |
$11,603.71
|
| Rate for Payer: VA VA |
$11,265.74
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$23,760.42
|
|
|
Service Code
|
MS-DRG 559
|
| Min. Negotiated Rate |
$16,480.60 |
| Max. Negotiated Rate |
$23,760.42 |
| Rate for Payer: Aetna Medicare |
$17,348.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,685.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,685.00
|
| Rate for Payer: BCBS MAPPO |
$17,348.00
|
| Rate for Payer: BCN Medicare Advantage |
$17,348.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,348.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,348.00
|
| Rate for Payer: Mclaren Medicare |
$17,348.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,215.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,950.20
|
| Rate for Payer: PACE Medicare |
$16,480.60
|
| Rate for Payer: PACE SWMI |
$17,348.00
|
| Rate for Payer: PHP Commercial |
$19,082.80
|
| Rate for Payer: PHP Medicare Advantage |
$17,348.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,760.42
|
| Rate for Payer: Priority Health Medicare |
$17,348.00
|
| Rate for Payer: Priority Health Narrow Network |
$19,008.34
|
| Rate for Payer: Railroad Medicare Medicare |
$17,348.00
|
| Rate for Payer: UHC Medicare Advantage |
$17,868.44
|
| Rate for Payer: VA VA |
$17,348.00
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$10,358.01
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$7,872.09 |
| Max. Negotiated Rate |
$10,358.01 |
| Rate for Payer: Aetna Medicare |
$8,286.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,358.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,358.01
|
| Rate for Payer: BCBS MAPPO |
$8,286.41
|
| Rate for Payer: BCN Medicare Advantage |
$8,286.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,286.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,286.41
|
| Rate for Payer: Mclaren Medicare |
$8,286.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,700.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,529.37
|
| Rate for Payer: PACE Medicare |
$7,872.09
|
| Rate for Payer: PACE SWMI |
$8,286.41
|
| Rate for Payer: PHP Commercial |
$9,115.05
|
| Rate for Payer: PHP Medicare Advantage |
$8,286.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,017.77
|
| Rate for Payer: Priority Health Medicare |
$8,286.41
|
| Rate for Payer: Priority Health Narrow Network |
$8,014.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8,286.41
|
| Rate for Payer: UHC Medicare Advantage |
$8,535.00
|
| Rate for Payer: VA VA |
$8,286.41
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
IP
|
$13,454.61
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$10,225.51 |
| Max. Negotiated Rate |
$13,454.61 |
| Rate for Payer: Aetna Medicare |
$10,763.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,454.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,454.61
|
| Rate for Payer: BCBS MAPPO |
$10,763.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,763.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,763.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,763.69
|
| Rate for Payer: Mclaren Medicare |
$10,763.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,301.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,378.24
|
| Rate for Payer: PACE Medicare |
$10,225.51
|
| Rate for Payer: PACE SWMI |
$10,763.69
|
| Rate for Payer: PHP Commercial |
$11,840.06
|
| Rate for Payer: PHP Medicare Advantage |
$10,763.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,303.52
|
| Rate for Payer: Priority Health Medicare |
$10,763.69
|
| Rate for Payer: Priority Health Narrow Network |
$10,642.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10,763.69
|
| Rate for Payer: UHC Medicare Advantage |
$11,086.60
|
| Rate for Payer: VA VA |
$10,763.69
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$8,859.48
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$6,452.87 |
| Max. Negotiated Rate |
$8,859.48 |
| Rate for Payer: Aetna Medicare |
$7,087.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,859.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,859.48
|
| Rate for Payer: BCBS MAPPO |
$7,087.58
|
| Rate for Payer: BCN Medicare Advantage |
$7,087.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,087.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,087.58
|
| Rate for Payer: Mclaren Medicare |
$7,087.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,441.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,150.72
|
| Rate for Payer: PACE Medicare |
$6,733.20
|
| Rate for Payer: PACE SWMI |
$7,087.58
|
| Rate for Payer: PHP Commercial |
$7,796.34
|
| Rate for Payer: PHP Medicare Advantage |
$7,087.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,066.09
|
| Rate for Payer: Priority Health Medicare |
$7,087.58
|
| Rate for Payer: Priority Health Narrow Network |
$6,452.87
|
| Rate for Payer: Railroad Medicare Medicare |
$7,087.58
|
| Rate for Payer: UHC Medicare Advantage |
$7,300.21
|
| Rate for Payer: VA VA |
$7,087.58
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
IP
|
$58,183.18
|
|
|
Service Code
|
MS-DRG 245
|
| Min. Negotiated Rate |
$38,043.30 |
| Max. Negotiated Rate |
$58,183.18 |
| Rate for Payer: Aetna Medicare |
$40,045.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,056.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,056.98
|
| Rate for Payer: BCBS MAPPO |
$40,045.58
|
| Rate for Payer: BCN Medicare Advantage |
$40,045.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,045.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$40,045.58
|
| Rate for Payer: Mclaren Medicare |
$40,045.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,047.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,052.42
|
| Rate for Payer: PACE Medicare |
$38,043.30
|
| Rate for Payer: PACE SWMI |
$40,045.58
|
| Rate for Payer: PHP Commercial |
$44,050.14
|
| Rate for Payer: PHP Medicare Advantage |
$40,045.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58,183.18
|
| Rate for Payer: Priority Health Medicare |
$40,045.58
|
| Rate for Payer: Priority Health Narrow Network |
$46,546.54
|
| Rate for Payer: Railroad Medicare Medicare |
$40,045.58
|
| Rate for Payer: UHC Medicare Advantage |
$41,246.95
|
| Rate for Payer: VA VA |
$40,045.58
|
|
|
AICD LEAD PROCEDURES
|
Facility
IP
|
$45,377.84
|
|
|
Service Code
|
MS-DRG 265
|
| Min. Negotiated Rate |
$30,021.94 |
| Max. Negotiated Rate |
$45,377.84 |
| Rate for Payer: Aetna Medicare |
$31,602.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,502.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,502.55
|
| Rate for Payer: BCBS MAPPO |
$31,602.04
|
| Rate for Payer: BCN Medicare Advantage |
$31,602.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,602.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,602.04
|
| Rate for Payer: Mclaren Medicare |
$31,602.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,182.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,342.35
|
| Rate for Payer: PACE Medicare |
$30,021.94
|
| Rate for Payer: PACE SWMI |
$31,602.04
|
| Rate for Payer: PHP Commercial |
$34,762.24
|
| Rate for Payer: PHP Medicare Advantage |
$31,602.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,377.84
|
| Rate for Payer: Priority Health Medicare |
$31,602.04
|
| Rate for Payer: Priority Health Narrow Network |
$36,302.27
|
| Rate for Payer: Railroad Medicare Medicare |
$31,602.04
|
| Rate for Payer: UHC Medicare Advantage |
$32,550.10
|
| Rate for Payer: VA VA |
$31,602.04
|
|
|
ALBUMIN, HUMAN 25 % INTRAVENOUS SOLUTION
|
Facility
IP
|
$147.29
|
|
|
Service Code
|
HCPCS P9047
|
| Hospital Charge Code |
8981
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$147.29 |
| Rate for Payer: Cofinity Commercial |
$266.62
|
| Rate for Payer: Aetna Commercial |
$132.56
|
| Rate for Payer: Aetna Commercial |
$211.82
|
| Rate for Payer: Aetna Commercial |
$255.28
|
| Rate for Payer: Aetna Commercial |
$243.14
|
| Rate for Payer: Aetna Commercial |
$217.26
|
| Rate for Payer: Aetna Commercial |
$152.39
|
| Rate for Payer: ASR ASR |
$164.24
|
| Rate for Payer: ASR ASR |
$262.05
|
| Rate for Payer: ASR ASR |
$234.16
|
| Rate for Payer: ASR ASR |
$142.87
|
| Rate for Payer: ASR ASR |
$228.30
|
| Rate for Payer: ASR ASR |
$275.13
|
| Rate for Payer: BCBS Trust/PPO |
$182.47
|
| Rate for Payer: BCBS Trust/PPO |
$209.45
|
| Rate for Payer: BCBS Trust/PPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$131.27
|
| Rate for Payer: BCBS Trust/PPO |
$187.16
|
| Rate for Payer: BCBS Trust/PPO |
$114.19
|
| Rate for Payer: BCN Commercial |
$182.47
|
| Rate for Payer: BCN Commercial |
$114.19
|
| Rate for Payer: BCN Commercial |
$131.27
|
| Rate for Payer: BCN Commercial |
$187.16
|
| Rate for Payer: BCN Commercial |
$209.45
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: Cash Price |
$216.12
|
| Rate for Payer: Cash Price |
$193.12
|
| Rate for Payer: Cash Price |
$226.92
|
| Rate for Payer: Cash Price |
$135.46
|
| Rate for Payer: Cash Price |
$188.29
|
| Rate for Payer: Cash Price |
$117.84
|
| Rate for Payer: Cofinity Commercial |
$253.94
|
| Rate for Payer: Cofinity Commercial |
$226.92
|
| Rate for Payer: Cofinity Commercial |
$221.24
|
| Rate for Payer: Cofinity Commercial |
$138.45
|
| Rate for Payer: Cofinity Commercial |
$159.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.83
|
| Rate for Payer: Healthscope Commercial |
$283.64
|
| Rate for Payer: Healthscope Commercial |
$147.29
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$270.15
|
| Rate for Payer: Healthscope Commercial |
$169.32
|
| Rate for Payer: Healthscope Commercial |
$241.40
|
| Rate for Payer: Healthscope Whirlpool |
$262.05
|
| Rate for Payer: Healthscope Whirlpool |
$164.24
|
| Rate for Payer: Healthscope Whirlpool |
$234.16
|
| Rate for Payer: Healthscope Whirlpool |
$142.87
|
| Rate for Payer: Healthscope Whirlpool |
$275.13
|
| Rate for Payer: Healthscope Whirlpool |
$228.30
|
| Rate for Payer: Mclaren Commercial |
$152.39
|
| Rate for Payer: Mclaren Commercial |
$217.26
|
| Rate for Payer: Mclaren Commercial |
$211.82
|
| Rate for Payer: Mclaren Commercial |
$255.28
|
| Rate for Payer: Mclaren Commercial |
$132.56
|
| Rate for Payer: Mclaren Commercial |
$243.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$241.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.60
|
|
|
ALBUTEROL SULFATE 2.5 MG/3 ML (0.083 %) SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$3.52
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.52 |
| Rate for Payer: Aetna Commercial |
$3.17
|
| Rate for Payer: Aetna Commercial |
$2.08
|
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: ASR ASR |
$3.97
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR ASR |
$3.41
|
| Rate for Payer: ASR ASR |
$3.36
|
| Rate for Payer: ASR ASR |
$2.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$1.79
|
| Rate for Payer: BCBS Trust/PPO |
$3.17
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: BCN Commercial |
$2.68
|
| Rate for Payer: BCN Commercial |
$1.79
|
| Rate for Payer: BCN Commercial |
$2.73
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Cofinity Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.27
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Healthscope Whirlpool |
$2.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.97
|
| Rate for Payer: Healthscope Whirlpool |
$3.41
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Mclaren Commercial |
$3.68
|
| Rate for Payer: Mclaren Commercial |
$2.08
|
| Rate for Payer: Mclaren Commercial |
$3.11
|
| Rate for Payer: Mclaren Commercial |
$3.17
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.04
|
|
|
ALBUTEROL SULFATE CONCENTRATE 2.5 MG/0.5 ML SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$3.35
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
115221
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: ASR ASR |
$3.25
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.35
|
| Rate for Payer: Healthscope Whirlpool |
$3.25
|
| Rate for Payer: Mclaren Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.95
|
|
|
ALBUTEROL SULFATE CONCENTRATE 5 MG/ML(0.5 %) SOLUTION FOR NEBULIZATION
|
Facility
IP
|
$166.20
|
|
|
Service Code
|
HCPCS J7611
|
| Hospital Charge Code |
251
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.34 |
| Max. Negotiated Rate |
$166.20 |
| Rate for Payer: Aetna Commercial |
$149.58
|
| Rate for Payer: ASR ASR |
$161.21
|
| Rate for Payer: BCBS Trust/PPO |
$128.85
|
| Rate for Payer: BCN Commercial |
$128.85
|
| Rate for Payer: Cash Price |
$132.96
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.96
|
| Rate for Payer: Healthscope Commercial |
$166.20
|
| Rate for Payer: Healthscope Whirlpool |
$161.21
|
| Rate for Payer: Mclaren Commercial |
$149.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$141.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.26
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
IP
|
$109.20
|
|
|
Service Code
|
NDC 9900-0011-69
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: ASR ASR |
$105.92
|
| Rate for Payer: BCBS Trust/PPO |
$84.66
|
| Rate for Payer: BCN Commercial |
$84.66
|
| Rate for Payer: Cash Price |
$87.36
|
| Rate for Payer: Cofinity Commercial |
$102.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.36
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$105.92
|
| Rate for Payer: Mclaren Commercial |
$98.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.10
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
IP
|
$46.90
|
|
|
Service Code
|
NDC 0781-7296-85
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$46.90 |
| Rate for Payer: Aetna Commercial |
$42.21
|
| Rate for Payer: ASR ASR |
$45.49
|
| Rate for Payer: BCBS Trust/PPO |
$36.36
|
| Rate for Payer: BCN Commercial |
$36.36
|
| Rate for Payer: Cash Price |
$37.52
|
| Rate for Payer: Cofinity Commercial |
$44.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.52
|
| Rate for Payer: Healthscope Commercial |
$46.90
|
| Rate for Payer: Healthscope Whirlpool |
$45.49
|
| Rate for Payer: Mclaren Commercial |
$42.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.27
|
|
|
ALBUTEROL SULFATE HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
IP
|
$146.30
|
|
|
Service Code
|
NDC 68180-963-01
|
| Hospital Charge Code |
300450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$131.67
|
| Rate for Payer: ASR ASR |
$141.91
|
| Rate for Payer: BCBS Trust/PPO |
$113.43
|
| Rate for Payer: BCN Commercial |
$113.43
|
| Rate for Payer: Cash Price |
$117.04
|
| Rate for Payer: Cofinity Commercial |
$137.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.04
|
| Rate for Payer: Healthscope Commercial |
$146.30
|
| Rate for Payer: Healthscope Whirlpool |
$141.91
|
| Rate for Payer: Mclaren Commercial |
$131.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$124.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.74
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
IP
|
$8,181.11
|
|
|
Service Code
|
MS-DRG 894
|
| Min. Negotiated Rate |
$5,901.26 |
| Max. Negotiated Rate |
$8,181.11 |
| Rate for Payer: Aetna Medicare |
$6,544.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,181.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,181.11
|
| Rate for Payer: BCBS MAPPO |
$6,544.89
|
| Rate for Payer: BCN Medicare Advantage |
$6,544.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,544.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,544.89
|
| Rate for Payer: Mclaren Medicare |
$6,544.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,872.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,526.62
|
| Rate for Payer: PACE Medicare |
$6,217.65
|
| Rate for Payer: PACE SWMI |
$6,544.89
|
| Rate for Payer: PHP Commercial |
$7,199.38
|
| Rate for Payer: PHP Medicare Advantage |
$6,544.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,376.58
|
| Rate for Payer: Priority Health Medicare |
$6,544.89
|
| Rate for Payer: Priority Health Narrow Network |
$5,901.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6,544.89
|
| Rate for Payer: UHC Medicare Advantage |
$6,741.24
|
| Rate for Payer: VA VA |
$6,544.89
|
|
