|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$15,185.06
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$9,306.97 |
| Max. Negotiated Rate |
$15,185.06 |
| Rate for Payer: Aetna Medicare |
$9,796.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,246.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,246.01
|
| Rate for Payer: BCBS MAPPO |
$9,796.81
|
| Rate for Payer: BCN Medicare Advantage |
$9,796.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,796.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,796.81
|
| Rate for Payer: Mclaren Medicare |
$9,796.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,286.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,266.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,776.49
|
| Rate for Payer: PACE Medicare |
$9,306.97
|
| Rate for Payer: PACE SWMI |
$9,796.81
|
| Rate for Payer: PHP Commercial |
$10,776.49
|
| Rate for Payer: PHP Medicare Advantage |
$9,796.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,469.33
|
| Rate for Payer: Priority Health Medicare |
$9,796.81
|
| Rate for Payer: Priority Health Narrow Network |
$9,975.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9,796.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,796.81
|
| Rate for Payer: UHC Exchange |
$15,185.06
|
| Rate for Payer: UHCCP DNSP |
$9,796.81
|
| Rate for Payer: VA VA |
$9,796.81
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$21,131.01
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$12,951.26 |
| Max. Negotiated Rate |
$21,131.01 |
| Rate for Payer: Aetna Medicare |
$13,632.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,041.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,041.14
|
| Rate for Payer: BCBS MAPPO |
$13,632.91
|
| Rate for Payer: BCN Medicare Advantage |
$13,632.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,632.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,632.91
|
| Rate for Payer: Mclaren Medicare |
$13,632.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,314.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,677.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,996.20
|
| Rate for Payer: PACE Medicare |
$12,951.26
|
| Rate for Payer: PACE SWMI |
$13,632.91
|
| Rate for Payer: PHP Commercial |
$14,996.20
|
| Rate for Payer: PHP Medicare Advantage |
$13,632.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,933.26
|
| Rate for Payer: Priority Health Medicare |
$13,632.91
|
| Rate for Payer: Priority Health Narrow Network |
$14,346.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13,632.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,632.91
|
| Rate for Payer: UHC Exchange |
$21,131.01
|
| Rate for Payer: UHCCP DNSP |
$13,632.91
|
| Rate for Payer: VA VA |
$13,632.91
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,421.47
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$8,226.06 |
| Max. Negotiated Rate |
$13,421.47 |
| Rate for Payer: Aetna Medicare |
$8,659.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,823.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,823.76
|
| Rate for Payer: BCBS MAPPO |
$8,659.01
|
| Rate for Payer: BCN Medicare Advantage |
$8,659.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,659.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,659.01
|
| Rate for Payer: Mclaren Medicare |
$8,659.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,091.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,957.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,524.91
|
| Rate for Payer: PACE Medicare |
$8,226.06
|
| Rate for Payer: PACE SWMI |
$8,659.01
|
| Rate for Payer: PHP Commercial |
$9,524.91
|
| Rate for Payer: PHP Medicare Advantage |
$8,659.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,162.77
|
| Rate for Payer: Priority Health Medicare |
$8,659.01
|
| Rate for Payer: Priority Health Narrow Network |
$8,930.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8,659.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,659.01
|
| Rate for Payer: UHC Exchange |
$13,421.47
|
| Rate for Payer: UHCCP DNSP |
$8,659.01
|
| Rate for Payer: VA VA |
$8,659.01
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$3,614.65
|
|
|
Service Code
|
APR-DRG 5392
|
| Min. Negotiated Rate |
$3,268.08 |
| Max. Negotiated Rate |
$3,614.65 |
| Rate for Payer: BCBS Complete |
$3,614.65
|
| Rate for Payer: Mclaren Medicaid |
$3,442.53
|
| Rate for Payer: Meridian Medicaid |
$3,614.65
|
| Rate for Payer: PHP Medicaid |
$3,268.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,442.53
|
| Rate for Payer: UHC Medicaid |
$3,442.53
|
| Rate for Payer: UHCCP Medicaid |
$3,442.53
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$6,971.55
|
|
|
Service Code
|
APR-DRG 5393
|
| Min. Negotiated Rate |
$6,303.11 |
| Max. Negotiated Rate |
$6,971.55 |
| Rate for Payer: BCBS Complete |
$6,971.55
|
| Rate for Payer: Mclaren Medicaid |
$6,639.57
|
| Rate for Payer: Meridian Medicaid |
$6,971.55
|
| Rate for Payer: PHP Medicaid |
$6,303.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,639.57
|
| Rate for Payer: UHC Medicaid |
$6,639.57
|
| Rate for Payer: UHCCP Medicaid |
$6,639.57
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$14,946.34
|
|
|
Service Code
|
APR-DRG 5394
|
| Min. Negotiated Rate |
$13,513.28 |
| Max. Negotiated Rate |
$14,946.34 |
| Rate for Payer: BCBS Complete |
$14,946.34
|
| Rate for Payer: Mclaren Medicaid |
$14,234.61
|
| Rate for Payer: Meridian Medicaid |
$14,946.34
|
| Rate for Payer: PHP Medicaid |
$13,513.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,234.61
|
| Rate for Payer: UHC Medicaid |
$14,234.61
|
| Rate for Payer: UHCCP Medicaid |
$14,234.61
|
|
|
CESAREAN SECTION WITH STERILIZATION
|
Facility
|
IP
|
$2,771.62
|
|
|
Service Code
|
APR-DRG 5391
|
| Min. Negotiated Rate |
$2,505.87 |
| Max. Negotiated Rate |
$2,771.62 |
| Rate for Payer: BCBS Complete |
$2,771.62
|
| Rate for Payer: Mclaren Medicaid |
$2,639.63
|
| Rate for Payer: Meridian Medicaid |
$2,771.62
|
| Rate for Payer: PHP Medicaid |
$2,505.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,639.63
|
| Rate for Payer: UHC Medicaid |
$2,639.63
|
| Rate for Payer: UHCCP Medicaid |
$2,639.63
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$14,552.19
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$8,919.08 |
| Max. Negotiated Rate |
$14,552.19 |
| Rate for Payer: Aetna Medicare |
$9,388.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,735.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,735.64
|
| Rate for Payer: BCBS MAPPO |
$9,388.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,388.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,388.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,388.51
|
| Rate for Payer: Mclaren Medicare |
$9,388.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,857.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,796.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,327.36
|
| Rate for Payer: PACE Medicare |
$8,919.08
|
| Rate for Payer: PACE SWMI |
$9,388.51
|
| Rate for Payer: PHP Commercial |
$10,327.36
|
| Rate for Payer: PHP Medicare Advantage |
$9,388.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12,711.14
|
| Rate for Payer: Priority Health Medicare |
$9,388.51
|
| Rate for Payer: Priority Health Narrow Network |
$10,168.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9,388.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,388.51
|
| Rate for Payer: UHC Exchange |
$14,552.19
|
| Rate for Payer: UHCCP DNSP |
$9,388.51
|
| Rate for Payer: VA VA |
$9,388.51
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$30,123.06
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$16,106.27 |
| Max. Negotiated Rate |
$30,123.06 |
| Rate for Payer: Aetna Medicare |
$19,434.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,292.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,292.79
|
| Rate for Payer: BCBS MAPPO |
$19,434.23
|
| Rate for Payer: BCN Medicare Advantage |
$19,434.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,434.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,434.23
|
| Rate for Payer: Mclaren Medicare |
$19,434.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,405.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,349.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,377.65
|
| Rate for Payer: PACE Medicare |
$18,462.52
|
| Rate for Payer: PACE SWMI |
$19,434.23
|
| Rate for Payer: PHP Commercial |
$21,377.65
|
| Rate for Payer: PHP Medicare Advantage |
$19,434.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,132.84
|
| Rate for Payer: Priority Health Medicare |
$19,434.23
|
| Rate for Payer: Priority Health Narrow Network |
$16,106.27
|
| Rate for Payer: Railroad Medicare Medicare |
$19,434.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,434.23
|
| Rate for Payer: UHC Exchange |
$30,123.06
|
| Rate for Payer: UHCCP DNSP |
$19,434.23
|
| Rate for Payer: VA VA |
$19,434.23
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,410.31
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$8,219.22 |
| Max. Negotiated Rate |
$13,410.31 |
| Rate for Payer: Aetna Medicare |
$8,651.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,814.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,814.76
|
| Rate for Payer: BCBS MAPPO |
$8,651.81
|
| Rate for Payer: BCN Medicare Advantage |
$8,651.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,651.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,651.81
|
| Rate for Payer: Mclaren Medicare |
$8,651.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,084.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,949.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,516.99
|
| Rate for Payer: PACE Medicare |
$8,219.22
|
| Rate for Payer: PACE SWMI |
$8,651.81
|
| Rate for Payer: PHP Commercial |
$9,516.99
|
| Rate for Payer: PHP Medicare Advantage |
$8,651.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,478.58
|
| Rate for Payer: Priority Health Medicare |
$8,651.81
|
| Rate for Payer: Priority Health Narrow Network |
$8,382.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8,651.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,651.81
|
| Rate for Payer: UHC Exchange |
$13,410.31
|
| Rate for Payer: UHCCP DNSP |
$8,651.81
|
| Rate for Payer: VA VA |
$8,651.81
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 904671740
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: Aetna Medicare |
$113.03
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: BCBS Trust/PPO |
$251.88
|
| Rate for Payer: BCN Commercial |
$251.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.68
|
| Rate for Payer: Priority Health Narrow Network |
$214.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
CETIRIZINE 10 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 904671740
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$305.50 |
| Rate for Payer: Aetna Commercial |
$274.95
|
| Rate for Payer: ASR ASR |
$296.33
|
| Rate for Payer: BCBS Trust/PPO |
$250.88
|
| Rate for Payer: BCN Commercial |
$250.88
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$287.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$296.33
|
| Rate for Payer: Healthscope Whirlpool |
$305.50
|
| Rate for Payer: Mclaren Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$268.84
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$79.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$14,993.75
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$13,556.15 |
| Max. Negotiated Rate |
$14,993.75 |
| Rate for Payer: BCBS Complete |
$14,993.75
|
| Rate for Payer: Mclaren Medicaid |
$14,279.77
|
| Rate for Payer: Meridian Medicaid |
$14,993.75
|
| Rate for Payer: PHP Medicaid |
$13,556.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,279.77
|
| Rate for Payer: UHC Medicaid |
$14,279.77
|
| Rate for Payer: UHCCP Medicaid |
$14,279.77
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$4,862.59
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$4,396.36 |
| Max. Negotiated Rate |
$4,862.59 |
| Rate for Payer: BCBS Complete |
$4,862.59
|
| Rate for Payer: Mclaren Medicaid |
$4,631.04
|
| Rate for Payer: Meridian Medicaid |
$4,862.59
|
| Rate for Payer: PHP Medicaid |
$4,396.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,631.04
|
| Rate for Payer: UHC Medicaid |
$4,631.04
|
| Rate for Payer: UHCCP Medicaid |
$4,631.04
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$6,250.58
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$5,651.27 |
| Max. Negotiated Rate |
$6,250.58 |
| Rate for Payer: BCBS Complete |
$6,250.58
|
| Rate for Payer: Mclaren Medicaid |
$5,952.93
|
| Rate for Payer: Meridian Medicaid |
$6,250.58
|
| Rate for Payer: PHP Medicaid |
$5,651.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,952.93
|
| Rate for Payer: UHC Medicaid |
$5,952.93
|
| Rate for Payer: UHCCP Medicaid |
$5,952.93
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$32,893.18
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$29,739.37 |
| Max. Negotiated Rate |
$32,893.18 |
| Rate for Payer: BCBS Complete |
$32,893.18
|
| Rate for Payer: Mclaren Medicaid |
$31,326.84
|
| Rate for Payer: Meridian Medicaid |
$32,893.18
|
| Rate for Payer: PHP Medicaid |
$29,739.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,326.84
|
| Rate for Payer: UHC Medicaid |
$31,326.84
|
| Rate for Payer: UHCCP Medicaid |
$31,326.84
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC
|
Facility
|
IP
|
$66,005.32
|
|
|
Service Code
|
MSDRG 837
|
| Min. Negotiated Rate |
$34,533.83 |
| Max. Negotiated Rate |
$66,005.32 |
| Rate for Payer: Aetna Medicare |
$36,351.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,439.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,439.25
|
| Rate for Payer: BCBS MAPPO |
$36,351.40
|
| Rate for Payer: BCN Medicare Advantage |
$36,351.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,351.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,351.40
|
| Rate for Payer: Mclaren Medicare |
$36,351.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,168.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,804.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,986.54
|
| Rate for Payer: PACE Medicare |
$34,533.83
|
| Rate for Payer: PACE SWMI |
$36,351.40
|
| Rate for Payer: PHP Commercial |
$39,986.54
|
| Rate for Payer: PHP Medicare Advantage |
$36,351.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$66,005.32
|
| Rate for Payer: Priority Health Medicare |
$36,351.40
|
| Rate for Payer: Priority Health Narrow Network |
$52,804.25
|
| Rate for Payer: Railroad Medicare Medicare |
$36,351.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,351.40
|
| Rate for Payer: UHC Exchange |
$56,344.67
|
| Rate for Payer: UHCCP DNSP |
$36,351.40
|
| Rate for Payer: VA VA |
$36,351.40
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT
|
Facility
|
IP
|
$28,678.37
|
|
|
Service Code
|
MSDRG 838
|
| Min. Negotiated Rate |
$15,947.02 |
| Max. Negotiated Rate |
$28,678.37 |
| Rate for Payer: Aetna Medicare |
$16,786.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,982.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,982.92
|
| Rate for Payer: BCBS MAPPO |
$16,786.34
|
| Rate for Payer: BCN Medicare Advantage |
$16,786.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,786.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,786.34
|
| Rate for Payer: Mclaren Medicare |
$16,786.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,625.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,304.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,464.97
|
| Rate for Payer: PACE Medicare |
$15,947.02
|
| Rate for Payer: PACE SWMI |
$16,786.34
|
| Rate for Payer: PHP Commercial |
$18,464.97
|
| Rate for Payer: PHP Medicare Advantage |
$16,786.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28,678.37
|
| Rate for Payer: Priority Health Medicare |
$16,786.34
|
| Rate for Payer: Priority Health Narrow Network |
$22,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,786.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,786.34
|
| Rate for Payer: UHC Exchange |
$26,018.83
|
| Rate for Payer: UHCCP DNSP |
$16,786.34
|
| Rate for Payer: VA VA |
$16,786.34
|
|
|
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,837.45
|
|
|
Service Code
|
MSDRG 839
|
| Min. Negotiated Rate |
$11,544.72 |
| Max. Negotiated Rate |
$19,837.45 |
| Rate for Payer: Aetna Medicare |
$12,152.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,190.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,190.42
|
| Rate for Payer: BCBS MAPPO |
$12,152.34
|
| Rate for Payer: BCN Medicare Advantage |
$12,152.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,152.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,152.34
|
| Rate for Payer: Mclaren Medicare |
$12,152.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,759.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,975.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,367.57
|
| Rate for Payer: PACE Medicare |
$11,544.72
|
| Rate for Payer: PACE SWMI |
$12,152.34
|
| Rate for Payer: PHP Commercial |
$13,367.57
|
| Rate for Payer: PHP Medicare Advantage |
$12,152.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,837.45
|
| Rate for Payer: Priority Health Medicare |
$12,152.34
|
| Rate for Payer: Priority Health Narrow Network |
$15,869.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12,152.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,152.34
|
| Rate for Payer: UHC Exchange |
$18,836.13
|
| Rate for Payer: UHCCP DNSP |
$12,152.34
|
| Rate for Payer: VA VA |
$12,152.34
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC
|
Facility
|
IP
|
$17,973.10
|
|
|
Service Code
|
MSDRG 847
|
| Min. Negotiated Rate |
$10,616.36 |
| Max. Negotiated Rate |
$17,973.10 |
| Rate for Payer: Aetna Medicare |
$11,175.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,968.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,968.90
|
| Rate for Payer: BCBS MAPPO |
$11,175.12
|
| Rate for Payer: BCN Medicare Advantage |
$11,175.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,175.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,175.12
|
| Rate for Payer: Mclaren Medicare |
$11,175.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,733.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,851.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,292.63
|
| Rate for Payer: PACE Medicare |
$10,616.36
|
| Rate for Payer: PACE SWMI |
$11,175.12
|
| Rate for Payer: PHP Commercial |
$12,292.63
|
| Rate for Payer: PHP Medicare Advantage |
$11,175.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,973.10
|
| Rate for Payer: Priority Health Medicare |
$11,175.12
|
| Rate for Payer: Priority Health Narrow Network |
$14,378.48
|
| Rate for Payer: Railroad Medicare Medicare |
$11,175.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,175.12
|
| Rate for Payer: UHC Exchange |
$17,321.44
|
| Rate for Payer: UHCCP DNSP |
$11,175.12
|
| Rate for Payer: VA VA |
$11,175.12
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$35,617.84
|
|
|
Service Code
|
MSDRG 846
|
| Min. Negotiated Rate |
$19,402.50 |
| Max. Negotiated Rate |
$35,617.84 |
| Rate for Payer: Aetna Medicare |
$20,423.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,529.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,529.60
|
| Rate for Payer: BCBS MAPPO |
$20,423.68
|
| Rate for Payer: BCN Medicare Advantage |
$20,423.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,423.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,423.68
|
| Rate for Payer: Mclaren Medicare |
$20,423.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,444.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,487.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,466.05
|
| Rate for Payer: PACE Medicare |
$19,402.50
|
| Rate for Payer: PACE SWMI |
$20,423.68
|
| Rate for Payer: PHP Commercial |
$22,466.05
|
| Rate for Payer: PHP Medicare Advantage |
$20,423.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$35,617.84
|
| Rate for Payer: Priority Health Medicare |
$20,423.68
|
| Rate for Payer: Priority Health Narrow Network |
$28,494.27
|
| Rate for Payer: Railroad Medicare Medicare |
$20,423.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,423.68
|
| Rate for Payer: UHC Exchange |
$31,656.70
|
| Rate for Payer: UHCCP DNSP |
$20,423.68
|
| Rate for Payer: VA VA |
$20,423.68
|
|
|
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,200.36
|
|
|
Service Code
|
MSDRG 848
|
| Min. Negotiated Rate |
$7,477.64 |
| Max. Negotiated Rate |
$12,200.36 |
| Rate for Payer: Aetna Medicare |
$7,871.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,839.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,839.00
|
| Rate for Payer: BCBS MAPPO |
$7,871.20
|
| Rate for Payer: BCN Medicare Advantage |
$7,871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,871.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,871.20
|
| Rate for Payer: Mclaren Medicare |
$7,871.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,264.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,051.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,658.32
|
| Rate for Payer: PACE Medicare |
$7,477.64
|
| Rate for Payer: PACE SWMI |
$7,871.20
|
| Rate for Payer: PHP Commercial |
$8,658.32
|
| Rate for Payer: PHP Medicare Advantage |
$7,871.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,669.74
|
| Rate for Payer: Priority Health Medicare |
$7,871.20
|
| Rate for Payer: Priority Health Narrow Network |
$9,335.79
|
| Rate for Payer: Railroad Medicare Medicare |
$7,871.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,871.20
|
| Rate for Payer: UHC Exchange |
$12,200.36
|
| Rate for Payer: UHCCP DNSP |
$7,871.20
|
| Rate for Payer: VA VA |
$7,871.20
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$4,553.60
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$4,117.00 |
| Max. Negotiated Rate |
$4,553.60 |
| Rate for Payer: BCBS Complete |
$4,553.60
|
| Rate for Payer: Mclaren Medicaid |
$4,336.76
|
| Rate for Payer: Meridian Medicaid |
$4,553.60
|
| Rate for Payer: PHP Medicaid |
$4,117.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,336.76
|
| Rate for Payer: UHC Medicaid |
$4,336.76
|
| Rate for Payer: UHCCP Medicaid |
$4,336.76
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$8,402.58
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$7,596.94 |
| Max. Negotiated Rate |
$8,402.58 |
| Rate for Payer: BCBS Complete |
$8,402.58
|
| Rate for Payer: Mclaren Medicaid |
$8,002.46
|
| Rate for Payer: Meridian Medicaid |
$8,402.58
|
| Rate for Payer: PHP Medicaid |
$7,596.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,002.46
|
| Rate for Payer: UHC Medicaid |
$8,002.46
|
| Rate for Payer: UHCCP Medicaid |
$8,002.46
|
|
