|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$51,889.01
|
|
|
Service Code
|
MS-DRG 236
|
| Min. Negotiated Rate |
$34,100.57 |
| Max. Negotiated Rate |
$51,889.01 |
| Rate for Payer: Aetna Medicare |
$35,895.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,869.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,869.18
|
| Rate for Payer: BCBS MAPPO |
$35,895.34
|
| Rate for Payer: BCN Medicare Advantage |
$35,895.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,895.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$35,895.34
|
| Rate for Payer: Mclaren Medicare |
$35,895.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,690.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,279.64
|
| Rate for Payer: PACE Medicare |
$34,100.57
|
| Rate for Payer: PACE SWMI |
$35,895.34
|
| Rate for Payer: PHP Commercial |
$39,484.87
|
| Rate for Payer: PHP Medicare Advantage |
$35,895.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,889.01
|
| Rate for Payer: Priority Health Medicare |
$35,895.34
|
| Rate for Payer: Priority Health Narrow Network |
$41,511.21
|
| Rate for Payer: Railroad Medicare Medicare |
$35,895.34
|
| Rate for Payer: UHC Medicare Advantage |
$36,972.20
|
| Rate for Payer: VA VA |
$35,895.34
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$104,199.17
|
|
|
Service Code
|
MS-DRG 231
|
| Min. Negotiated Rate |
$66,868.08 |
| Max. Negotiated Rate |
$104,199.17 |
| Rate for Payer: Aetna Medicare |
$70,387.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87,984.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87,984.31
|
| Rate for Payer: BCBS MAPPO |
$70,387.45
|
| Rate for Payer: BCN Medicare Advantage |
$70,387.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70,387.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$70,387.45
|
| Rate for Payer: Mclaren Medicare |
$70,387.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73,906.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80,945.57
|
| Rate for Payer: PACE Medicare |
$66,868.08
|
| Rate for Payer: PACE SWMI |
$70,387.45
|
| Rate for Payer: PHP Commercial |
$77,426.20
|
| Rate for Payer: PHP Medicare Advantage |
$70,387.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104,199.17
|
| Rate for Payer: Priority Health Medicare |
$70,387.45
|
| Rate for Payer: Priority Health Narrow Network |
$83,359.34
|
| Rate for Payer: Railroad Medicare Medicare |
$70,387.45
|
| Rate for Payer: UHC Medicare Advantage |
$72,499.07
|
| Rate for Payer: VA VA |
$70,387.45
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$76,380.02
|
|
|
Service Code
|
MS-DRG 232
|
| Min. Negotiated Rate |
$49,441.94 |
| Max. Negotiated Rate |
$76,380.02 |
| Rate for Payer: Aetna Medicare |
$52,044.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65,055.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65,055.19
|
| Rate for Payer: BCBS MAPPO |
$52,044.15
|
| Rate for Payer: BCN Medicare Advantage |
$52,044.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52,044.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$52,044.15
|
| Rate for Payer: Mclaren Medicare |
$52,044.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54,646.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59,850.77
|
| Rate for Payer: PACE Medicare |
$49,441.94
|
| Rate for Payer: PACE SWMI |
$52,044.15
|
| Rate for Payer: PHP Commercial |
$57,248.56
|
| Rate for Payer: PHP Medicare Advantage |
$52,044.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76,380.02
|
| Rate for Payer: Priority Health Medicare |
$52,044.15
|
| Rate for Payer: Priority Health Narrow Network |
$61,104.02
|
| Rate for Payer: Railroad Medicare Medicare |
$52,044.15
|
| Rate for Payer: UHC Medicare Advantage |
$53,605.47
|
| Rate for Payer: VA VA |
$52,044.15
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$53,157.60
|
|
|
Service Code
|
MS-DRG 323
|
| Min. Negotiated Rate |
$34,895.22 |
| Max. Negotiated Rate |
$53,157.60 |
| Rate for Payer: Aetna Medicare |
$36,731.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,914.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,914.76
|
| Rate for Payer: BCBS MAPPO |
$36,731.81
|
| Rate for Payer: BCN Medicare Advantage |
$36,731.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,731.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,731.81
|
| Rate for Payer: Mclaren Medicare |
$36,731.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38,568.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,241.58
|
| Rate for Payer: PACE Medicare |
$34,895.22
|
| Rate for Payer: PACE SWMI |
$36,731.81
|
| Rate for Payer: PHP Commercial |
$40,404.99
|
| Rate for Payer: PHP Medicare Advantage |
$36,731.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53,157.60
|
| Rate for Payer: Priority Health Medicare |
$36,731.81
|
| Rate for Payer: Priority Health Narrow Network |
$42,526.08
|
| Rate for Payer: Railroad Medicare Medicare |
$36,731.81
|
| Rate for Payer: UHC Medicare Advantage |
$37,833.76
|
| Rate for Payer: VA VA |
$36,731.81
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$38,116.82
|
|
|
Service Code
|
MS-DRG 324
|
| Min. Negotiated Rate |
$25,473.57 |
| Max. Negotiated Rate |
$38,116.82 |
| Rate for Payer: Aetna Medicare |
$26,814.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,517.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,517.85
|
| Rate for Payer: BCBS MAPPO |
$26,814.28
|
| Rate for Payer: BCN Medicare Advantage |
$26,814.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,814.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,814.28
|
| Rate for Payer: Mclaren Medicare |
$26,814.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,154.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,836.42
|
| Rate for Payer: PACE Medicare |
$25,473.57
|
| Rate for Payer: PACE SWMI |
$26,814.28
|
| Rate for Payer: PHP Commercial |
$29,495.71
|
| Rate for Payer: PHP Medicare Advantage |
$26,814.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,116.82
|
| Rate for Payer: Priority Health Medicare |
$26,814.28
|
| Rate for Payer: Priority Health Narrow Network |
$30,493.46
|
| Rate for Payer: Railroad Medicare Medicare |
$26,814.28
|
| Rate for Payer: UHC Medicare Advantage |
$27,618.71
|
| Rate for Payer: VA VA |
$26,814.28
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$33,952.81
|
|
|
Service Code
|
MS-DRG 325
|
| Min. Negotiated Rate |
$22,865.21 |
| Max. Negotiated Rate |
$33,952.81 |
| Rate for Payer: Aetna Medicare |
$24,068.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,085.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,085.80
|
| Rate for Payer: BCBS MAPPO |
$24,068.64
|
| Rate for Payer: BCN Medicare Advantage |
$24,068.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,068.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,068.64
|
| Rate for Payer: Mclaren Medicare |
$24,068.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,272.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,678.94
|
| Rate for Payer: PACE Medicare |
$22,865.21
|
| Rate for Payer: PACE SWMI |
$24,068.64
|
| Rate for Payer: PHP Commercial |
$26,475.50
|
| Rate for Payer: PHP Medicare Advantage |
$24,068.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,952.81
|
| Rate for Payer: Priority Health Medicare |
$24,068.64
|
| Rate for Payer: Priority Health Narrow Network |
$27,162.25
|
| Rate for Payer: Railroad Medicare Medicare |
$24,068.64
|
| Rate for Payer: UHC Medicare Advantage |
$24,790.70
|
| Rate for Payer: VA VA |
$24,068.64
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$221.16
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$154.81 |
| Max. Negotiated Rate |
$221.16 |
| Rate for Payer: Aetna Commercial |
$199.04
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: ASR ASR |
$214.53
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: BCBS Trust/PPO |
$171.47
|
| Rate for Payer: BCBS Trust/PPO |
$225.68
|
| Rate for Payer: BCBS Trust/PPO |
$64.17
|
| Rate for Payer: BCN Commercial |
$171.47
|
| Rate for Payer: BCN Commercial |
$225.68
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$207.89
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$291.09
|
| Rate for Payer: Healthscope Commercial |
$221.16
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$214.53
|
| Rate for Payer: Healthscope Whirlpool |
$282.36
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$199.04
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
|
|
CPT 0255T
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$312.20 |
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.20
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$19,426.92
|
|
|
Service Code
|
MS-DRG 073
|
| Min. Negotiated Rate |
$13,766.07 |
| Max. Negotiated Rate |
$19,426.92 |
| Rate for Payer: Aetna Medicare |
$14,490.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,113.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,113.25
|
| Rate for Payer: BCBS MAPPO |
$14,490.60
|
| Rate for Payer: BCN Medicare Advantage |
$14,490.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,490.60
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,490.60
|
| Rate for Payer: Mclaren Medicare |
$14,490.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,215.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,664.19
|
| Rate for Payer: PACE Medicare |
$13,766.07
|
| Rate for Payer: PACE SWMI |
$14,490.60
|
| Rate for Payer: PHP Commercial |
$15,939.66
|
| Rate for Payer: PHP Medicare Advantage |
$14,490.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,426.92
|
| Rate for Payer: Priority Health Medicare |
$14,490.60
|
| Rate for Payer: Priority Health Narrow Network |
$15,541.54
|
| Rate for Payer: Railroad Medicare Medicare |
$14,490.60
|
| Rate for Payer: UHC Medicare Advantage |
$14,925.32
|
| Rate for Payer: VA VA |
$14,490.60
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$13,176.41
|
|
|
Service Code
|
MS-DRG 074
|
| Min. Negotiated Rate |
$9,850.70 |
| Max. Negotiated Rate |
$13,176.41 |
| Rate for Payer: Aetna Medicare |
$10,369.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,961.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,961.45
|
| Rate for Payer: BCBS MAPPO |
$10,369.16
|
| Rate for Payer: BCN Medicare Advantage |
$10,369.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,369.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,369.16
|
| Rate for Payer: Mclaren Medicare |
$10,369.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,887.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,924.53
|
| Rate for Payer: PACE Medicare |
$9,850.70
|
| Rate for Payer: PACE SWMI |
$10,369.16
|
| Rate for Payer: PHP Commercial |
$11,406.08
|
| Rate for Payer: PHP Medicare Advantage |
$10,369.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,176.41
|
| Rate for Payer: Priority Health Medicare |
$10,369.16
|
| Rate for Payer: Priority Health Narrow Network |
$10,541.13
|
| Rate for Payer: Railroad Medicare Medicare |
$10,369.16
|
| Rate for Payer: UHC Medicare Advantage |
$10,680.23
|
| Rate for Payer: VA VA |
$10,369.16
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$37,917.80
|
|
|
Service Code
|
MS-DRG 026
|
| Min. Negotiated Rate |
$25,348.90 |
| Max. Negotiated Rate |
$37,917.80 |
| Rate for Payer: Aetna Medicare |
$26,683.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,353.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,353.81
|
| Rate for Payer: BCBS MAPPO |
$26,683.05
|
| Rate for Payer: BCN Medicare Advantage |
$26,683.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,683.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,683.05
|
| Rate for Payer: Mclaren Medicare |
$26,683.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,017.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,685.51
|
| Rate for Payer: PACE Medicare |
$25,348.90
|
| Rate for Payer: PACE SWMI |
$26,683.05
|
| Rate for Payer: PHP Commercial |
$29,351.36
|
| Rate for Payer: PHP Medicare Advantage |
$26,683.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,917.80
|
| Rate for Payer: Priority Health Medicare |
$26,683.05
|
| Rate for Payer: Priority Health Narrow Network |
$30,334.24
|
| Rate for Payer: Railroad Medicare Medicare |
$26,683.05
|
| Rate for Payer: UHC Medicare Advantage |
$27,483.54
|
| Rate for Payer: VA VA |
$26,683.05
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$56,701.44
|
|
|
Service Code
|
MS-DRG 025
|
| Min. Negotiated Rate |
$37,115.12 |
| Max. Negotiated Rate |
$56,701.44 |
| Rate for Payer: Aetna Medicare |
$39,068.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,835.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,835.69
|
| Rate for Payer: BCBS MAPPO |
$39,068.55
|
| Rate for Payer: BCN Medicare Advantage |
$39,068.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,068.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,068.55
|
| Rate for Payer: Mclaren Medicare |
$39,068.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,021.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,928.83
|
| Rate for Payer: PACE Medicare |
$37,115.12
|
| Rate for Payer: PACE SWMI |
$39,068.55
|
| Rate for Payer: PHP Commercial |
$42,975.40
|
| Rate for Payer: PHP Medicare Advantage |
$39,068.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,701.44
|
| Rate for Payer: Priority Health Medicare |
$39,068.55
|
| Rate for Payer: Priority Health Narrow Network |
$45,361.15
|
| Rate for Payer: Railroad Medicare Medicare |
$39,068.55
|
| Rate for Payer: UHC Medicare Advantage |
$40,240.61
|
| Rate for Payer: VA VA |
$39,068.55
|
|
|
CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$31,238.44
|
|
|
Service Code
|
MS-DRG 027
|
| Min. Negotiated Rate |
$21,164.89 |
| Max. Negotiated Rate |
$31,238.44 |
| Rate for Payer: Aetna Medicare |
$22,278.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,848.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,848.54
|
| Rate for Payer: BCBS MAPPO |
$22,278.83
|
| Rate for Payer: BCN Medicare Advantage |
$22,278.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,278.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,278.83
|
| Rate for Payer: Mclaren Medicare |
$22,278.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,392.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,620.65
|
| Rate for Payer: PACE Medicare |
$21,164.89
|
| Rate for Payer: PACE SWMI |
$22,278.83
|
| Rate for Payer: PHP Commercial |
$24,506.71
|
| Rate for Payer: PHP Medicare Advantage |
$22,278.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,238.44
|
| Rate for Payer: Priority Health Medicare |
$22,278.83
|
| Rate for Payer: Priority Health Narrow Network |
$24,990.75
|
| Rate for Payer: Railroad Medicare Medicare |
$22,278.83
|
| Rate for Payer: UHC Medicare Advantage |
$22,947.19
|
| Rate for Payer: VA VA |
$22,278.83
|
|
|
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$78,198.17
|
|
|
Service Code
|
MS-DRG 955
|
| Min. Negotiated Rate |
$50,580.84 |
| Max. Negotiated Rate |
$78,198.17 |
| Rate for Payer: Aetna Medicare |
$53,242.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,553.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,553.74
|
| Rate for Payer: BCBS MAPPO |
$53,242.99
|
| Rate for Payer: BCN Medicare Advantage |
$53,242.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,242.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,242.99
|
| Rate for Payer: Mclaren Medicare |
$53,242.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55,905.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,229.44
|
| Rate for Payer: PACE Medicare |
$50,580.84
|
| Rate for Payer: PACE SWMI |
$53,242.99
|
| Rate for Payer: PHP Commercial |
$58,567.29
|
| Rate for Payer: PHP Medicare Advantage |
$53,242.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78,198.17
|
| Rate for Payer: Priority Health Medicare |
$53,242.99
|
| Rate for Payer: Priority Health Narrow Network |
$62,558.54
|
| Rate for Payer: Railroad Medicare Medicare |
$53,242.99
|
| Rate for Payer: UHC Medicare Advantage |
$54,840.28
|
| Rate for Payer: VA VA |
$53,242.99
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR
|
Facility
|
IP
|
$72,787.39
|
|
|
Service Code
|
MS-DRG 023
|
| Min. Negotiated Rate |
$47,191.49 |
| Max. Negotiated Rate |
$72,787.39 |
| Rate for Payer: Aetna Medicare |
$49,675.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,094.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,094.06
|
| Rate for Payer: BCBS MAPPO |
$49,675.25
|
| Rate for Payer: BCN Medicare Advantage |
$49,675.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,675.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,675.25
|
| Rate for Payer: Mclaren Medicare |
$49,675.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,159.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,126.54
|
| Rate for Payer: PACE Medicare |
$47,191.49
|
| Rate for Payer: PACE SWMI |
$49,675.25
|
| Rate for Payer: PHP Commercial |
$54,642.78
|
| Rate for Payer: PHP Medicare Advantage |
$49,675.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72,787.39
|
| Rate for Payer: Priority Health Medicare |
$49,675.25
|
| Rate for Payer: Priority Health Narrow Network |
$58,229.91
|
| Rate for Payer: Railroad Medicare Medicare |
$49,675.25
|
| Rate for Payer: UHC Medicare Advantage |
$51,165.51
|
| Rate for Payer: VA VA |
$49,675.25
|
|
|
CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC
|
Facility
|
IP
|
$48,648.19
|
|
|
Service Code
|
MS-DRG 024
|
| Min. Negotiated Rate |
$32,070.49 |
| Max. Negotiated Rate |
$48,648.19 |
| Rate for Payer: Aetna Medicare |
$33,758.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,198.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,198.01
|
| Rate for Payer: BCBS MAPPO |
$33,758.41
|
| Rate for Payer: BCN Medicare Advantage |
$33,758.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,758.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$33,758.41
|
| Rate for Payer: Mclaren Medicare |
$33,758.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35,446.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,822.17
|
| Rate for Payer: PACE Medicare |
$32,070.49
|
| Rate for Payer: PACE SWMI |
$33,758.41
|
| Rate for Payer: PHP Commercial |
$37,134.25
|
| Rate for Payer: PHP Medicare Advantage |
$33,758.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,648.19
|
| Rate for Payer: Priority Health Medicare |
$33,758.41
|
| Rate for Payer: Priority Health Narrow Network |
$38,918.55
|
| Rate for Payer: Railroad Medicare Medicare |
$33,758.41
|
| Rate for Payer: UHC Medicare Advantage |
$34,771.16
|
| Rate for Payer: VA VA |
$33,758.41
|
|
|
CROMOLYN 4 % EYE DROPS
|
Facility
|
IP
|
$19.93
|
|
|
Service Code
|
NDC 61314-237-10
|
| Hospital Charge Code |
9691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.95 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: ASR ASR |
$19.33
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.94
|
| Rate for Payer: Healthscope Commercial |
$19.93
|
| Rate for Payer: Healthscope Whirlpool |
$19.33
|
| Rate for Payer: Mclaren Commercial |
$17.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.54
|
|
|
CUPRIC CHLORIDE 0.4 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$177.53
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
108145
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$124.27 |
| Max. Negotiated Rate |
$177.53 |
| Rate for Payer: Aetna Commercial |
$159.78
|
| Rate for Payer: ASR ASR |
$172.20
|
| Rate for Payer: BCBS Trust/PPO |
$137.64
|
| Rate for Payer: BCN Commercial |
$137.64
|
| Rate for Payer: Cash Price |
$142.02
|
| Rate for Payer: Cofinity Commercial |
$166.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$177.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.20
|
| Rate for Payer: Mclaren Commercial |
$159.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.23
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.98
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$21.98 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$15.27
|
| Rate for Payer: Aetna Commercial |
$26.37
|
| Rate for Payer: Aetna Commercial |
$21.30
|
| Rate for Payer: Aetna Commercial |
$20.30
|
| Rate for Payer: ASR ASR |
$21.87
|
| Rate for Payer: ASR ASR |
$22.96
|
| Rate for Payer: ASR ASR |
$28.42
|
| Rate for Payer: ASR ASR |
$21.32
|
| Rate for Payer: ASR ASR |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$18.35
|
| Rate for Payer: BCN Commercial |
$17.04
|
| Rate for Payer: BCN Commercial |
$22.72
|
| Rate for Payer: BCN Commercial |
$13.16
|
| Rate for Payer: BCN Commercial |
$18.35
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cash Price |
$17.59
|
| Rate for Payer: Cash Price |
$23.44
|
| Rate for Payer: Cash Price |
$13.58
|
| Rate for Payer: Cash Price |
$18.04
|
| Rate for Payer: Cofinity Commercial |
$20.66
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$27.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.58
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$16.97
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Whirlpool |
$22.96
|
| Rate for Payer: Healthscope Whirlpool |
$21.87
|
| Rate for Payer: Healthscope Whirlpool |
$16.46
|
| Rate for Payer: Healthscope Whirlpool |
$28.42
|
| Rate for Payer: Healthscope Whirlpool |
$21.32
|
| Rate for Payer: Mclaren Commercial |
$15.27
|
| Rate for Payer: Mclaren Commercial |
$19.78
|
| Rate for Payer: Mclaren Commercial |
$21.30
|
| Rate for Payer: Mclaren Commercial |
$20.30
|
| Rate for Payer: Mclaren Commercial |
$26.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.78
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 5026885515
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.02 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$160.74
|
| Rate for Payer: ASR ASR |
$173.24
|
| Rate for Payer: BCBS Trust/PPO |
$138.47
|
| Rate for Payer: BCN Commercial |
$138.47
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$167.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$178.60
|
| Rate for Payer: Healthscope Whirlpool |
$173.24
|
| Rate for Payer: Mclaren Commercial |
$160.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.17
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.13
|
|
|
Service Code
|
NDC 7733393825
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.13 |
| Rate for Payer: Aetna Commercial |
$2.82
|
| Rate for Payer: ASR ASR |
$3.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.43
|
| Rate for Payer: BCN Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$3.13
|
| Rate for Payer: Healthscope Whirlpool |
$3.04
|
| Rate for Payer: Mclaren Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.75
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 7733393810
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.78 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$281.30
|
| Rate for Payer: ASR ASR |
$303.17
|
| Rate for Payer: BCBS Trust/PPO |
$242.32
|
| Rate for Payer: BCN Commercial |
$242.32
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$293.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$312.55
|
| Rate for Payer: Healthscope Whirlpool |
$303.17
|
| Rate for Payer: Mclaren Commercial |
$281.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$275.04
|
|
|
CYANOCOBALAMIN (VIT B-12) 1,000 MCG TABLET
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 5026885511
|
| Hospital Charge Code |
2009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: ASR ASR |
$3.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.77
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Healthscope Whirlpool |
$3.46
|
| Rate for Payer: Mclaren Commercial |
$3.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.14
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$3.90
|
|
|
Service Code
|
NDC 60687-558-11
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: ASR ASR |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Mclaren Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.43
|
|
|
CYCLOBENZAPRINE 10 MG TABLET
|
Facility
|
IP
|
$390.10
|
|
|
Service Code
|
NDC 60687-558-01
|
| Hospital Charge Code |
2017
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.07 |
| Max. Negotiated Rate |
$390.10 |
| Rate for Payer: Aetna Commercial |
$351.09
|
| Rate for Payer: ASR ASR |
$378.40
|
| Rate for Payer: BCBS Trust/PPO |
$302.44
|
| Rate for Payer: BCN Commercial |
$302.44
|
| Rate for Payer: Cash Price |
$312.08
|
| Rate for Payer: Cofinity Commercial |
$366.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.08
|
| Rate for Payer: Healthscope Commercial |
$390.10
|
| Rate for Payer: Healthscope Whirlpool |
$378.40
|
| Rate for Payer: Mclaren Commercial |
$351.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$343.29
|
|
