|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
NDC 51079-868-01
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.61 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: ASR ASR |
$2.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$2.09
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.09
|
| Rate for Payer: Healthscope Commercial |
$2.61
|
| Rate for Payer: Healthscope Whirlpool |
$2.53
|
| Rate for Payer: Mclaren Commercial |
$2.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.30
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 43975-304-10
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.10 |
| Max. Negotiated Rate |
$350.15 |
| Rate for Payer: Aetna Commercial |
$315.14
|
| Rate for Payer: ASR ASR |
$339.65
|
| Rate for Payer: BCBS Trust/PPO |
$271.47
|
| Rate for Payer: BCN Commercial |
$271.47
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$329.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$350.15
|
| Rate for Payer: Healthscope Whirlpool |
$339.65
|
| Rate for Payer: Mclaren Commercial |
$315.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.13
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 62559-511-01
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: Aetna Commercial |
$270.72
|
| Rate for Payer: ASR ASR |
$291.78
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Commercial |
$233.21
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$282.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$300.80
|
| Rate for Payer: Healthscope Whirlpool |
$291.78
|
| Rate for Payer: Mclaren Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.70
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 23155-010-01
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.46 |
| Max. Negotiated Rate |
$420.65 |
| Rate for Payer: Aetna Commercial |
$378.58
|
| Rate for Payer: ASR ASR |
$408.03
|
| Rate for Payer: BCBS Trust/PPO |
$326.13
|
| Rate for Payer: BCN Commercial |
$326.13
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$395.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$420.65
|
| Rate for Payer: Healthscope Whirlpool |
$408.03
|
| Rate for Payer: Mclaren Commercial |
$378.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.17
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 68462-406-01
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: BCBS Trust/PPO |
$127.54
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$117.33
|
|
|
Service Code
|
NDC 50268-430-15
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.13 |
| Max. Negotiated Rate |
$117.33 |
| Rate for Payer: Aetna Commercial |
$105.60
|
| Rate for Payer: ASR ASR |
$113.81
|
| Rate for Payer: BCBS Trust/PPO |
$90.97
|
| Rate for Payer: BCN Commercial |
$90.97
|
| Rate for Payer: Cash Price |
$93.86
|
| Rate for Payer: Cofinity Commercial |
$110.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.86
|
| Rate for Payer: Healthscope Commercial |
$117.33
|
| Rate for Payer: Healthscope Whirlpool |
$113.81
|
| Rate for Payer: Mclaren Commercial |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.25
|
|
|
INDOMETHACIN 25 MG CAPSULE
|
Facility
|
IP
|
$2.35
|
|
|
Service Code
|
NDC 50268-430-11
|
| Hospital Charge Code |
3897
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.35 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: ASR ASR |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.88
|
| Rate for Payer: Healthscope Commercial |
$2.35
|
| Rate for Payer: Healthscope Whirlpool |
$2.28
|
| Rate for Payer: Mclaren Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.07
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC
|
Facility
|
IP
|
$12,744.98
|
|
|
Service Code
|
MS-DRG 758
|
| Min. Negotiated Rate |
$9,580.46 |
| Max. Negotiated Rate |
$12,744.98 |
| Rate for Payer: Aetna Medicare |
$10,084.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,605.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,605.86
|
| Rate for Payer: BCBS MAPPO |
$10,084.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,084.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,084.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,084.69
|
| Rate for Payer: Mclaren Medicare |
$10,084.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,588.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,597.39
|
| Rate for Payer: PACE Medicare |
$9,580.46
|
| Rate for Payer: PACE SWMI |
$10,084.69
|
| Rate for Payer: PHP Commercial |
$11,093.16
|
| Rate for Payer: PHP Medicare Advantage |
$10,084.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,744.98
|
| Rate for Payer: Priority Health Medicare |
$10,084.69
|
| Rate for Payer: Priority Health Narrow Network |
$10,195.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10,084.69
|
| Rate for Payer: UHC Medicare Advantage |
$10,387.23
|
| Rate for Payer: VA VA |
$10,084.69
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$19,152.14
|
|
|
Service Code
|
MS-DRG 757
|
| Min. Negotiated Rate |
$13,593.94 |
| Max. Negotiated Rate |
$19,152.14 |
| Rate for Payer: Aetna Medicare |
$14,309.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,886.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,886.76
|
| Rate for Payer: BCBS MAPPO |
$14,309.41
|
| Rate for Payer: BCN Medicare Advantage |
$14,309.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,309.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,309.41
|
| Rate for Payer: Mclaren Medicare |
$14,309.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,024.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,455.82
|
| Rate for Payer: PACE Medicare |
$13,593.94
|
| Rate for Payer: PACE SWMI |
$14,309.41
|
| Rate for Payer: PHP Commercial |
$15,740.35
|
| Rate for Payer: PHP Medicare Advantage |
$14,309.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,152.14
|
| Rate for Payer: Priority Health Medicare |
$14,309.41
|
| Rate for Payer: Priority Health Narrow Network |
$15,321.71
|
| Rate for Payer: Railroad Medicare Medicare |
$14,309.41
|
| Rate for Payer: UHC Medicare Advantage |
$14,738.69
|
| Rate for Payer: VA VA |
$14,309.41
|
|
|
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$8,939.91
|
|
|
Service Code
|
MS-DRG 759
|
| Min. Negotiated Rate |
$6,637.77 |
| Max. Negotiated Rate |
$8,939.91 |
| Rate for Payer: Aetna Medicare |
$7,151.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,939.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,939.91
|
| Rate for Payer: BCBS MAPPO |
$7,151.93
|
| Rate for Payer: BCN Medicare Advantage |
$7,151.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,151.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,151.93
|
| Rate for Payer: Mclaren Medicare |
$7,151.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,509.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,224.72
|
| Rate for Payer: PACE Medicare |
$6,794.33
|
| Rate for Payer: PACE SWMI |
$7,151.93
|
| Rate for Payer: PHP Commercial |
$7,867.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,151.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,297.21
|
| Rate for Payer: Priority Health Medicare |
$7,151.93
|
| Rate for Payer: Priority Health Narrow Network |
$6,637.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7,151.93
|
| Rate for Payer: UHC Medicare Advantage |
$7,366.49
|
| Rate for Payer: VA VA |
$7,151.93
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$26,170.49
|
|
|
Service Code
|
MS-DRG 854
|
| Min. Negotiated Rate |
$17,990.29 |
| Max. Negotiated Rate |
$26,170.49 |
| Rate for Payer: Aetna Medicare |
$18,937.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,671.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,671.44
|
| Rate for Payer: BCBS MAPPO |
$18,937.15
|
| Rate for Payer: BCN Medicare Advantage |
$18,937.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,937.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,937.15
|
| Rate for Payer: Mclaren Medicare |
$18,937.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,884.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,777.72
|
| Rate for Payer: PACE Medicare |
$17,990.29
|
| Rate for Payer: PACE SWMI |
$18,937.15
|
| Rate for Payer: PHP Commercial |
$20,830.86
|
| Rate for Payer: PHP Medicare Advantage |
$18,937.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,170.49
|
| Rate for Payer: Priority Health Medicare |
$18,937.15
|
| Rate for Payer: Priority Health Narrow Network |
$20,936.39
|
| Rate for Payer: Railroad Medicare Medicare |
$18,937.15
|
| Rate for Payer: UHC Medicare Advantage |
$19,505.26
|
| Rate for Payer: VA VA |
$18,937.15
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$64,191.01
|
|
|
Service Code
|
MS-DRG 853
|
| Min. Negotiated Rate |
$41,806.64 |
| Max. Negotiated Rate |
$64,191.01 |
| Rate for Payer: Aetna Medicare |
$44,006.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,008.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,008.74
|
| Rate for Payer: BCBS MAPPO |
$44,006.99
|
| Rate for Payer: BCN Medicare Advantage |
$44,006.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,006.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$44,006.99
|
| Rate for Payer: Mclaren Medicare |
$44,006.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,207.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,608.04
|
| Rate for Payer: PACE Medicare |
$41,806.64
|
| Rate for Payer: PACE SWMI |
$44,006.99
|
| Rate for Payer: PHP Commercial |
$48,407.69
|
| Rate for Payer: PHP Medicare Advantage |
$44,006.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64,191.01
|
| Rate for Payer: Priority Health Medicare |
$44,006.99
|
| Rate for Payer: Priority Health Narrow Network |
$51,352.81
|
| Rate for Payer: Railroad Medicare Medicare |
$44,006.99
|
| Rate for Payer: UHC Medicare Advantage |
$45,327.20
|
| Rate for Payer: VA VA |
$44,006.99
|
|
|
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,851.11
|
|
|
Service Code
|
MS-DRG 855
|
| Min. Negotiated Rate |
$15,284.59 |
| Max. Negotiated Rate |
$21,851.11 |
| Rate for Payer: Aetna Medicare |
$16,089.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,111.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,111.30
|
| Rate for Payer: BCBS MAPPO |
$16,089.04
|
| Rate for Payer: BCN Medicare Advantage |
$16,089.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,089.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,089.04
|
| Rate for Payer: Mclaren Medicare |
$16,089.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,893.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,502.40
|
| Rate for Payer: PACE Medicare |
$15,284.59
|
| Rate for Payer: PACE SWMI |
$16,089.04
|
| Rate for Payer: PHP Commercial |
$17,697.94
|
| Rate for Payer: PHP Medicare Advantage |
$16,089.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,851.11
|
| Rate for Payer: Priority Health Medicare |
$16,089.04
|
| Rate for Payer: Priority Health Narrow Network |
$17,480.89
|
| Rate for Payer: Railroad Medicare Medicare |
$16,089.04
|
| Rate for Payer: UHC Medicare Advantage |
$16,571.71
|
| Rate for Payer: VA VA |
$16,089.04
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC
|
Facility
|
IP
|
$20,813.64
|
|
|
Service Code
|
MS-DRG 727
|
| Min. Negotiated Rate |
$14,634.73 |
| Max. Negotiated Rate |
$20,813.64 |
| Rate for Payer: Aetna Medicare |
$15,404.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,256.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,256.22
|
| Rate for Payer: BCBS MAPPO |
$15,404.98
|
| Rate for Payer: BCN Medicare Advantage |
$15,404.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,404.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,404.98
|
| Rate for Payer: Mclaren Medicare |
$15,404.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,175.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,715.73
|
| Rate for Payer: PACE Medicare |
$14,634.73
|
| Rate for Payer: PACE SWMI |
$15,404.98
|
| Rate for Payer: PHP Commercial |
$16,945.48
|
| Rate for Payer: PHP Medicare Advantage |
$15,404.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,813.64
|
| Rate for Payer: Priority Health Medicare |
$15,404.98
|
| Rate for Payer: Priority Health Narrow Network |
$16,650.91
|
| Rate for Payer: Railroad Medicare Medicare |
$15,404.98
|
| Rate for Payer: UHC Medicare Advantage |
$15,867.13
|
| Rate for Payer: VA VA |
$15,404.98
|
|
|
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$10,568.62
|
|
|
Service Code
|
MS-DRG 728
|
| Min. Negotiated Rate |
$8,032.16 |
| Max. Negotiated Rate |
$10,568.62 |
| Rate for Payer: Aetna Medicare |
$8,454.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,568.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,568.62
|
| Rate for Payer: BCBS MAPPO |
$8,454.90
|
| Rate for Payer: BCN Medicare Advantage |
$8,454.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,454.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,454.90
|
| Rate for Payer: Mclaren Medicare |
$8,454.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,877.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,723.14
|
| Rate for Payer: PACE Medicare |
$8,032.16
|
| Rate for Payer: PACE SWMI |
$8,454.90
|
| Rate for Payer: PHP Commercial |
$9,300.39
|
| Rate for Payer: PHP Medicare Advantage |
$8,454.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,273.28
|
| Rate for Payer: Priority Health Medicare |
$8,454.90
|
| Rate for Payer: Priority Health Narrow Network |
$8,218.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8,454.90
|
| Rate for Payer: UHC Medicare Advantage |
$8,708.55
|
| Rate for Payer: VA VA |
$8,454.90
|
|
|
INFLAMMATORY BOWEL DISEASE WITH CC
|
Facility
|
IP
|
$12,475.34
|
|
|
Service Code
|
MS-DRG 386
|
| Min. Negotiated Rate |
$9,411.56 |
| Max. Negotiated Rate |
$12,475.34 |
| Rate for Payer: Aetna Medicare |
$9,906.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,383.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,383.62
|
| Rate for Payer: BCBS MAPPO |
$9,906.90
|
| Rate for Payer: BCN Medicare Advantage |
$9,906.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,906.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,906.90
|
| Rate for Payer: Mclaren Medicare |
$9,906.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,402.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,392.94
|
| Rate for Payer: PACE Medicare |
$9,411.56
|
| Rate for Payer: PACE SWMI |
$9,906.90
|
| Rate for Payer: PHP Commercial |
$10,897.59
|
| Rate for Payer: PHP Medicare Advantage |
$9,906.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,475.34
|
| Rate for Payer: Priority Health Medicare |
$9,906.90
|
| Rate for Payer: Priority Health Narrow Network |
$9,980.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9,906.90
|
| Rate for Payer: UHC Medicare Advantage |
$10,204.11
|
| Rate for Payer: VA VA |
$9,906.90
|
|
|
INFLAMMATORY BOWEL DISEASE WITH MCC
|
Facility
|
IP
|
$20,119.00
|
|
|
Service Code
|
MS-DRG 385
|
| Min. Negotiated Rate |
$14,199.58 |
| Max. Negotiated Rate |
$20,119.00 |
| Rate for Payer: Aetna Medicare |
$14,946.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,683.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,683.66
|
| Rate for Payer: BCBS MAPPO |
$14,946.93
|
| Rate for Payer: BCN Medicare Advantage |
$14,946.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,946.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,946.93
|
| Rate for Payer: Mclaren Medicare |
$14,946.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,694.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,188.97
|
| Rate for Payer: PACE Medicare |
$14,199.58
|
| Rate for Payer: PACE SWMI |
$14,946.93
|
| Rate for Payer: PHP Commercial |
$16,441.62
|
| Rate for Payer: PHP Medicare Advantage |
$14,946.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,119.00
|
| Rate for Payer: Priority Health Medicare |
$14,946.93
|
| Rate for Payer: Priority Health Narrow Network |
$16,095.20
|
| Rate for Payer: Railroad Medicare Medicare |
$14,946.93
|
| Rate for Payer: UHC Medicare Advantage |
$15,395.34
|
| Rate for Payer: VA VA |
$14,946.93
|
|
|
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
MS-DRG 387
|
| Min. Negotiated Rate |
$7,027.07 |
| Max. Negotiated Rate |
$9,341.00 |
| Rate for Payer: Aetna Medicare |
$7,472.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,341.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,341.00
|
| Rate for Payer: BCBS MAPPO |
$7,472.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,472.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,472.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,472.80
|
| Rate for Payer: Mclaren Medicare |
$7,472.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,846.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,593.72
|
| Rate for Payer: PACE Medicare |
$7,099.16
|
| Rate for Payer: PACE SWMI |
$7,472.80
|
| Rate for Payer: PHP Commercial |
$8,220.08
|
| Rate for Payer: PHP Medicare Advantage |
$7,472.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,783.84
|
| Rate for Payer: Priority Health Medicare |
$7,472.80
|
| Rate for Payer: Priority Health Narrow Network |
$7,027.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7,472.80
|
| Rate for Payer: UHC Medicare Advantage |
$7,696.98
|
| Rate for Payer: VA VA |
$7,472.80
|
|
|
INFLIXIMAB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,641.79
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
23796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,549.25 |
| Max. Negotiated Rate |
$3,641.79 |
| Rate for Payer: Aetna Commercial |
$3,277.61
|
| Rate for Payer: ASR ASR |
$3,532.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,823.48
|
| Rate for Payer: BCN Commercial |
$2,823.48
|
| Rate for Payer: Cash Price |
$2,913.43
|
| Rate for Payer: Cofinity Commercial |
$3,423.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,913.43
|
| Rate for Payer: Healthscope Commercial |
$3,641.79
|
| Rate for Payer: Healthscope Whirlpool |
$3,532.54
|
| Rate for Payer: Mclaren Commercial |
$3,277.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,095.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,549.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,204.78
|
|
|
INFLIXIMAB-DYYB 100 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,653.60
|
|
|
Service Code
|
HCPCS Q5103
|
| Hospital Charge Code |
181037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,157.52 |
| Max. Negotiated Rate |
$1,653.60 |
| Rate for Payer: Aetna Commercial |
$1,488.24
|
| Rate for Payer: ASR ASR |
$1,603.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,282.04
|
| Rate for Payer: BCN Commercial |
$1,282.04
|
| Rate for Payer: Cash Price |
$1,322.88
|
| Rate for Payer: Cofinity Commercial |
$1,554.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,322.88
|
| Rate for Payer: Healthscope Commercial |
$1,653.60
|
| Rate for Payer: Healthscope Whirlpool |
$1,603.99
|
| Rate for Payer: Mclaren Commercial |
$1,488.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,405.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,455.17
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC
|
Facility
|
IP
|
$18,689.90
|
|
|
Service Code
|
MS-DRG 351
|
| Min. Negotiated Rate |
$13,304.40 |
| Max. Negotiated Rate |
$18,689.90 |
| Rate for Payer: Aetna Medicare |
$14,004.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,505.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,505.79
|
| Rate for Payer: BCBS MAPPO |
$14,004.63
|
| Rate for Payer: BCN Medicare Advantage |
$14,004.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,004.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,004.63
|
| Rate for Payer: Mclaren Medicare |
$14,004.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,704.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,105.32
|
| Rate for Payer: PACE Medicare |
$13,304.40
|
| Rate for Payer: PACE SWMI |
$14,004.63
|
| Rate for Payer: PHP Commercial |
$15,405.09
|
| Rate for Payer: PHP Medicare Advantage |
$14,004.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,689.90
|
| Rate for Payer: Priority Health Medicare |
$14,004.63
|
| Rate for Payer: Priority Health Narrow Network |
$14,951.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14,004.63
|
| Rate for Payer: UHC Medicare Advantage |
$14,424.77
|
| Rate for Payer: VA VA |
$14,004.63
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC
|
Facility
|
IP
|
$30,816.00
|
|
|
Service Code
|
MS-DRG 350
|
| Min. Negotiated Rate |
$20,900.27 |
| Max. Negotiated Rate |
$30,816.00 |
| Rate for Payer: Aetna Medicare |
$22,000.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,500.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,500.35
|
| Rate for Payer: BCBS MAPPO |
$22,000.28
|
| Rate for Payer: BCN Medicare Advantage |
$22,000.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,000.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,000.28
|
| Rate for Payer: Mclaren Medicare |
$22,000.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,100.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,300.32
|
| Rate for Payer: PACE Medicare |
$20,900.27
|
| Rate for Payer: PACE SWMI |
$22,000.28
|
| Rate for Payer: PHP Commercial |
$24,200.31
|
| Rate for Payer: PHP Medicare Advantage |
$22,000.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,816.00
|
| Rate for Payer: Priority Health Medicare |
$22,000.28
|
| Rate for Payer: Priority Health Narrow Network |
$24,652.80
|
| Rate for Payer: Railroad Medicare Medicare |
$22,000.28
|
| Rate for Payer: UHC Medicare Advantage |
$22,660.29
|
| Rate for Payer: VA VA |
$22,000.28
|
|
|
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,239.56
|
|
|
Service Code
|
MS-DRG 352
|
| Min. Negotiated Rate |
$10,516.67 |
| Max. Negotiated Rate |
$14,239.56 |
| Rate for Payer: Aetna Medicare |
$11,070.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,837.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,837.72
|
| Rate for Payer: BCBS MAPPO |
$11,070.18
|
| Rate for Payer: BCN Medicare Advantage |
$11,070.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,070.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,070.18
|
| Rate for Payer: Mclaren Medicare |
$11,070.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,623.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,730.71
|
| Rate for Payer: PACE Medicare |
$10,516.67
|
| Rate for Payer: PACE SWMI |
$11,070.18
|
| Rate for Payer: PHP Commercial |
$12,177.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,070.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,239.56
|
| Rate for Payer: Priority Health Medicare |
$11,070.18
|
| Rate for Payer: Priority Health Narrow Network |
$11,391.65
|
| Rate for Payer: Railroad Medicare Medicare |
$11,070.18
|
| Rate for Payer: UHC Medicare Advantage |
$11,402.29
|
| Rate for Payer: VA VA |
$11,070.18
|
|
|
INPATIENT APRDRG 0041: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$31,339.64
|
|
|
Service Code
|
APR-DRG 0041
|
| Hospital Charge Code |
APRDRG 0041
|
| Min. Negotiated Rate |
$29,847.28 |
| Max. Negotiated Rate |
$31,339.64 |
| Rate for Payer: BCBS Complete |
$31,339.64
|
| Rate for Payer: Mclaren Medicaid |
$29,847.28
|
| Rate for Payer: Meridian Medicaid |
$31,339.64
|
| Rate for Payer: PHP Medicaid |
$29,847.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,847.28
|
|
|
INPATIENT APRDRG 0042: TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$35,071.21
|
|
|
Service Code
|
APR-DRG 0042
|
| Hospital Charge Code |
APRDRG 0042
|
| Min. Negotiated Rate |
$33,401.15 |
| Max. Negotiated Rate |
$35,071.21 |
| Rate for Payer: BCBS Complete |
$35,071.21
|
| Rate for Payer: Mclaren Medicaid |
$33,401.15
|
| Rate for Payer: Meridian Medicaid |
$35,071.21
|
| Rate for Payer: PHP Medicaid |
$33,401.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,401.15
|
|
