|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$10,640.58
|
|
|
Service Code
|
MS-DRG 690
|
| Min. Negotiated Rate |
$8,086.84 |
| Max. Negotiated Rate |
$10,640.58 |
| Rate for Payer: Aetna Medicare |
$8,512.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,640.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,640.58
|
| Rate for Payer: BCBS MAPPO |
$8,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$8,512.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,512.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,512.46
|
| Rate for Payer: Mclaren Medicare |
$8,512.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,938.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,789.33
|
| Rate for Payer: PACE Medicare |
$8,086.84
|
| Rate for Payer: PACE SWMI |
$8,512.46
|
| Rate for Payer: PHP Commercial |
$9,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$8,512.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,360.60
|
| Rate for Payer: Priority Health Medicare |
$8,512.46
|
| Rate for Payer: Priority Health Narrow Network |
$8,288.48
|
| Rate for Payer: Railroad Medicare Medicare |
$8,512.46
|
| Rate for Payer: UHC Medicare Advantage |
$8,767.83
|
| Rate for Payer: VA VA |
$8,512.46
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC
|
Facility
|
IP
|
$13,421.65
|
|
|
Service Code
|
MS-DRG 687
|
| Min. Negotiated Rate |
$10,004.32 |
| Max. Negotiated Rate |
$13,421.65 |
| Rate for Payer: Aetna Medicare |
$10,530.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,163.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,163.58
|
| Rate for Payer: BCBS MAPPO |
$10,530.86
|
| Rate for Payer: BCN Medicare Advantage |
$10,530.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,530.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,530.86
|
| Rate for Payer: Mclaren Medicare |
$10,530.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,057.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,110.49
|
| Rate for Payer: PACE Medicare |
$10,004.32
|
| Rate for Payer: PACE SWMI |
$10,530.86
|
| Rate for Payer: PHP Commercial |
$11,583.95
|
| Rate for Payer: PHP Medicare Advantage |
$10,530.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,421.65
|
| Rate for Payer: Priority Health Medicare |
$10,530.86
|
| Rate for Payer: Priority Health Narrow Network |
$10,737.32
|
| Rate for Payer: Railroad Medicare Medicare |
$10,530.86
|
| Rate for Payer: UHC Medicare Advantage |
$10,846.79
|
| Rate for Payer: VA VA |
$10,530.86
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC
|
Facility
|
IP
|
$23,617.90
|
|
|
Service Code
|
MS-DRG 686
|
| Min. Negotiated Rate |
$16,391.33 |
| Max. Negotiated Rate |
$23,617.90 |
| Rate for Payer: Aetna Medicare |
$17,254.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,567.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,567.54
|
| Rate for Payer: BCBS MAPPO |
$17,254.03
|
| Rate for Payer: BCN Medicare Advantage |
$17,254.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,254.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,254.03
|
| Rate for Payer: Mclaren Medicare |
$17,254.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,116.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,842.13
|
| Rate for Payer: PACE Medicare |
$16,391.33
|
| Rate for Payer: PACE SWMI |
$17,254.03
|
| Rate for Payer: PHP Commercial |
$18,979.43
|
| Rate for Payer: PHP Medicare Advantage |
$17,254.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,617.90
|
| Rate for Payer: Priority Health Medicare |
$17,254.03
|
| Rate for Payer: Priority Health Narrow Network |
$18,894.32
|
| Rate for Payer: Railroad Medicare Medicare |
$17,254.03
|
| Rate for Payer: UHC Medicare Advantage |
$17,771.65
|
| Rate for Payer: VA VA |
$17,254.03
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,365.42
|
|
|
Service Code
|
MS-DRG 688
|
| Min. Negotiated Rate |
$7,877.72 |
| Max. Negotiated Rate |
$10,365.42 |
| Rate for Payer: Aetna Medicare |
$8,292.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,365.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,365.42
|
| Rate for Payer: BCBS MAPPO |
$8,292.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,292.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,292.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,292.34
|
| Rate for Payer: Mclaren Medicare |
$8,292.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,706.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,536.19
|
| Rate for Payer: PACE Medicare |
$7,877.72
|
| Rate for Payer: PACE SWMI |
$8,292.34
|
| Rate for Payer: PHP Commercial |
$9,121.57
|
| Rate for Payer: PHP Medicare Advantage |
$8,292.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,026.76
|
| Rate for Payer: Priority Health Medicare |
$8,292.34
|
| Rate for Payer: Priority Health Narrow Network |
$8,021.41
|
| Rate for Payer: Railroad Medicare Medicare |
$8,292.34
|
| Rate for Payer: UHC Medicare Advantage |
$8,541.11
|
| Rate for Payer: VA VA |
$8,292.34
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$15,356.64
|
|
|
Service Code
|
MS-DRG 695
|
| Min. Negotiated Rate |
$11,216.41 |
| Max. Negotiated Rate |
$15,356.64 |
| Rate for Payer: Aetna Medicare |
$11,806.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,758.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,758.44
|
| Rate for Payer: BCBS MAPPO |
$11,806.75
|
| Rate for Payer: BCN Medicare Advantage |
$11,806.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,806.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,806.75
|
| Rate for Payer: Mclaren Medicare |
$11,806.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,397.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,577.76
|
| Rate for Payer: PACE Medicare |
$11,216.41
|
| Rate for Payer: PACE SWMI |
$11,806.75
|
| Rate for Payer: PHP Commercial |
$12,987.42
|
| Rate for Payer: PHP Medicare Advantage |
$11,806.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,356.64
|
| Rate for Payer: Priority Health Medicare |
$11,806.75
|
| Rate for Payer: Priority Health Narrow Network |
$12,285.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,806.75
|
| Rate for Payer: UHC Medicare Advantage |
$12,160.95
|
| Rate for Payer: VA VA |
$11,806.75
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$9,425.68
|
|
|
Service Code
|
MS-DRG 696
|
| Min. Negotiated Rate |
$7,109.25 |
| Max. Negotiated Rate |
$9,425.68 |
| Rate for Payer: Aetna Medicare |
$7,540.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,425.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,425.68
|
| Rate for Payer: BCBS MAPPO |
$7,540.54
|
| Rate for Payer: BCN Medicare Advantage |
$7,540.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,540.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,540.54
|
| Rate for Payer: Mclaren Medicare |
$7,540.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,917.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,671.62
|
| Rate for Payer: PACE Medicare |
$7,163.51
|
| Rate for Payer: PACE SWMI |
$7,540.54
|
| Rate for Payer: PHP Commercial |
$8,294.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,540.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,886.56
|
| Rate for Payer: Priority Health Medicare |
$7,540.54
|
| Rate for Payer: Priority Health Narrow Network |
$7,109.25
|
| Rate for Payer: Railroad Medicare Medicare |
$7,540.54
|
| Rate for Payer: UHC Medicare Advantage |
$7,766.76
|
| Rate for Payer: VA VA |
$7,540.54
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$38,576.50
|
|
|
Service Code
|
MS-DRG 652
|
| Min. Negotiated Rate |
$25,761.51 |
| Max. Negotiated Rate |
$38,576.50 |
| Rate for Payer: Aetna Medicare |
$27,117.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,896.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,896.72
|
| Rate for Payer: BCBS MAPPO |
$27,117.38
|
| Rate for Payer: BCN Medicare Advantage |
$27,117.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,117.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,117.38
|
| Rate for Payer: Mclaren Medicare |
$27,117.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,473.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,184.99
|
| Rate for Payer: PACE Medicare |
$25,761.51
|
| Rate for Payer: PACE SWMI |
$27,117.38
|
| Rate for Payer: PHP Commercial |
$29,829.12
|
| Rate for Payer: PHP Medicare Advantage |
$27,117.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,576.50
|
| Rate for Payer: Priority Health Medicare |
$27,117.38
|
| Rate for Payer: Priority Health Narrow Network |
$30,861.20
|
| Rate for Payer: Railroad Medicare Medicare |
$27,117.38
|
| Rate for Payer: UHC Medicare Advantage |
$27,930.90
|
| Rate for Payer: VA VA |
$27,117.38
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$57,747.90
|
|
|
Service Code
|
MS-DRG 650
|
| Min. Negotiated Rate |
$37,770.62 |
| Max. Negotiated Rate |
$57,747.90 |
| Rate for Payer: Aetna Medicare |
$39,758.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,698.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,698.19
|
| Rate for Payer: BCBS MAPPO |
$39,758.55
|
| Rate for Payer: BCN Medicare Advantage |
$39,758.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,758.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,758.55
|
| Rate for Payer: Mclaren Medicare |
$39,758.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,746.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,722.33
|
| Rate for Payer: PACE Medicare |
$37,770.62
|
| Rate for Payer: PACE SWMI |
$39,758.55
|
| Rate for Payer: PHP Commercial |
$43,734.40
|
| Rate for Payer: PHP Medicare Advantage |
$39,758.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,747.90
|
| Rate for Payer: Priority Health Medicare |
$39,758.55
|
| Rate for Payer: Priority Health Narrow Network |
$46,198.32
|
| Rate for Payer: Railroad Medicare Medicare |
$39,758.55
|
| Rate for Payer: UHC Medicare Advantage |
$40,951.31
|
| Rate for Payer: VA VA |
$39,758.55
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$44,405.86
|
|
|
Service Code
|
MS-DRG 651
|
| Min. Negotiated Rate |
$29,413.05 |
| Max. Negotiated Rate |
$44,405.86 |
| Rate for Payer: Aetna Medicare |
$30,961.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,701.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,701.39
|
| Rate for Payer: BCBS MAPPO |
$30,961.11
|
| Rate for Payer: BCN Medicare Advantage |
$30,961.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,961.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,961.11
|
| Rate for Payer: Mclaren Medicare |
$30,961.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,509.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,605.28
|
| Rate for Payer: PACE Medicare |
$29,413.05
|
| Rate for Payer: PACE SWMI |
$30,961.11
|
| Rate for Payer: PHP Commercial |
$34,057.22
|
| Rate for Payer: PHP Medicare Advantage |
$30,961.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,405.86
|
| Rate for Payer: Priority Health Medicare |
$30,961.11
|
| Rate for Payer: Priority Health Narrow Network |
$35,524.69
|
| Rate for Payer: Railroad Medicare Medicare |
$30,961.11
|
| Rate for Payer: UHC Medicare Advantage |
$31,889.94
|
| Rate for Payer: VA VA |
$30,961.11
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$27,048.74
|
|
|
Service Code
|
MS-DRG 488
|
| Min. Negotiated Rate |
$18,540.44 |
| Max. Negotiated Rate |
$27,048.74 |
| Rate for Payer: Aetna Medicare |
$19,516.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,395.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,395.31
|
| Rate for Payer: BCBS MAPPO |
$19,516.25
|
| Rate for Payer: BCN Medicare Advantage |
$19,516.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,516.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,516.25
|
| Rate for Payer: Mclaren Medicare |
$19,516.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,492.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,443.69
|
| Rate for Payer: PACE Medicare |
$18,540.44
|
| Rate for Payer: PACE SWMI |
$19,516.25
|
| Rate for Payer: PHP Commercial |
$21,467.88
|
| Rate for Payer: PHP Medicare Advantage |
$19,516.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,048.74
|
| Rate for Payer: Priority Health Medicare |
$19,516.25
|
| Rate for Payer: Priority Health Narrow Network |
$21,638.99
|
| Rate for Payer: Railroad Medicare Medicare |
$19,516.25
|
| Rate for Payer: UHC Medicare Advantage |
$20,101.74
|
| Rate for Payer: VA VA |
$19,516.25
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,892.07
|
|
|
Service Code
|
MS-DRG 489
|
| Min. Negotiated Rate |
$11,551.81 |
| Max. Negotiated Rate |
$15,892.07 |
| Rate for Payer: Aetna Medicare |
$12,159.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,199.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,199.75
|
| Rate for Payer: BCBS MAPPO |
$12,159.80
|
| Rate for Payer: BCN Medicare Advantage |
$12,159.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,159.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,159.80
|
| Rate for Payer: Mclaren Medicare |
$12,159.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,767.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,983.77
|
| Rate for Payer: PACE Medicare |
$11,551.81
|
| Rate for Payer: PACE SWMI |
$12,159.80
|
| Rate for Payer: PHP Commercial |
$13,375.78
|
| Rate for Payer: PHP Medicare Advantage |
$12,159.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,892.07
|
| Rate for Payer: Priority Health Medicare |
$12,159.80
|
| Rate for Payer: Priority Health Narrow Network |
$12,713.66
|
| Rate for Payer: Railroad Medicare Medicare |
$12,159.80
|
| Rate for Payer: UHC Medicare Advantage |
$12,524.59
|
| Rate for Payer: VA VA |
$12,159.80
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$25,786.57
|
|
|
Service Code
|
MS-DRG 486
|
| Min. Negotiated Rate |
$17,749.80 |
| Max. Negotiated Rate |
$25,786.57 |
| Rate for Payer: Aetna Medicare |
$18,684.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,355.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,355.00
|
| Rate for Payer: BCBS MAPPO |
$18,684.00
|
| Rate for Payer: BCN Medicare Advantage |
$18,684.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,684.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,684.00
|
| Rate for Payer: Mclaren Medicare |
$18,684.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,618.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,486.60
|
| Rate for Payer: PACE Medicare |
$17,749.80
|
| Rate for Payer: PACE SWMI |
$18,684.00
|
| Rate for Payer: PHP Commercial |
$20,552.40
|
| Rate for Payer: PHP Medicare Advantage |
$18,684.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,786.57
|
| Rate for Payer: Priority Health Medicare |
$18,684.00
|
| Rate for Payer: Priority Health Narrow Network |
$20,629.26
|
| Rate for Payer: Railroad Medicare Medicare |
$18,684.00
|
| Rate for Payer: UHC Medicare Advantage |
$19,244.52
|
| Rate for Payer: VA VA |
$18,684.00
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$42,294.96
|
|
|
Service Code
|
MS-DRG 485
|
| Min. Negotiated Rate |
$28,090.79 |
| Max. Negotiated Rate |
$42,294.96 |
| Rate for Payer: Aetna Medicare |
$29,569.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,961.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,961.56
|
| Rate for Payer: BCBS MAPPO |
$29,569.25
|
| Rate for Payer: BCN Medicare Advantage |
$29,569.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,569.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,569.25
|
| Rate for Payer: Mclaren Medicare |
$29,569.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,047.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,004.64
|
| Rate for Payer: PACE Medicare |
$28,090.79
|
| Rate for Payer: PACE SWMI |
$29,569.25
|
| Rate for Payer: PHP Commercial |
$32,526.18
|
| Rate for Payer: PHP Medicare Advantage |
$29,569.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,294.96
|
| Rate for Payer: Priority Health Medicare |
$29,569.25
|
| Rate for Payer: Priority Health Narrow Network |
$33,835.97
|
| Rate for Payer: Railroad Medicare Medicare |
$29,569.25
|
| Rate for Payer: UHC Medicare Advantage |
$30,456.33
|
| Rate for Payer: VA VA |
$29,569.25
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$19,836.52
|
|
|
Service Code
|
MS-DRG 487
|
| Min. Negotiated Rate |
$14,022.63 |
| Max. Negotiated Rate |
$19,836.52 |
| Rate for Payer: Aetna Medicare |
$14,760.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,450.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,450.82
|
| Rate for Payer: BCBS MAPPO |
$14,760.66
|
| Rate for Payer: BCN Medicare Advantage |
$14,760.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,760.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,760.66
|
| Rate for Payer: Mclaren Medicare |
$14,760.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,498.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,974.76
|
| Rate for Payer: PACE Medicare |
$14,022.63
|
| Rate for Payer: PACE SWMI |
$14,760.66
|
| Rate for Payer: PHP Commercial |
$16,236.73
|
| Rate for Payer: PHP Medicare Advantage |
$14,760.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,836.52
|
| Rate for Payer: Priority Health Medicare |
$14,760.66
|
| Rate for Payer: Priority Health Narrow Network |
$15,869.22
|
| Rate for Payer: Railroad Medicare Medicare |
$14,760.66
|
| Rate for Payer: UHC Medicare Advantage |
$15,203.48
|
| Rate for Payer: VA VA |
$14,760.66
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 51079-928-01
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: ASR ASR |
$2.76
|
| Rate for Payer: BCBS Trust/PPO |
$2.21
|
| Rate for Payer: BCN Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.85
|
| Rate for Payer: Healthscope Whirlpool |
$2.76
|
| Rate for Payer: Mclaren Commercial |
$2.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.51
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 51079-928-20
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: ASR ASR |
$276.45
|
| Rate for Payer: BCBS Trust/PPO |
$220.96
|
| Rate for Payer: BCN Commercial |
$220.96
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$267.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$285.00
|
| Rate for Payer: Healthscope Whirlpool |
$276.45
|
| Rate for Payer: Mclaren Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.80
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$346.75
|
|
|
Service Code
|
NDC 60687-450-01
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.72 |
| Max. Negotiated Rate |
$346.75 |
| Rate for Payer: Aetna Commercial |
$312.08
|
| Rate for Payer: ASR ASR |
$336.35
|
| Rate for Payer: BCBS Trust/PPO |
$268.84
|
| Rate for Payer: BCN Commercial |
$268.84
|
| Rate for Payer: Cash Price |
$277.40
|
| Rate for Payer: Cofinity Commercial |
$325.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$277.40
|
| Rate for Payer: Healthscope Commercial |
$346.75
|
| Rate for Payer: Healthscope Whirlpool |
$336.35
|
| Rate for Payer: Mclaren Commercial |
$312.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$294.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$242.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$305.14
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$384.75
|
|
|
Service Code
|
NDC 51079-929-20
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.32 |
| Max. Negotiated Rate |
$384.75 |
| Rate for Payer: Aetna Commercial |
$346.28
|
| Rate for Payer: ASR ASR |
$373.21
|
| Rate for Payer: BCBS Trust/PPO |
$298.30
|
| Rate for Payer: BCN Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.80
|
| Rate for Payer: Healthscope Commercial |
$384.75
|
| Rate for Payer: Healthscope Whirlpool |
$373.21
|
| Rate for Payer: Mclaren Commercial |
$346.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$327.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$338.58
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079-929-01
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: ASR ASR |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.85
|
| Rate for Payer: Healthscope Whirlpool |
$3.73
|
| Rate for Payer: Mclaren Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.39
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 0904-7110-61
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.49 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: ASR ASR |
$281.98
|
| Rate for Payer: BCBS Trust/PPO |
$225.38
|
| Rate for Payer: BCN Commercial |
$225.38
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$273.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Healthscope Whirlpool |
$281.98
|
| Rate for Payer: Mclaren Commercial |
$261.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$255.82
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.47
|
|
|
Service Code
|
NDC 60687-450-11
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: ASR ASR |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$2.69
|
| Rate for Payer: BCN Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.78
|
| Rate for Payer: Healthscope Commercial |
$3.47
|
| Rate for Payer: Healthscope Whirlpool |
$3.37
|
| Rate for Payer: Mclaren Commercial |
$3.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.05
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$251.75
|
|
|
Service Code
|
NDC 68382-799-01
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.22 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$226.58
|
| Rate for Payer: ASR ASR |
$244.20
|
| Rate for Payer: BCBS Trust/PPO |
$195.18
|
| Rate for Payer: BCN Commercial |
$195.18
|
| Rate for Payer: Cash Price |
$201.40
|
| Rate for Payer: Cofinity Commercial |
$236.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.40
|
| Rate for Payer: Healthscope Commercial |
$251.75
|
| Rate for Payer: Healthscope Whirlpool |
$244.20
|
| Rate for Payer: Mclaren Commercial |
$226.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.54
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$233.70
|
|
|
Service Code
|
NDC 0904-5929-61
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.59 |
| Max. Negotiated Rate |
$233.70 |
| Rate for Payer: Aetna Commercial |
$210.33
|
| Rate for Payer: ASR ASR |
$226.69
|
| Rate for Payer: BCBS Trust/PPO |
$181.19
|
| Rate for Payer: BCN Commercial |
$181.19
|
| Rate for Payer: Cash Price |
$186.96
|
| Rate for Payer: Cofinity Commercial |
$219.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.96
|
| Rate for Payer: Healthscope Commercial |
$233.70
|
| Rate for Payer: Healthscope Whirlpool |
$226.69
|
| Rate for Payer: Mclaren Commercial |
$210.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.66
|
|
|
LABETALOL 20 MG/4 ML (5 MG/ML) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$26.65
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
155884
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Commercial |
$23.98
|
| Rate for Payer: ASR ASR |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$20.66
|
| Rate for Payer: BCN Commercial |
$20.66
|
| Rate for Payer: Cash Price |
$21.32
|
| Rate for Payer: Cofinity Commercial |
$25.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.32
|
| Rate for Payer: Healthscope Commercial |
$26.65
|
| Rate for Payer: Healthscope Whirlpool |
$25.85
|
| Rate for Payer: Mclaren Commercial |
$23.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.45
|
|
|
LABETALOL 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.50
|
|
|
Service Code
|
HCPCS J1920
|
| Hospital Charge Code |
10372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Commercial |
$76.05
|
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Commercial |
$288.40
|
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Commercial |
$43.65
|
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: ASR ASR |
$310.84
|
| Rate for Payer: ASR ASR |
$47.04
|
| Rate for Payer: ASR ASR |
$57.23
|
| Rate for Payer: ASR ASR |
$41.22
|
| Rate for Payer: ASR ASR |
$44.62
|
| Rate for Payer: ASR ASR |
$152.29
|
| Rate for Payer: ASR ASR |
$81.96
|
| Rate for Payer: BCBS Trust/PPO |
$35.66
|
| Rate for Payer: BCBS Trust/PPO |
$121.72
|
| Rate for Payer: BCBS Trust/PPO |
$248.44
|
| Rate for Payer: BCBS Trust/PPO |
$45.74
|
| Rate for Payer: BCBS Trust/PPO |
$65.51
|
| Rate for Payer: BCBS Trust/PPO |
$32.95
|
| Rate for Payer: BCBS Trust/PPO |
$37.60
|
| Rate for Payer: BCN Commercial |
$35.66
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: BCN Commercial |
$121.72
|
| Rate for Payer: BCN Commercial |
$248.44
|
| Rate for Payer: BCN Commercial |
$45.74
|
| Rate for Payer: BCN Commercial |
$65.51
|
| Rate for Payer: BCN Commercial |
$37.60
|
| Rate for Payer: Cash Price |
$38.80
|
| Rate for Payer: Cash Price |
$67.60
|
| Rate for Payer: Cash Price |
$256.36
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$34.00
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$39.95
|
| Rate for Payer: Cofinity Commercial |
$55.46
|
| Rate for Payer: Cofinity Commercial |
$79.43
|
| Rate for Payer: Cofinity Commercial |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$301.22
|
| Rate for Payer: Cofinity Commercial |
$147.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.20
|
| Rate for Payer: Healthscope Commercial |
$46.00
|
| Rate for Payer: Healthscope Commercial |
$157.00
|
| Rate for Payer: Healthscope Commercial |
$84.50
|
| Rate for Payer: Healthscope Commercial |
$320.45
|
| Rate for Payer: Healthscope Commercial |
$42.50
|
| Rate for Payer: Healthscope Commercial |
$48.50
|
| Rate for Payer: Healthscope Commercial |
$59.00
|
| Rate for Payer: Healthscope Whirlpool |
$41.22
|
| Rate for Payer: Healthscope Whirlpool |
$152.29
|
| Rate for Payer: Healthscope Whirlpool |
$47.04
|
| Rate for Payer: Healthscope Whirlpool |
$44.62
|
| Rate for Payer: Healthscope Whirlpool |
$310.84
|
| Rate for Payer: Healthscope Whirlpool |
$81.96
|
| Rate for Payer: Healthscope Whirlpool |
$57.23
|
| Rate for Payer: Mclaren Commercial |
$41.40
|
| Rate for Payer: Mclaren Commercial |
$53.10
|
| Rate for Payer: Mclaren Commercial |
$38.25
|
| Rate for Payer: Mclaren Commercial |
$141.30
|
| Rate for Payer: Mclaren Commercial |
$43.65
|
| Rate for Payer: Mclaren Commercial |
$76.05
|
| Rate for Payer: Mclaren Commercial |
$288.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$272.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$51.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.36
|
|
