|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 0143-9310-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: ASR ASR |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.92
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$18.66
|
| Rate for Payer: Mclaren Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.93
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 72266-146-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.75
|
| Rate for Payer: BCN Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.96
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0143-9311-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$24.11
|
| Rate for Payer: ASR ASR |
$25.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$26.79
|
| Rate for Payer: Healthscope Whirlpool |
$25.99
|
| Rate for Payer: Mclaren Commercial |
$24.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.58
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 0143-9310-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: ASR ASR |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.92
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$18.66
|
| Rate for Payer: Mclaren Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.93
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.61
|
|
|
Service Code
|
NDC 72266-146-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$21.61 |
| Rate for Payer: Aetna Commercial |
$19.45
|
| Rate for Payer: ASR ASR |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.75
|
| Rate for Payer: BCN Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$17.29
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$21.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.96
|
| Rate for Payer: Mclaren Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.02
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 0409-6695-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219-445-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 0143-9506-01
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Aetna Commercial |
$17.32
|
| Rate for Payer: ASR ASR |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$14.92
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Whirlpool |
$18.66
|
| Rate for Payer: Mclaren Commercial |
$17.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.93
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.20
|
|
|
Service Code
|
NDC 55150-222-20
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.31
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.06
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.43
|
|
|
Service Code
|
NDC 65219-445-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Aetna Commercial |
$16.59
|
| Rate for Payer: ASR ASR |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$14.29
|
| Rate for Payer: BCN Commercial |
$14.29
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$18.43
|
| Rate for Payer: Healthscope Whirlpool |
$17.88
|
| Rate for Payer: Mclaren Commercial |
$16.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.22
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.57
|
|
|
Service Code
|
NDC 55150-221-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$18.57 |
| Rate for Payer: Aetna Commercial |
$16.71
|
| Rate for Payer: ASR ASR |
$18.01
|
| Rate for Payer: BCBS Trust/PPO |
$14.40
|
| Rate for Payer: BCN Commercial |
$14.40
|
| Rate for Payer: Cash Price |
$14.86
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.86
|
| Rate for Payer: Healthscope Commercial |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$18.01
|
| Rate for Payer: Mclaren Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.34
|
|
|
ETOMIDATE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.79
|
|
|
Service Code
|
NDC 0143-9311-10
|
| Hospital Charge Code |
20472
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$24.11
|
| Rate for Payer: ASR ASR |
$25.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$25.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$26.79
|
| Rate for Payer: Healthscope Whirlpool |
$25.99
|
| Rate for Payer: Mclaren Commercial |
$24.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.58
|
|
|
ETOMIDATE 2 MG/ML IV (CODE)
|
Facility
|
IP
|
$22.92
|
|
|
Service Code
|
NDC 0409-6695-01
|
| Hospital Charge Code |
163720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$20.63
|
| Rate for Payer: ASR ASR |
$22.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.34
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.23
|
| Rate for Payer: Mclaren Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.17
|
|
|
ETONOGESTREL IMPLANT SYSTEM
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS J7307
|
| Min. Negotiated Rate |
$935.20 |
| Max. Negotiated Rate |
$1,214.09 |
| Rate for Payer: Aetna Commercial |
$1,092.48
|
| Rate for Payer: BCBS Complete |
$1,214.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,107.77
|
| Rate for Payer: BCN Commercial |
$1,107.77
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Meridian Medicaid |
$1,214.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,156.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$935.20
|
|
|
EUFLEXXA 10 MG/ML (MW 2.4-3.6 MILLION) INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$484.22
|
|
|
Service Code
|
HCPCS J7323
|
| Hospital Charge Code |
43247
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$338.95 |
| Max. Negotiated Rate |
$484.22 |
| Rate for Payer: Aetna Commercial |
$435.80
|
| Rate for Payer: ASR ASR |
$469.69
|
| Rate for Payer: BCBS Trust/PPO |
$375.42
|
| Rate for Payer: BCN Commercial |
$375.42
|
| Rate for Payer: Cash Price |
$387.38
|
| Rate for Payer: Cofinity Commercial |
$455.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.38
|
| Rate for Payer: Healthscope Commercial |
$484.22
|
| Rate for Payer: Healthscope Whirlpool |
$469.69
|
| Rate for Payer: Mclaren Commercial |
$435.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$411.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$426.11
|
|
|
EUFLEXXA INJ PER DOSE
|
Professional
|
Both
|
$289.30
|
|
|
Service Code
|
HCPCS J7323
|
| Min. Negotiated Rate |
$115.72 |
| Max. Negotiated Rate |
$202.51 |
| Rate for Payer: Aetna Commercial |
$176.10
|
| Rate for Payer: Aetna Medicare |
$131.42
|
| Rate for Payer: BCBS Complete |
$115.72
|
| Rate for Payer: BCBS MAPPO |
$131.42
|
| Rate for Payer: BCBS Trust/PPO |
$129.70
|
| Rate for Payer: BCN Commercial |
$137.68
|
| Rate for Payer: BCN Medicare Advantage |
$131.42
|
| Rate for Payer: Cash Price |
$231.44
|
| Rate for Payer: Cash Price |
$231.44
|
| Rate for Payer: Cofinity Commercial |
$176.10
|
| Rate for Payer: Cofinity Commercial |
$189.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.42
|
| Rate for Payer: Healthscope Commercial |
$157.70
|
| Rate for Payer: Healthscope Whirlpool |
$157.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.99
|
| Rate for Payer: PACE SWMI |
$131.42
|
| Rate for Payer: PHP Medicare Advantage |
$131.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.51
|
| Rate for Payer: Priority Health Medicare |
$131.42
|
| Rate for Payer: UHC Medicare Advantage |
$135.36
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$38,930.88
|
|
|
Service Code
|
MS-DRG 933
|
| Min. Negotiated Rate |
$25,983.50 |
| Max. Negotiated Rate |
$38,930.88 |
| Rate for Payer: Aetna Medicare |
$27,351.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,188.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,188.81
|
| Rate for Payer: BCBS MAPPO |
$27,351.05
|
| Rate for Payer: BCN Medicare Advantage |
$27,351.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,351.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,351.05
|
| Rate for Payer: Mclaren Medicare |
$27,351.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,718.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,453.71
|
| Rate for Payer: PACE Medicare |
$25,983.50
|
| Rate for Payer: PACE SWMI |
$27,351.05
|
| Rate for Payer: PHP Commercial |
$30,086.16
|
| Rate for Payer: PHP Medicare Advantage |
$27,351.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,930.88
|
| Rate for Payer: Priority Health Medicare |
$27,351.05
|
| Rate for Payer: Priority Health Narrow Network |
$31,144.70
|
| Rate for Payer: Railroad Medicare Medicare |
$27,351.05
|
| Rate for Payer: UHC Medicare Advantage |
$28,171.58
|
| Rate for Payer: VA VA |
$27,351.05
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$338,445.71
|
|
|
Service Code
|
MS-DRG 927
|
| Min. Negotiated Rate |
$213,601.93 |
| Max. Negotiated Rate |
$338,445.71 |
| Rate for Payer: Aetna Medicare |
$224,844.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281,055.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281,055.18
|
| Rate for Payer: BCBS MAPPO |
$224,844.14
|
| Rate for Payer: BCN Medicare Advantage |
$224,844.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224,844.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$224,844.14
|
| Rate for Payer: Mclaren Medicare |
$224,844.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236,086.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258,570.76
|
| Rate for Payer: PACE Medicare |
$213,601.93
|
| Rate for Payer: PACE SWMI |
$224,844.14
|
| Rate for Payer: PHP Commercial |
$247,328.55
|
| Rate for Payer: PHP Medicare Advantage |
$224,844.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338,445.71
|
| Rate for Payer: Priority Health Medicare |
$224,844.14
|
| Rate for Payer: Priority Health Narrow Network |
$270,756.57
|
| Rate for Payer: Railroad Medicare Medicare |
$224,844.14
|
| Rate for Payer: UHC Medicare Advantage |
$231,589.46
|
| Rate for Payer: VA VA |
$224,844.14
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$31,920.24
|
|
|
Service Code
|
MS-DRG 982
|
| Min. Negotiated Rate |
$21,591.98 |
| Max. Negotiated Rate |
$31,920.24 |
| Rate for Payer: Aetna Medicare |
$22,728.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,410.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,410.50
|
| Rate for Payer: BCBS MAPPO |
$22,728.40
|
| Rate for Payer: BCN Medicare Advantage |
$22,728.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,728.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,728.40
|
| Rate for Payer: Mclaren Medicare |
$22,728.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,864.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,137.66
|
| Rate for Payer: PACE Medicare |
$21,591.98
|
| Rate for Payer: PACE SWMI |
$22,728.40
|
| Rate for Payer: PHP Commercial |
$25,001.24
|
| Rate for Payer: PHP Medicare Advantage |
$22,728.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,920.24
|
| Rate for Payer: Priority Health Medicare |
$22,728.40
|
| Rate for Payer: Priority Health Narrow Network |
$25,536.19
|
| Rate for Payer: Railroad Medicare Medicare |
$22,728.40
|
| Rate for Payer: UHC Medicare Advantage |
$23,410.25
|
| Rate for Payer: VA VA |
$22,728.40
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$60,866.74
|
|
|
Service Code
|
MS-DRG 981
|
| Min. Negotiated Rate |
$39,724.30 |
| Max. Negotiated Rate |
$60,866.74 |
| Rate for Payer: Aetna Medicare |
$41,815.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,268.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,268.81
|
| Rate for Payer: BCBS MAPPO |
$41,815.05
|
| Rate for Payer: BCN Medicare Advantage |
$41,815.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,815.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,815.05
|
| Rate for Payer: Mclaren Medicare |
$41,815.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,905.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,087.31
|
| Rate for Payer: PACE Medicare |
$39,724.30
|
| Rate for Payer: PACE SWMI |
$41,815.05
|
| Rate for Payer: PHP Commercial |
$45,996.56
|
| Rate for Payer: PHP Medicare Advantage |
$41,815.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60,866.74
|
| Rate for Payer: Priority Health Medicare |
$41,815.05
|
| Rate for Payer: Priority Health Narrow Network |
$48,693.39
|
| Rate for Payer: Railroad Medicare Medicare |
$41,815.05
|
| Rate for Payer: UHC Medicare Advantage |
$43,069.50
|
| Rate for Payer: VA VA |
$41,815.05
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,995.97
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$14,748.93 |
| Max. Negotiated Rate |
$20,995.97 |
| Rate for Payer: Aetna Medicare |
$15,525.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,406.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,406.49
|
| Rate for Payer: BCBS MAPPO |
$15,525.19
|
| Rate for Payer: BCN Medicare Advantage |
$15,525.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,525.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,525.19
|
| Rate for Payer: Mclaren Medicare |
$15,525.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,301.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,853.97
|
| Rate for Payer: PACE Medicare |
$14,748.93
|
| Rate for Payer: PACE SWMI |
$15,525.19
|
| Rate for Payer: PHP Commercial |
$17,077.71
|
| Rate for Payer: PHP Medicare Advantage |
$15,525.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,995.97
|
| Rate for Payer: Priority Health Medicare |
$15,525.19
|
| Rate for Payer: Priority Health Narrow Network |
$16,796.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15,525.19
|
| Rate for Payer: UHC Medicare Advantage |
$15,990.95
|
| Rate for Payer: VA VA |
$15,525.19
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$20,542.72
|
|
|
Service Code
|
MS-DRG 038
|
| Min. Negotiated Rate |
$14,465.01 |
| Max. Negotiated Rate |
$20,542.72 |
| Rate for Payer: Aetna Medicare |
$15,226.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,032.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,032.91
|
| Rate for Payer: BCBS MAPPO |
$15,226.33
|
| Rate for Payer: BCN Medicare Advantage |
$15,226.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,226.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,226.33
|
| Rate for Payer: Mclaren Medicare |
$15,226.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,987.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,510.28
|
| Rate for Payer: PACE Medicare |
$14,465.01
|
| Rate for Payer: PACE SWMI |
$15,226.33
|
| Rate for Payer: PHP Commercial |
$16,748.96
|
| Rate for Payer: PHP Medicare Advantage |
$15,226.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,542.72
|
| Rate for Payer: Priority Health Medicare |
$15,226.33
|
| Rate for Payer: Priority Health Narrow Network |
$16,434.18
|
| Rate for Payer: Railroad Medicare Medicare |
$15,226.33
|
| Rate for Payer: UHC Medicare Advantage |
$15,683.12
|
| Rate for Payer: VA VA |
$15,226.33
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$43,342.70
|
|
|
Service Code
|
MS-DRG 037
|
| Min. Negotiated Rate |
$28,747.10 |
| Max. Negotiated Rate |
$43,342.70 |
| Rate for Payer: Aetna Medicare |
$30,260.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,825.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,825.14
|
| Rate for Payer: BCBS MAPPO |
$30,260.11
|
| Rate for Payer: BCN Medicare Advantage |
$30,260.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,260.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,260.11
|
| Rate for Payer: Mclaren Medicare |
$30,260.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,773.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,799.13
|
| Rate for Payer: PACE Medicare |
$28,747.10
|
| Rate for Payer: PACE SWMI |
$30,260.11
|
| Rate for Payer: PHP Commercial |
$33,286.12
|
| Rate for Payer: PHP Medicare Advantage |
$30,260.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,342.70
|
| Rate for Payer: Priority Health Medicare |
$30,260.11
|
| Rate for Payer: Priority Health Narrow Network |
$34,674.16
|
| Rate for Payer: Railroad Medicare Medicare |
$30,260.11
|
| Rate for Payer: UHC Medicare Advantage |
$31,167.91
|
| Rate for Payer: VA VA |
$30,260.11
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,650.44
|
|
|
Service Code
|
MS-DRG 039
|
| Min. Negotiated Rate |
$10,774.04 |
| Max. Negotiated Rate |
$14,650.44 |
| Rate for Payer: Aetna Medicare |
$11,341.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,176.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,176.36
|
| Rate for Payer: BCBS MAPPO |
$11,341.09
|
| Rate for Payer: BCN Medicare Advantage |
$11,341.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,341.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,341.09
|
| Rate for Payer: Mclaren Medicare |
$11,341.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,908.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,042.25
|
| Rate for Payer: PACE Medicare |
$10,774.04
|
| Rate for Payer: PACE SWMI |
$11,341.09
|
| Rate for Payer: PHP Commercial |
$12,475.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,341.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,650.44
|
| Rate for Payer: Priority Health Medicare |
$11,341.09
|
| Rate for Payer: Priority Health Narrow Network |
$11,720.35
|
| Rate for Payer: Railroad Medicare Medicare |
$11,341.09
|
| Rate for Payer: UHC Medicare Advantage |
$11,681.32
|
| Rate for Payer: VA VA |
$11,341.09
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$20,086.90
|
|
|
Service Code
|
MS-DRG 115
|
| Min. Negotiated Rate |
$14,179.47 |
| Max. Negotiated Rate |
$20,086.90 |
| Rate for Payer: Aetna Medicare |
$14,925.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,657.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,657.20
|
| Rate for Payer: BCBS MAPPO |
$14,925.76
|
| Rate for Payer: BCN Medicare Advantage |
$14,925.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,925.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,925.76
|
| Rate for Payer: Mclaren Medicare |
$14,925.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,672.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,164.62
|
| Rate for Payer: PACE Medicare |
$14,179.47
|
| Rate for Payer: PACE SWMI |
$14,925.76
|
| Rate for Payer: PHP Commercial |
$16,418.34
|
| Rate for Payer: PHP Medicare Advantage |
$14,925.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,086.90
|
| Rate for Payer: Priority Health Medicare |
$14,925.76
|
| Rate for Payer: Priority Health Narrow Network |
$16,069.52
|
| Rate for Payer: Railroad Medicare Medicare |
$14,925.76
|
| Rate for Payer: UHC Medicare Advantage |
$15,373.53
|
| Rate for Payer: VA VA |
$14,925.76
|
|
