|
COLESTIPOL 1 GRAM TABLET
|
Facility
|
IP
|
$395.71
|
|
|
Service Code
|
NDC 0115-5211-16
|
| Hospital Charge Code |
13884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$356.14
|
| Rate for Payer: ASR ASR |
$383.84
|
| Rate for Payer: BCBS Trust/PPO |
$306.79
|
| Rate for Payer: BCN Commercial |
$306.79
|
| Rate for Payer: Cash Price |
$316.57
|
| Rate for Payer: Cofinity Commercial |
$371.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.57
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Healthscope Whirlpool |
$383.84
|
| Rate for Payer: Mclaren Commercial |
$356.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$336.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$348.22
|
|
|
COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT
|
Facility
|
IP
|
$875.38
|
|
|
Service Code
|
NDC 50484-010-30
|
| Hospital Charge Code |
9682
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$612.77 |
| Max. Negotiated Rate |
$875.38 |
| Rate for Payer: Aetna Commercial |
$787.84
|
| Rate for Payer: ASR ASR |
$849.12
|
| Rate for Payer: BCBS Trust/PPO |
$678.68
|
| Rate for Payer: BCN Commercial |
$678.68
|
| Rate for Payer: Cash Price |
$700.31
|
| Rate for Payer: Cofinity Commercial |
$822.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.30
|
| Rate for Payer: Healthscope Commercial |
$875.38
|
| Rate for Payer: Healthscope Whirlpool |
$849.12
|
| Rate for Payer: Mclaren Commercial |
$787.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$744.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.33
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$78,533.29
|
|
|
Service Code
|
MS-DRG 454
|
| Min. Negotiated Rate |
$50,790.75 |
| Max. Negotiated Rate |
$78,533.29 |
| Rate for Payer: Aetna Medicare |
$53,463.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,829.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,829.94
|
| Rate for Payer: BCBS MAPPO |
$53,463.95
|
| Rate for Payer: BCN Medicare Advantage |
$53,463.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,463.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,463.95
|
| Rate for Payer: Mclaren Medicare |
$53,463.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,137.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,483.54
|
| Rate for Payer: PACE Medicare |
$50,790.75
|
| Rate for Payer: PACE SWMI |
$53,463.95
|
| Rate for Payer: PHP Commercial |
$58,810.34
|
| Rate for Payer: PHP Medicare Advantage |
$53,463.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78,533.29
|
| Rate for Payer: Priority Health Medicare |
$53,463.95
|
| Rate for Payer: Priority Health Narrow Network |
$62,826.63
|
| Rate for Payer: Railroad Medicare Medicare |
$53,463.95
|
| Rate for Payer: UHC Medicare Advantage |
$55,067.87
|
| Rate for Payer: VA VA |
$53,463.95
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$113,780.38
|
|
|
Service Code
|
MS-DRG 453
|
| Min. Negotiated Rate |
$72,869.81 |
| Max. Negotiated Rate |
$113,780.38 |
| Rate for Payer: Aetna Medicare |
$76,705.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95,881.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95,881.32
|
| Rate for Payer: BCBS MAPPO |
$76,705.06
|
| Rate for Payer: BCN Medicare Advantage |
$76,705.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76,705.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$76,705.06
|
| Rate for Payer: Mclaren Medicare |
$76,705.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80,540.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88,210.82
|
| Rate for Payer: PACE Medicare |
$72,869.81
|
| Rate for Payer: PACE SWMI |
$76,705.06
|
| Rate for Payer: PHP Commercial |
$84,375.57
|
| Rate for Payer: PHP Medicare Advantage |
$76,705.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113,780.38
|
| Rate for Payer: Priority Health Medicare |
$76,705.06
|
| Rate for Payer: Priority Health Narrow Network |
$91,024.30
|
| Rate for Payer: Railroad Medicare Medicare |
$76,705.06
|
| Rate for Payer: UHC Medicare Advantage |
$79,006.21
|
| Rate for Payer: VA VA |
$76,705.06
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$59,135.90
|
|
|
Service Code
|
MS-DRG 455
|
| Min. Negotiated Rate |
$38,640.09 |
| Max. Negotiated Rate |
$59,135.90 |
| Rate for Payer: Aetna Medicare |
$40,673.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,842.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,842.22
|
| Rate for Payer: BCBS MAPPO |
$40,673.78
|
| Rate for Payer: BCN Medicare Advantage |
$40,673.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,673.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$40,673.78
|
| Rate for Payer: Mclaren Medicare |
$40,673.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,707.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,774.85
|
| Rate for Payer: PACE Medicare |
$38,640.09
|
| Rate for Payer: PACE SWMI |
$40,673.78
|
| Rate for Payer: PHP Commercial |
$44,741.16
|
| Rate for Payer: PHP Medicare Advantage |
$40,673.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59,135.90
|
| Rate for Payer: Priority Health Medicare |
$40,673.78
|
| Rate for Payer: Priority Health Narrow Network |
$47,308.72
|
| Rate for Payer: Railroad Medicare Medicare |
$40,673.78
|
| Rate for Payer: UHC Medicare Advantage |
$41,893.99
|
| Rate for Payer: VA VA |
$40,673.78
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$13,777.32
|
|
|
Service Code
|
MS-DRG 381
|
| Min. Negotiated Rate |
$10,227.11 |
| Max. Negotiated Rate |
$13,777.32 |
| Rate for Payer: Aetna Medicare |
$10,765.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,456.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,456.72
|
| Rate for Payer: BCBS MAPPO |
$10,765.38
|
| Rate for Payer: BCN Medicare Advantage |
$10,765.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,765.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,765.38
|
| Rate for Payer: Mclaren Medicare |
$10,765.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,303.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,380.19
|
| Rate for Payer: PACE Medicare |
$10,227.11
|
| Rate for Payer: PACE SWMI |
$10,765.38
|
| Rate for Payer: PHP Commercial |
$11,841.92
|
| Rate for Payer: PHP Medicare Advantage |
$10,765.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,777.32
|
| Rate for Payer: Priority Health Medicare |
$10,765.38
|
| Rate for Payer: Priority Health Narrow Network |
$11,021.86
|
| Rate for Payer: Railroad Medicare Medicare |
$10,765.38
|
| Rate for Payer: UHC Medicare Advantage |
$11,088.34
|
| Rate for Payer: VA VA |
$10,765.38
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$25,018.74
|
|
|
Service Code
|
MS-DRG 380
|
| Min. Negotiated Rate |
$17,268.82 |
| Max. Negotiated Rate |
$25,018.74 |
| Rate for Payer: Aetna Medicare |
$18,177.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,722.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,722.14
|
| Rate for Payer: BCBS MAPPO |
$18,177.71
|
| Rate for Payer: BCN Medicare Advantage |
$18,177.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,177.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,177.71
|
| Rate for Payer: Mclaren Medicare |
$18,177.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,086.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,904.37
|
| Rate for Payer: PACE Medicare |
$17,268.82
|
| Rate for Payer: PACE SWMI |
$18,177.71
|
| Rate for Payer: PHP Commercial |
$19,995.48
|
| Rate for Payer: PHP Medicare Advantage |
$18,177.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,018.74
|
| Rate for Payer: Priority Health Medicare |
$18,177.71
|
| Rate for Payer: Priority Health Narrow Network |
$20,014.99
|
| Rate for Payer: Railroad Medicare Medicare |
$18,177.71
|
| Rate for Payer: UHC Medicare Advantage |
$18,723.04
|
| Rate for Payer: VA VA |
$18,177.71
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$10,113.55
|
|
|
Service Code
|
MS-DRG 382
|
| Min. Negotiated Rate |
$7,686.30 |
| Max. Negotiated Rate |
$10,113.55 |
| Rate for Payer: Aetna Medicare |
$8,090.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,113.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,113.55
|
| Rate for Payer: BCBS MAPPO |
$8,090.84
|
| Rate for Payer: BCN Medicare Advantage |
$8,090.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,090.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,090.84
|
| Rate for Payer: Mclaren Medicare |
$8,090.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,495.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,304.47
|
| Rate for Payer: PACE Medicare |
$7,686.30
|
| Rate for Payer: PACE SWMI |
$8,090.84
|
| Rate for Payer: PHP Commercial |
$8,899.92
|
| Rate for Payer: PHP Medicare Advantage |
$8,090.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,721.16
|
| Rate for Payer: Priority Health Medicare |
$8,090.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,776.93
|
| Rate for Payer: Railroad Medicare Medicare |
$8,090.84
|
| Rate for Payer: UHC Medicare Advantage |
$8,333.57
|
| Rate for Payer: VA VA |
$8,090.84
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$13,273.99
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$9,911.82 |
| Max. Negotiated Rate |
$13,273.99 |
| Rate for Payer: Aetna Medicare |
$10,433.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,041.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,041.88
|
| Rate for Payer: BCBS MAPPO |
$10,433.50
|
| Rate for Payer: BCN Medicare Advantage |
$10,433.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,433.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,433.50
|
| Rate for Payer: Mclaren Medicare |
$10,433.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,955.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,998.52
|
| Rate for Payer: PACE Medicare |
$9,911.82
|
| Rate for Payer: PACE SWMI |
$10,433.50
|
| Rate for Payer: PHP Commercial |
$11,476.85
|
| Rate for Payer: PHP Medicare Advantage |
$10,433.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,273.99
|
| Rate for Payer: Priority Health Medicare |
$10,433.50
|
| Rate for Payer: Priority Health Narrow Network |
$10,619.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,433.50
|
| Rate for Payer: UHC Medicare Advantage |
$10,746.50
|
| Rate for Payer: VA VA |
$10,433.50
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$23,429.15
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$16,273.08 |
| Max. Negotiated Rate |
$23,429.15 |
| Rate for Payer: Aetna Medicare |
$17,129.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,411.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,411.95
|
| Rate for Payer: BCBS MAPPO |
$17,129.56
|
| Rate for Payer: BCN Medicare Advantage |
$17,129.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,129.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,129.56
|
| Rate for Payer: Mclaren Medicare |
$17,129.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,986.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,698.99
|
| Rate for Payer: PACE Medicare |
$16,273.08
|
| Rate for Payer: PACE SWMI |
$17,129.56
|
| Rate for Payer: PHP Commercial |
$18,842.52
|
| Rate for Payer: PHP Medicare Advantage |
$17,129.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,429.15
|
| Rate for Payer: Priority Health Medicare |
$17,129.56
|
| Rate for Payer: Priority Health Narrow Network |
$18,743.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17,129.56
|
| Rate for Payer: UHC Medicare Advantage |
$17,643.45
|
| Rate for Payer: VA VA |
$17,129.56
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$9,485.99
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$7,167.80 |
| Max. Negotiated Rate |
$9,485.99 |
| Rate for Payer: Aetna Medicare |
$7,588.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,485.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,485.99
|
| Rate for Payer: BCBS MAPPO |
$7,588.79
|
| Rate for Payer: BCN Medicare Advantage |
$7,588.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,588.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,588.79
|
| Rate for Payer: Mclaren Medicare |
$7,588.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,968.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,727.11
|
| Rate for Payer: PACE Medicare |
$7,209.35
|
| Rate for Payer: PACE SWMI |
$7,588.79
|
| Rate for Payer: PHP Commercial |
$8,347.67
|
| Rate for Payer: PHP Medicare Advantage |
$7,588.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,959.75
|
| Rate for Payer: Priority Health Medicare |
$7,588.79
|
| Rate for Payer: Priority Health Narrow Network |
$7,167.80
|
| Rate for Payer: Railroad Medicare Medicare |
$7,588.79
|
| Rate for Payer: UHC Medicare Advantage |
$7,816.45
|
| Rate for Payer: VA VA |
$7,588.79
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$158.93
|
|
|
Service Code
|
NDC 3932801416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$158.93 |
| Rate for Payer: Aetna Commercial |
$143.04
|
| Rate for Payer: ASR ASR |
$154.16
|
| Rate for Payer: BCBS Trust/PPO |
$123.22
|
| Rate for Payer: BCN Commercial |
$123.22
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cofinity Commercial |
$149.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.14
|
| Rate for Payer: Healthscope Commercial |
$158.93
|
| Rate for Payer: Healthscope Whirlpool |
$154.16
|
| Rate for Payer: Mclaren Commercial |
$143.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.86
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVEÂ PROCEDURES
|
Facility
|
IP
|
$138,295.79
|
|
|
Service Code
|
MS-DRG 212
|
| Min. Negotiated Rate |
$88,226.45 |
| Max. Negotiated Rate |
$138,295.79 |
| Rate for Payer: Aetna Medicare |
$92,869.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$116,087.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$116,087.44
|
| Rate for Payer: BCBS MAPPO |
$92,869.95
|
| Rate for Payer: BCN Medicare Advantage |
$92,869.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92,869.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$92,869.95
|
| Rate for Payer: Mclaren Medicare |
$92,869.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$97,513.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106,800.44
|
| Rate for Payer: PACE Medicare |
$88,226.45
|
| Rate for Payer: PACE SWMI |
$92,869.95
|
| Rate for Payer: PHP Commercial |
$102,156.94
|
| Rate for Payer: PHP Medicare Advantage |
$92,869.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138,295.79
|
| Rate for Payer: Priority Health Medicare |
$92,869.95
|
| Rate for Payer: Priority Health Narrow Network |
$110,636.63
|
| Rate for Payer: Railroad Medicare Medicare |
$92,869.95
|
| Rate for Payer: UHC Medicare Advantage |
$95,656.05
|
| Rate for Payer: VA VA |
$92,869.95
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$14,764.72
|
|
|
Service Code
|
MS-DRG 089
|
| Min. Negotiated Rate |
$10,845.63 |
| Max. Negotiated Rate |
$14,764.72 |
| Rate for Payer: Aetna Medicare |
$11,416.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,270.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,270.56
|
| Rate for Payer: BCBS MAPPO |
$11,416.45
|
| Rate for Payer: BCN Medicare Advantage |
$11,416.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,416.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,416.45
|
| Rate for Payer: Mclaren Medicare |
$11,416.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,987.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,128.92
|
| Rate for Payer: PACE Medicare |
$10,845.63
|
| Rate for Payer: PACE SWMI |
$11,416.45
|
| Rate for Payer: PHP Commercial |
$12,558.10
|
| Rate for Payer: PHP Medicare Advantage |
$11,416.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,764.72
|
| Rate for Payer: Priority Health Medicare |
$11,416.45
|
| Rate for Payer: Priority Health Narrow Network |
$11,811.78
|
| Rate for Payer: Railroad Medicare Medicare |
$11,416.45
|
| Rate for Payer: UHC Medicare Advantage |
$11,758.94
|
| Rate for Payer: VA VA |
$11,416.45
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$19,693.99
|
|
|
Service Code
|
MS-DRG 088
|
| Min. Negotiated Rate |
$13,933.36 |
| Max. Negotiated Rate |
$19,693.99 |
| Rate for Payer: Aetna Medicare |
$14,666.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,333.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,333.38
|
| Rate for Payer: BCBS MAPPO |
$14,666.70
|
| Rate for Payer: BCN Medicare Advantage |
$14,666.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,666.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,666.70
|
| Rate for Payer: Mclaren Medicare |
$14,666.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,400.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,866.70
|
| Rate for Payer: PACE Medicare |
$13,933.36
|
| Rate for Payer: PACE SWMI |
$14,666.70
|
| Rate for Payer: PHP Commercial |
$16,133.37
|
| Rate for Payer: PHP Medicare Advantage |
$14,666.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,693.99
|
| Rate for Payer: Priority Health Medicare |
$14,666.70
|
| Rate for Payer: Priority Health Narrow Network |
$15,755.19
|
| Rate for Payer: Railroad Medicare Medicare |
$14,666.70
|
| Rate for Payer: UHC Medicare Advantage |
$15,106.70
|
| Rate for Payer: VA VA |
$14,666.70
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$12,002.83
|
|
|
Service Code
|
MS-DRG 090
|
| Min. Negotiated Rate |
$9,115.56 |
| Max. Negotiated Rate |
$12,002.83 |
| Rate for Payer: Aetna Medicare |
$9,595.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,994.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,994.16
|
| Rate for Payer: BCBS MAPPO |
$9,595.33
|
| Rate for Payer: BCN Medicare Advantage |
$9,595.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,595.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,595.33
|
| Rate for Payer: Mclaren Medicare |
$9,595.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,075.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,034.63
|
| Rate for Payer: PACE Medicare |
$9,115.56
|
| Rate for Payer: PACE SWMI |
$9,595.33
|
| Rate for Payer: PHP Commercial |
$10,554.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,595.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,002.83
|
| Rate for Payer: Priority Health Medicare |
$9,595.33
|
| Rate for Payer: Priority Health Narrow Network |
$9,602.26
|
| Rate for Payer: Railroad Medicare Medicare |
$9,595.33
|
| Rate for Payer: UHC Medicare Advantage |
$9,883.19
|
| Rate for Payer: VA VA |
$9,595.33
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,464.96
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,025.47 |
| Max. Negotiated Rate |
$1,464.96 |
| Rate for Payer: Aetna Commercial |
$1,318.46
|
| Rate for Payer: ASR ASR |
$1,421.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.78
|
| Rate for Payer: BCN Commercial |
$1,135.78
|
| Rate for Payer: Cash Price |
$1,171.97
|
| Rate for Payer: Cofinity Commercial |
$1,377.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,171.97
|
| Rate for Payer: Healthscope Commercial |
$1,464.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,421.01
|
| Rate for Payer: Mclaren Commercial |
$1,318.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,245.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,289.16
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,376.14
|
|
|
Service Code
|
NDC 0046-1102-81
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,663.30 |
| Max. Negotiated Rate |
$2,376.14 |
| Rate for Payer: Aetna Commercial |
$2,138.53
|
| Rate for Payer: ASR ASR |
$2,304.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,842.22
|
| Rate for Payer: BCN Commercial |
$1,842.22
|
| Rate for Payer: Cash Price |
$1,900.91
|
| Rate for Payer: Cofinity Commercial |
$2,233.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,900.91
|
| Rate for Payer: Healthscope Commercial |
$2,376.14
|
| Rate for Payer: Healthscope Whirlpool |
$2,304.86
|
| Rate for Payer: Mclaren Commercial |
$2,138.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,019.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,091.00
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,095.33
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$766.73 |
| Max. Negotiated Rate |
$1,095.33 |
| Rate for Payer: Aetna Commercial |
$985.80
|
| Rate for Payer: ASR ASR |
$1,062.47
|
| Rate for Payer: BCBS Trust/PPO |
$849.21
|
| Rate for Payer: BCN Commercial |
$849.21
|
| Rate for Payer: Cash Price |
$876.26
|
| Rate for Payer: Cofinity Commercial |
$1,029.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$876.26
|
| Rate for Payer: Healthscope Commercial |
$1,095.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,062.47
|
| Rate for Payer: Mclaren Commercial |
$985.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$931.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$766.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$963.89
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$15,399.01
|
|
|
Service Code
|
MS-DRG 546
|
| Min. Negotiated Rate |
$11,242.96 |
| Max. Negotiated Rate |
$15,399.01 |
| Rate for Payer: Aetna Medicare |
$11,834.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,793.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,793.36
|
| Rate for Payer: BCBS MAPPO |
$11,834.69
|
| Rate for Payer: BCN Medicare Advantage |
$11,834.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,834.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,834.69
|
| Rate for Payer: Mclaren Medicare |
$11,834.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,426.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,609.89
|
| Rate for Payer: PACE Medicare |
$11,242.96
|
| Rate for Payer: PACE SWMI |
$11,834.69
|
| Rate for Payer: PHP Commercial |
$13,018.16
|
| Rate for Payer: PHP Medicare Advantage |
$11,834.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,399.01
|
| Rate for Payer: Priority Health Medicare |
$11,834.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,319.21
|
| Rate for Payer: Railroad Medicare Medicare |
$11,834.69
|
| Rate for Payer: UHC Medicare Advantage |
$12,189.73
|
| Rate for Payer: VA VA |
$11,834.69
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$32,012.69
|
|
|
Service Code
|
MS-DRG 545
|
| Min. Negotiated Rate |
$21,649.89 |
| Max. Negotiated Rate |
$32,012.69 |
| Rate for Payer: Aetna Medicare |
$22,789.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,486.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,486.70
|
| Rate for Payer: BCBS MAPPO |
$22,789.36
|
| Rate for Payer: BCN Medicare Advantage |
$22,789.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,789.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,789.36
|
| Rate for Payer: Mclaren Medicare |
$22,789.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,928.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,207.76
|
| Rate for Payer: PACE Medicare |
$21,649.89
|
| Rate for Payer: PACE SWMI |
$22,789.36
|
| Rate for Payer: PHP Commercial |
$25,068.30
|
| Rate for Payer: PHP Medicare Advantage |
$22,789.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,012.69
|
| Rate for Payer: Priority Health Medicare |
$22,789.36
|
| Rate for Payer: Priority Health Narrow Network |
$25,610.15
|
| Rate for Payer: Railroad Medicare Medicare |
$22,789.36
|
| Rate for Payer: UHC Medicare Advantage |
$23,473.04
|
| Rate for Payer: VA VA |
$22,789.36
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,814.18
|
|
|
Service Code
|
MS-DRG 547
|
| Min. Negotiated Rate |
$8,218.77 |
| Max. Negotiated Rate |
$10,814.18 |
| Rate for Payer: Aetna Medicare |
$8,651.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,814.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,814.18
|
| Rate for Payer: BCBS MAPPO |
$8,651.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,651.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,651.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,651.34
|
| Rate for Payer: Mclaren Medicare |
$8,651.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,083.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,949.04
|
| Rate for Payer: PACE Medicare |
$8,218.77
|
| Rate for Payer: PACE SWMI |
$8,651.34
|
| Rate for Payer: PHP Commercial |
$9,516.47
|
| Rate for Payer: PHP Medicare Advantage |
$8,651.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,444.06
|
| Rate for Payer: Priority Health Medicare |
$8,651.34
|
| Rate for Payer: Priority Health Narrow Network |
$8,355.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8,651.34
|
| Rate for Payer: UHC Medicare Advantage |
$8,910.88
|
| Rate for Payer: VA VA |
$8,651.34
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$100,146.86
|
|
|
Service Code
|
MS-DRG 233
|
| Min. Negotiated Rate |
$64,329.68 |
| Max. Negotiated Rate |
$100,146.86 |
| Rate for Payer: Aetna Medicare |
$67,715.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84,644.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84,644.31
|
| Rate for Payer: BCBS MAPPO |
$67,715.45
|
| Rate for Payer: BCN Medicare Advantage |
$67,715.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67,715.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$67,715.45
|
| Rate for Payer: Mclaren Medicare |
$67,715.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71,101.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77,872.77
|
| Rate for Payer: PACE Medicare |
$64,329.68
|
| Rate for Payer: PACE SWMI |
$67,715.45
|
| Rate for Payer: PHP Commercial |
$74,487.00
|
| Rate for Payer: PHP Medicare Advantage |
$67,715.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100,146.86
|
| Rate for Payer: Priority Health Medicare |
$67,715.45
|
| Rate for Payer: Priority Health Narrow Network |
$80,117.49
|
| Rate for Payer: Railroad Medicare Medicare |
$67,715.45
|
| Rate for Payer: UHC Medicare Advantage |
$69,746.91
|
| Rate for Payer: VA VA |
$67,715.45
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$66,741.04
|
|
|
Service Code
|
MS-DRG 234
|
| Min. Negotiated Rate |
$43,404.01 |
| Max. Negotiated Rate |
$66,741.04 |
| Rate for Payer: Aetna Medicare |
$45,688.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,110.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,110.54
|
| Rate for Payer: BCBS MAPPO |
$45,688.43
|
| Rate for Payer: BCN Medicare Advantage |
$45,688.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,688.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$45,688.43
|
| Rate for Payer: Mclaren Medicare |
$45,688.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,972.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,541.69
|
| Rate for Payer: PACE Medicare |
$43,404.01
|
| Rate for Payer: PACE SWMI |
$45,688.43
|
| Rate for Payer: PHP Commercial |
$50,257.27
|
| Rate for Payer: PHP Medicare Advantage |
$45,688.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,741.04
|
| Rate for Payer: Priority Health Medicare |
$45,688.43
|
| Rate for Payer: Priority Health Narrow Network |
$53,392.83
|
| Rate for Payer: Railroad Medicare Medicare |
$45,688.43
|
| Rate for Payer: UHC Medicare Advantage |
$47,059.08
|
| Rate for Payer: VA VA |
$45,688.43
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$75,506.90
|
|
|
Service Code
|
MS-DRG 235
|
| Min. Negotiated Rate |
$48,895.01 |
| Max. Negotiated Rate |
$75,506.90 |
| Rate for Payer: Aetna Medicare |
$51,468.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64,335.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64,335.54
|
| Rate for Payer: BCBS MAPPO |
$51,468.43
|
| Rate for Payer: BCN Medicare Advantage |
$51,468.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,468.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$51,468.43
|
| Rate for Payer: Mclaren Medicare |
$51,468.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54,041.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59,188.69
|
| Rate for Payer: PACE Medicare |
$48,895.01
|
| Rate for Payer: PACE SWMI |
$51,468.43
|
| Rate for Payer: PHP Commercial |
$56,615.27
|
| Rate for Payer: PHP Medicare Advantage |
$51,468.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75,506.90
|
| Rate for Payer: Priority Health Medicare |
$51,468.43
|
| Rate for Payer: Priority Health Narrow Network |
$60,405.52
|
| Rate for Payer: Railroad Medicare Medicare |
$51,468.43
|
| Rate for Payer: UHC Medicare Advantage |
$53,012.48
|
| Rate for Payer: VA VA |
$51,468.43
|
|
