|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
NDC 63739-354-10
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: ASR ASR |
$287.12
|
| Rate for Payer: BCBS Trust/PPO |
$229.49
|
| Rate for Payer: BCN Commercial |
$229.49
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$278.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.80
|
| Rate for Payer: Healthscope Commercial |
$296.00
|
| Rate for Payer: Healthscope Whirlpool |
$287.12
|
| Rate for Payer: Mclaren Commercial |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.48
|
|
|
MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) TABLET
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
NDC 1000670028
|
| Hospital Charge Code |
10491
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: ASR ASR |
$244.44
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$195.38
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.60
|
| Rate for Payer: Healthscope Commercial |
$252.00
|
| Rate for Payer: Healthscope Whirlpool |
$244.44
|
| Rate for Payer: Mclaren Commercial |
$226.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$214.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.76
|
|
|
MAGNESIUM SULFATE 0.5 GRAM/ML (50 %) INJECTION (CODE)
|
Facility
|
IP
|
$40.25
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna Commercial |
$36.22
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: ASR ASR |
$39.04
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCBS Trust/PPO |
$31.21
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Commercial |
$31.21
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$32.20
|
| Rate for Payer: Cofinity Commercial |
$37.84
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.20
|
| Rate for Payer: Healthscope Commercial |
$40.25
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$39.04
|
| Rate for Payer: Mclaren Commercial |
$36.22
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
|
|
MAGNESIUM SULFATE 1 GRAM/100 ML IN DEXTROSE 5 % INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
16162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: Aetna Commercial |
$41.63
|
| Rate for Payer: Aetna Commercial |
$75.51
|
| Rate for Payer: ASR ASR |
$44.87
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: ASR ASR |
$81.38
|
| Rate for Payer: BCBS Trust/PPO |
$65.05
|
| Rate for Payer: BCBS Trust/PPO |
$35.87
|
| Rate for Payer: BCBS Trust/PPO |
$86.56
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: BCN Commercial |
$35.87
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: Cash Price |
$37.00
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cash Price |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Cofinity Commercial |
$43.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.12
|
| Rate for Payer: Healthscope Commercial |
$83.90
|
| Rate for Payer: Healthscope Commercial |
$46.26
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Healthscope Whirlpool |
$81.38
|
| Rate for Payer: Healthscope Whirlpool |
$44.87
|
| Rate for Payer: Mclaren Commercial |
$75.51
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Mclaren Commercial |
$41.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
MAGNESIUM SULFATE 20 GRAM/500 ML (4 %) IN WATER INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$55.83
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.08 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.25
|
| Rate for Payer: ASR ASR |
$54.16
|
| Rate for Payer: BCBS Trust/PPO |
$43.28
|
| Rate for Payer: BCN Commercial |
$43.28
|
| Rate for Payer: Cash Price |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$55.83
|
| Rate for Payer: Healthscope Whirlpool |
$54.16
|
| Rate for Payer: Mclaren Commercial |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.13
|
|
|
MAGNESIUM SULFATE 2 GRAM/50 ML (4 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$18.02
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
117869
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna Commercial |
$16.22
|
| Rate for Payer: Aetna Commercial |
$21.31
|
| Rate for Payer: Aetna Commercial |
$53.47
|
| Rate for Payer: ASR ASR |
$57.63
|
| Rate for Payer: ASR ASR |
$22.97
|
| Rate for Payer: ASR ASR |
$17.48
|
| Rate for Payer: BCBS Trust/PPO |
$13.97
|
| Rate for Payer: BCBS Trust/PPO |
$46.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.36
|
| Rate for Payer: BCN Commercial |
$13.97
|
| Rate for Payer: BCN Commercial |
$18.36
|
| Rate for Payer: BCN Commercial |
$46.06
|
| Rate for Payer: Cash Price |
$47.53
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$55.85
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.53
|
| Rate for Payer: Healthscope Commercial |
$59.41
|
| Rate for Payer: Healthscope Commercial |
$23.68
|
| Rate for Payer: Healthscope Commercial |
$18.02
|
| Rate for Payer: Healthscope Whirlpool |
$22.97
|
| Rate for Payer: Healthscope Whirlpool |
$17.48
|
| Rate for Payer: Healthscope Whirlpool |
$57.63
|
| Rate for Payer: Mclaren Commercial |
$53.47
|
| Rate for Payer: Mclaren Commercial |
$16.22
|
| Rate for Payer: Mclaren Commercial |
$21.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.84
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$53.43
|
|
|
Service Code
|
NDC 63323-107-05
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$53.43 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: ASR ASR |
$51.83
|
| Rate for Payer: BCBS Trust/PPO |
$41.42
|
| Rate for Payer: BCN Commercial |
$41.42
|
| Rate for Payer: Cash Price |
$42.75
|
| Rate for Payer: Cofinity Commercial |
$50.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.74
|
| Rate for Payer: Healthscope Commercial |
$53.43
|
| Rate for Payer: Healthscope Whirlpool |
$51.83
|
| Rate for Payer: Mclaren Commercial |
$48.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.02
|
|
|
MAGNESIUM SULFATE 4 GRAM/50 ML (8 %) IN WATER INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
NDC 0409-6730-13
|
| Hospital Charge Code |
4721
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: BCBS Trust/PPO |
$86.56
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
MAGNESIUM SULFATE 4 MEQ/ML (50 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
4720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$19.29
|
| Rate for Payer: Aetna Commercial |
$21.01
|
| Rate for Payer: ASR ASR |
$22.64
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$20.79
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.61
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$18.68
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$21.43
|
| Rate for Payer: Healthscope Commercial |
$23.34
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$20.79
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$19.29
|
| Rate for Payer: Mclaren Commercial |
$21.01
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.54
|
|
|
MAGNESIUM SULFATE IN D5W 1 GRAM/100 ML IVPB (CODE)
|
Facility
|
IP
|
$111.65
|
|
|
Service Code
|
HCPCS J3475
|
| Hospital Charge Code |
163707
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$78.16 |
| Max. Negotiated Rate |
$111.65 |
| Rate for Payer: Aetna Commercial |
$100.48
|
| Rate for Payer: ASR ASR |
$108.30
|
| Rate for Payer: BCBS Trust/PPO |
$86.56
|
| Rate for Payer: BCN Commercial |
$86.56
|
| Rate for Payer: Cash Price |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$111.65
|
| Rate for Payer: Healthscope Whirlpool |
$108.30
|
| Rate for Payer: Mclaren Commercial |
$100.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.25
|
|
|
MAJOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$35,149.50
|
|
|
Service Code
|
MS-DRG 654
|
| Min. Negotiated Rate |
$23,614.82 |
| Max. Negotiated Rate |
$35,149.50 |
| Rate for Payer: Aetna Medicare |
$24,857.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,072.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,072.12
|
| Rate for Payer: BCBS MAPPO |
$24,857.70
|
| Rate for Payer: BCN Medicare Advantage |
$24,857.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,857.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,857.70
|
| Rate for Payer: Mclaren Medicare |
$24,857.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,100.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,586.36
|
| Rate for Payer: PACE Medicare |
$23,614.82
|
| Rate for Payer: PACE SWMI |
$24,857.70
|
| Rate for Payer: PHP Commercial |
$27,343.47
|
| Rate for Payer: PHP Medicare Advantage |
$24,857.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,149.50
|
| Rate for Payer: Priority Health Medicare |
$24,857.70
|
| Rate for Payer: Priority Health Narrow Network |
$28,119.60
|
| Rate for Payer: Railroad Medicare Medicare |
$24,857.70
|
| Rate for Payer: UHC Medicare Advantage |
$25,603.43
|
| Rate for Payer: VA VA |
$24,857.70
|
|
|
MAJOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$69,510.62
|
|
|
Service Code
|
MS-DRG 653
|
| Min. Negotiated Rate |
$45,138.90 |
| Max. Negotiated Rate |
$69,510.62 |
| Rate for Payer: Aetna Medicare |
$47,514.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,393.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,393.29
|
| Rate for Payer: BCBS MAPPO |
$47,514.63
|
| Rate for Payer: BCN Medicare Advantage |
$47,514.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,514.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$47,514.63
|
| Rate for Payer: Mclaren Medicare |
$47,514.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49,890.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,641.82
|
| Rate for Payer: PACE Medicare |
$45,138.90
|
| Rate for Payer: PACE SWMI |
$47,514.63
|
| Rate for Payer: PHP Commercial |
$52,266.09
|
| Rate for Payer: PHP Medicare Advantage |
$47,514.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69,510.62
|
| Rate for Payer: Priority Health Medicare |
$47,514.63
|
| Rate for Payer: Priority Health Narrow Network |
$55,608.50
|
| Rate for Payer: Railroad Medicare Medicare |
$47,514.63
|
| Rate for Payer: UHC Medicare Advantage |
$48,940.07
|
| Rate for Payer: VA VA |
$47,514.63
|
|
|
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,064.15
|
|
|
Service Code
|
MS-DRG 655
|
| Min. Negotiated Rate |
$18,550.09 |
| Max. Negotiated Rate |
$27,064.15 |
| Rate for Payer: Aetna Medicare |
$19,526.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,408.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,408.01
|
| Rate for Payer: BCBS MAPPO |
$19,526.41
|
| Rate for Payer: BCN Medicare Advantage |
$19,526.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,526.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,526.41
|
| Rate for Payer: Mclaren Medicare |
$19,526.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,502.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,455.37
|
| Rate for Payer: PACE Medicare |
$18,550.09
|
| Rate for Payer: PACE SWMI |
$19,526.41
|
| Rate for Payer: PHP Commercial |
$21,479.05
|
| Rate for Payer: PHP Medicare Advantage |
$19,526.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,064.15
|
| Rate for Payer: Priority Health Medicare |
$19,526.41
|
| Rate for Payer: Priority Health Narrow Network |
$21,651.32
|
| Rate for Payer: Railroad Medicare Medicare |
$19,526.41
|
| Rate for Payer: UHC Medicare Advantage |
$20,112.20
|
| Rate for Payer: VA VA |
$19,526.41
|
|
|
MAJOR CHEST PROCEDURES WITH CC
|
Facility
|
IP
|
$32,747.14
|
|
|
Service Code
|
MS-DRG 164
|
| Min. Negotiated Rate |
$22,109.95 |
| Max. Negotiated Rate |
$32,747.14 |
| Rate for Payer: Aetna Medicare |
$23,273.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,092.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,092.04
|
| Rate for Payer: BCBS MAPPO |
$23,273.63
|
| Rate for Payer: BCN Medicare Advantage |
$23,273.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,273.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,273.63
|
| Rate for Payer: Mclaren Medicare |
$23,273.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,437.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,764.67
|
| Rate for Payer: PACE Medicare |
$22,109.95
|
| Rate for Payer: PACE SWMI |
$23,273.63
|
| Rate for Payer: PHP Commercial |
$25,600.99
|
| Rate for Payer: PHP Medicare Advantage |
$23,273.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,747.14
|
| Rate for Payer: Priority Health Medicare |
$23,273.63
|
| Rate for Payer: Priority Health Narrow Network |
$26,197.71
|
| Rate for Payer: Railroad Medicare Medicare |
$23,273.63
|
| Rate for Payer: UHC Medicare Advantage |
$23,971.84
|
| Rate for Payer: VA VA |
$23,273.63
|
|
|
MAJOR CHEST PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,522.62
|
|
|
Service Code
|
MS-DRG 163
|
| Min. Negotiated Rate |
$39,508.74 |
| Max. Negotiated Rate |
$60,522.62 |
| Rate for Payer: Aetna Medicare |
$41,588.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,985.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,985.19
|
| Rate for Payer: BCBS MAPPO |
$41,588.15
|
| Rate for Payer: BCN Medicare Advantage |
$41,588.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,588.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,588.15
|
| Rate for Payer: Mclaren Medicare |
$41,588.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43,667.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,826.37
|
| Rate for Payer: PACE Medicare |
$39,508.74
|
| Rate for Payer: PACE SWMI |
$41,588.15
|
| Rate for Payer: PHP Commercial |
$45,746.96
|
| Rate for Payer: PHP Medicare Advantage |
$41,588.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60,522.62
|
| Rate for Payer: Priority Health Medicare |
$41,588.15
|
| Rate for Payer: Priority Health Narrow Network |
$48,418.10
|
| Rate for Payer: Railroad Medicare Medicare |
$41,588.15
|
| Rate for Payer: UHC Medicare Advantage |
$42,835.79
|
| Rate for Payer: VA VA |
$41,588.15
|
|
|
MAJOR CHEST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,092.98
|
|
|
Service Code
|
MS-DRG 165
|
| Min. Negotiated Rate |
$16,688.93 |
| Max. Negotiated Rate |
$24,092.98 |
| Rate for Payer: Aetna Medicare |
$17,567.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,959.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,959.11
|
| Rate for Payer: BCBS MAPPO |
$17,567.29
|
| Rate for Payer: BCN Medicare Advantage |
$17,567.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,567.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,567.29
|
| Rate for Payer: Mclaren Medicare |
$17,567.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,445.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,202.38
|
| Rate for Payer: PACE Medicare |
$16,688.93
|
| Rate for Payer: PACE SWMI |
$17,567.29
|
| Rate for Payer: PHP Commercial |
$19,324.02
|
| Rate for Payer: PHP Medicare Advantage |
$17,567.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,092.98
|
| Rate for Payer: Priority Health Medicare |
$17,567.29
|
| Rate for Payer: Priority Health Narrow Network |
$19,274.38
|
| Rate for Payer: Railroad Medicare Medicare |
$17,567.29
|
| Rate for Payer: UHC Medicare Advantage |
$18,094.31
|
| Rate for Payer: VA VA |
$17,567.29
|
|
|
MAJOR CHEST TRAUMA WITH CC
|
Facility
|
IP
|
$13,506.40
|
|
|
Service Code
|
MS-DRG 184
|
| Min. Negotiated Rate |
$10,057.41 |
| Max. Negotiated Rate |
$13,506.40 |
| Rate for Payer: Aetna Medicare |
$10,586.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,233.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,233.44
|
| Rate for Payer: BCBS MAPPO |
$10,586.75
|
| Rate for Payer: BCN Medicare Advantage |
$10,586.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,586.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,586.75
|
| Rate for Payer: Mclaren Medicare |
$10,586.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,116.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,174.76
|
| Rate for Payer: PACE Medicare |
$10,057.41
|
| Rate for Payer: PACE SWMI |
$10,586.75
|
| Rate for Payer: PHP Commercial |
$11,645.42
|
| Rate for Payer: PHP Medicare Advantage |
$10,586.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,506.40
|
| Rate for Payer: Priority Health Medicare |
$10,586.75
|
| Rate for Payer: Priority Health Narrow Network |
$10,805.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10,586.75
|
| Rate for Payer: UHC Medicare Advantage |
$10,904.35
|
| Rate for Payer: VA VA |
$10,586.75
|
|
|
MAJOR CHEST TRAUMA WITH MCC
|
Facility
|
IP
|
$20,216.58
|
|
|
Service Code
|
MS-DRG 183
|
| Min. Negotiated Rate |
$14,260.73 |
| Max. Negotiated Rate |
$20,216.58 |
| Rate for Payer: Aetna Medicare |
$15,011.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,764.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,764.11
|
| Rate for Payer: BCBS MAPPO |
$15,011.29
|
| Rate for Payer: BCN Medicare Advantage |
$15,011.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,011.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,011.29
|
| Rate for Payer: Mclaren Medicare |
$15,011.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,761.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,262.98
|
| Rate for Payer: PACE Medicare |
$14,260.73
|
| Rate for Payer: PACE SWMI |
$15,011.29
|
| Rate for Payer: PHP Commercial |
$16,512.42
|
| Rate for Payer: PHP Medicare Advantage |
$15,011.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,216.58
|
| Rate for Payer: Priority Health Medicare |
$15,011.29
|
| Rate for Payer: Priority Health Narrow Network |
$16,173.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15,011.29
|
| Rate for Payer: UHC Medicare Advantage |
$15,461.63
|
| Rate for Payer: VA VA |
$15,011.29
|
|
|
MAJOR CHEST TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$10,098.74
|
|
|
Service Code
|
MS-DRG 185
|
| Min. Negotiated Rate |
$7,675.04 |
| Max. Negotiated Rate |
$10,098.74 |
| Rate for Payer: Aetna Medicare |
$8,078.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,098.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,098.74
|
| Rate for Payer: BCBS MAPPO |
$8,078.99
|
| Rate for Payer: BCN Medicare Advantage |
$8,078.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,078.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,078.99
|
| Rate for Payer: Mclaren Medicare |
$8,078.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,482.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,290.84
|
| Rate for Payer: PACE Medicare |
$7,675.04
|
| Rate for Payer: PACE SWMI |
$8,078.99
|
| Rate for Payer: PHP Commercial |
$8,886.89
|
| Rate for Payer: PHP Medicare Advantage |
$8,078.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,703.19
|
| Rate for Payer: Priority Health Medicare |
$8,078.99
|
| Rate for Payer: Priority Health Narrow Network |
$7,762.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8,078.99
|
| Rate for Payer: UHC Medicare Advantage |
$8,321.36
|
| Rate for Payer: VA VA |
$8,078.99
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH CC
|
Facility
|
IP
|
$12,689.77
|
|
|
Service Code
|
MS-DRG 369
|
| Min. Negotiated Rate |
$9,545.87 |
| Max. Negotiated Rate |
$12,689.77 |
| Rate for Payer: Aetna Medicare |
$10,048.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,560.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,560.35
|
| Rate for Payer: BCBS MAPPO |
$10,048.28
|
| Rate for Payer: BCN Medicare Advantage |
$10,048.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,048.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,048.28
|
| Rate for Payer: Mclaren Medicare |
$10,048.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,550.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,555.52
|
| Rate for Payer: PACE Medicare |
$9,545.87
|
| Rate for Payer: PACE SWMI |
$10,048.28
|
| Rate for Payer: PHP Commercial |
$11,053.11
|
| Rate for Payer: PHP Medicare Advantage |
$10,048.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,689.77
|
| Rate for Payer: Priority Health Medicare |
$10,048.28
|
| Rate for Payer: Priority Health Narrow Network |
$10,151.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10,048.28
|
| Rate for Payer: UHC Medicare Advantage |
$10,349.73
|
| Rate for Payer: VA VA |
$10,048.28
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITH MCC
|
Facility
|
IP
|
$21,211.68
|
|
|
Service Code
|
MS-DRG 368
|
| Min. Negotiated Rate |
$14,884.04 |
| Max. Negotiated Rate |
$21,211.68 |
| Rate for Payer: Aetna Medicare |
$15,667.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,584.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,584.26
|
| Rate for Payer: BCBS MAPPO |
$15,667.41
|
| Rate for Payer: BCN Medicare Advantage |
$15,667.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,667.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,667.41
|
| Rate for Payer: Mclaren Medicare |
$15,667.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,450.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,017.52
|
| Rate for Payer: PACE Medicare |
$14,884.04
|
| Rate for Payer: PACE SWMI |
$15,667.41
|
| Rate for Payer: PHP Commercial |
$17,234.15
|
| Rate for Payer: PHP Medicare Advantage |
$15,667.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,211.68
|
| Rate for Payer: Priority Health Medicare |
$15,667.41
|
| Rate for Payer: Priority Health Narrow Network |
$16,969.34
|
| Rate for Payer: Railroad Medicare Medicare |
$15,667.41
|
| Rate for Payer: UHC Medicare Advantage |
$16,137.43
|
| Rate for Payer: VA VA |
$15,667.41
|
|
|
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,971.74
|
|
|
Service Code
|
MS-DRG 370
|
| Min. Negotiated Rate |
$7,578.52 |
| Max. Negotiated Rate |
$9,971.74 |
| Rate for Payer: Aetna Medicare |
$7,977.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,971.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,971.74
|
| Rate for Payer: BCBS MAPPO |
$7,977.39
|
| Rate for Payer: BCN Medicare Advantage |
$7,977.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,977.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,977.39
|
| Rate for Payer: Mclaren Medicare |
$7,977.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,376.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,174.00
|
| Rate for Payer: PACE Medicare |
$7,578.52
|
| Rate for Payer: PACE SWMI |
$7,977.39
|
| Rate for Payer: PHP Commercial |
$8,775.13
|
| Rate for Payer: PHP Medicare Advantage |
$7,977.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,549.11
|
| Rate for Payer: Priority Health Medicare |
$7,977.39
|
| Rate for Payer: Priority Health Narrow Network |
$7,639.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7,977.39
|
| Rate for Payer: UHC Medicare Advantage |
$8,216.71
|
| Rate for Payer: VA VA |
$7,977.39
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC
|
Facility
|
IP
|
$13,383.13
|
|
|
Service Code
|
MS-DRG 372
|
| Min. Negotiated Rate |
$9,980.21 |
| Max. Negotiated Rate |
$13,383.13 |
| Rate for Payer: Aetna Medicare |
$10,505.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,131.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,131.85
|
| Rate for Payer: BCBS MAPPO |
$10,505.48
|
| Rate for Payer: BCN Medicare Advantage |
$10,505.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,505.48
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,505.48
|
| Rate for Payer: Mclaren Medicare |
$10,505.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,030.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,081.30
|
| Rate for Payer: PACE Medicare |
$9,980.21
|
| Rate for Payer: PACE SWMI |
$10,505.48
|
| Rate for Payer: PHP Commercial |
$11,556.03
|
| Rate for Payer: PHP Medicare Advantage |
$10,505.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,383.13
|
| Rate for Payer: Priority Health Medicare |
$10,505.48
|
| Rate for Payer: Priority Health Narrow Network |
$10,706.50
|
| Rate for Payer: Railroad Medicare Medicare |
$10,505.48
|
| Rate for Payer: UHC Medicare Advantage |
$10,820.64
|
| Rate for Payer: VA VA |
$10,505.48
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC
|
Facility
|
IP
|
$22,440.47
|
|
|
Service Code
|
MS-DRG 371
|
| Min. Negotiated Rate |
$15,653.78 |
| Max. Negotiated Rate |
$22,440.47 |
| Rate for Payer: Aetna Medicare |
$16,477.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,597.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,597.08
|
| Rate for Payer: BCBS MAPPO |
$16,477.66
|
| Rate for Payer: BCN Medicare Advantage |
$16,477.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,477.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,477.66
|
| Rate for Payer: Mclaren Medicare |
$16,477.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,301.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,949.31
|
| Rate for Payer: PACE Medicare |
$15,653.78
|
| Rate for Payer: PACE SWMI |
$16,477.66
|
| Rate for Payer: PHP Commercial |
$18,125.43
|
| Rate for Payer: PHP Medicare Advantage |
$16,477.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,440.47
|
| Rate for Payer: Priority Health Medicare |
$16,477.66
|
| Rate for Payer: Priority Health Narrow Network |
$17,952.38
|
| Rate for Payer: Railroad Medicare Medicare |
$16,477.66
|
| Rate for Payer: UHC Medicare Advantage |
$16,971.99
|
| Rate for Payer: VA VA |
$16,477.66
|
|
|
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,683.89
|
|
|
Service Code
|
MS-DRG 373
|
| Min. Negotiated Rate |
$7,359.75 |
| Max. Negotiated Rate |
$9,683.89 |
| Rate for Payer: Aetna Medicare |
$7,747.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,683.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,683.89
|
| Rate for Payer: BCBS MAPPO |
$7,747.11
|
| Rate for Payer: BCN Medicare Advantage |
$7,747.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,747.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,747.11
|
| Rate for Payer: Mclaren Medicare |
$7,747.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,134.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,909.18
|
| Rate for Payer: PACE Medicare |
$7,359.75
|
| Rate for Payer: PACE SWMI |
$7,747.11
|
| Rate for Payer: PHP Commercial |
$8,521.82
|
| Rate for Payer: PHP Medicare Advantage |
$7,747.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,199.86
|
| Rate for Payer: Priority Health Medicare |
$7,747.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,359.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7,747.11
|
| Rate for Payer: UHC Medicare Advantage |
$7,979.52
|
| Rate for Payer: VA VA |
$7,747.11
|
|
