|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC
|
Facility
|
IP
|
$14,132.99
|
|
|
Service Code
|
MS-DRG 436
|
| Min. Negotiated Rate |
$10,449.90 |
| Max. Negotiated Rate |
$14,132.99 |
| Rate for Payer: Aetna Medicare |
$10,999.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,749.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,749.88
|
| Rate for Payer: BCBS MAPPO |
$10,999.90
|
| Rate for Payer: BCN Medicare Advantage |
$10,999.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,999.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,999.90
|
| Rate for Payer: Mclaren Medicare |
$10,999.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,549.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,649.88
|
| Rate for Payer: PACE Medicare |
$10,449.90
|
| Rate for Payer: PACE SWMI |
$10,999.90
|
| Rate for Payer: PHP Commercial |
$12,099.89
|
| Rate for Payer: PHP Medicare Advantage |
$10,999.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,132.99
|
| Rate for Payer: Priority Health Medicare |
$10,999.90
|
| Rate for Payer: Priority Health Narrow Network |
$11,306.39
|
| Rate for Payer: Railroad Medicare Medicare |
$10,999.90
|
| Rate for Payer: UHC Medicare Advantage |
$11,329.90
|
| Rate for Payer: VA VA |
$10,999.90
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC
|
Facility
|
IP
|
$22,597.12
|
|
|
Service Code
|
MS-DRG 435
|
| Min. Negotiated Rate |
$15,751.90 |
| Max. Negotiated Rate |
$22,597.12 |
| Rate for Payer: Aetna Medicare |
$16,580.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,726.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,726.19
|
| Rate for Payer: BCBS MAPPO |
$16,580.95
|
| Rate for Payer: BCN Medicare Advantage |
$16,580.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,580.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,580.95
|
| Rate for Payer: Mclaren Medicare |
$16,580.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,410.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,068.09
|
| Rate for Payer: PACE Medicare |
$15,751.90
|
| Rate for Payer: PACE SWMI |
$16,580.95
|
| Rate for Payer: PHP Commercial |
$18,239.04
|
| Rate for Payer: PHP Medicare Advantage |
$16,580.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,597.12
|
| Rate for Payer: Priority Health Medicare |
$16,580.95
|
| Rate for Payer: Priority Health Narrow Network |
$18,077.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,580.95
|
| Rate for Payer: UHC Medicare Advantage |
$17,078.38
|
| Rate for Payer: VA VA |
$16,580.95
|
|
|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,896.70
|
|
|
Service Code
|
MS-DRG 437
|
| Min. Negotiated Rate |
$8,281.49 |
| Max. Negotiated Rate |
$10,896.70 |
| Rate for Payer: Aetna Medicare |
$8,717.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,896.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,896.70
|
| Rate for Payer: BCBS MAPPO |
$8,717.36
|
| Rate for Payer: BCN Medicare Advantage |
$8,717.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,717.36
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,717.36
|
| Rate for Payer: Mclaren Medicare |
$8,717.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,153.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,024.96
|
| Rate for Payer: PACE Medicare |
$8,281.49
|
| Rate for Payer: PACE SWMI |
$8,717.36
|
| Rate for Payer: PHP Commercial |
$9,589.10
|
| Rate for Payer: PHP Medicare Advantage |
$8,717.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,671.32
|
| Rate for Payer: Priority Health Medicare |
$8,717.36
|
| Rate for Payer: Priority Health Narrow Network |
$8,537.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8,717.36
|
| Rate for Payer: UHC Medicare Advantage |
$8,978.88
|
| Rate for Payer: VA VA |
$8,717.36
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$15,392.59
|
|
|
Service Code
|
MS-DRG 598
|
| Min. Negotiated Rate |
$11,238.93 |
| Max. Negotiated Rate |
$15,392.59 |
| Rate for Payer: Aetna Medicare |
$11,830.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,788.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,788.06
|
| Rate for Payer: BCBS MAPPO |
$11,830.45
|
| Rate for Payer: BCN Medicare Advantage |
$11,830.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,830.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,830.45
|
| Rate for Payer: Mclaren Medicare |
$11,830.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,421.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,605.02
|
| Rate for Payer: PACE Medicare |
$11,238.93
|
| Rate for Payer: PACE SWMI |
$11,830.45
|
| Rate for Payer: PHP Commercial |
$13,013.50
|
| Rate for Payer: PHP Medicare Advantage |
$11,830.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,392.59
|
| Rate for Payer: Priority Health Medicare |
$11,830.45
|
| Rate for Payer: Priority Health Narrow Network |
$12,314.07
|
| Rate for Payer: Railroad Medicare Medicare |
$11,830.45
|
| Rate for Payer: UHC Medicare Advantage |
$12,185.36
|
| Rate for Payer: VA VA |
$11,830.45
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$20,550.42
|
|
|
Service Code
|
MS-DRG 597
|
| Min. Negotiated Rate |
$14,469.83 |
| Max. Negotiated Rate |
$20,550.42 |
| Rate for Payer: Aetna Medicare |
$15,231.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,039.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,039.25
|
| Rate for Payer: BCBS MAPPO |
$15,231.40
|
| Rate for Payer: BCN Medicare Advantage |
$15,231.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,231.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,231.40
|
| Rate for Payer: Mclaren Medicare |
$15,231.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,992.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,516.11
|
| Rate for Payer: PACE Medicare |
$14,469.83
|
| Rate for Payer: PACE SWMI |
$15,231.40
|
| Rate for Payer: PHP Commercial |
$16,754.54
|
| Rate for Payer: PHP Medicare Advantage |
$15,231.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,550.42
|
| Rate for Payer: Priority Health Medicare |
$15,231.40
|
| Rate for Payer: Priority Health Narrow Network |
$16,440.34
|
| Rate for Payer: Railroad Medicare Medicare |
$15,231.40
|
| Rate for Payer: UHC Medicare Advantage |
$15,688.34
|
| Rate for Payer: VA VA |
$15,231.40
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,221.42
|
|
|
Service Code
|
MS-DRG 599
|
| Min. Negotiated Rate |
$6,383.02 |
| Max. Negotiated Rate |
$9,221.42 |
| Rate for Payer: Aetna Medicare |
$7,377.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,221.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,221.42
|
| Rate for Payer: BCBS MAPPO |
$7,377.14
|
| Rate for Payer: BCN Medicare Advantage |
$7,377.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,377.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,377.14
|
| Rate for Payer: Mclaren Medicare |
$7,377.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,746.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,483.71
|
| Rate for Payer: PACE Medicare |
$7,008.28
|
| Rate for Payer: PACE SWMI |
$7,377.14
|
| Rate for Payer: PHP Commercial |
$8,114.85
|
| Rate for Payer: PHP Medicare Advantage |
$7,377.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,978.78
|
| Rate for Payer: Priority Health Medicare |
$7,377.14
|
| Rate for Payer: Priority Health Narrow Network |
$6,383.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7,377.14
|
| Rate for Payer: UHC Medicare Advantage |
$7,598.45
|
| Rate for Payer: VA VA |
$7,377.14
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 0990-7715-13
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$118.65 |
| Rate for Payer: Aetna Commercial |
$106.78
|
| Rate for Payer: ASR ASR |
$115.09
|
| Rate for Payer: BCBS Trust/PPO |
$91.99
|
| Rate for Payer: BCN Commercial |
$91.99
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$111.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$118.65
|
| Rate for Payer: Healthscope Whirlpool |
$115.09
|
| Rate for Payer: Mclaren Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.41
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$137.29
|
|
|
Service Code
|
NDC 0990-7715-02
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Aetna Commercial |
$123.56
|
| Rate for Payer: ASR ASR |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$106.44
|
| Rate for Payer: BCN Commercial |
$106.44
|
| Rate for Payer: Cash Price |
$109.84
|
| Rate for Payer: Cofinity Commercial |
$129.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.83
|
| Rate for Payer: Healthscope Commercial |
$137.29
|
| Rate for Payer: Healthscope Whirlpool |
$133.17
|
| Rate for Payer: Mclaren Commercial |
$123.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.82
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 0338-0357-03
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: BCBS Trust/PPO |
$73.59
|
| Rate for Payer: BCN Commercial |
$73.59
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$94.92
|
| Rate for Payer: Healthscope Whirlpool |
$92.07
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$137.29
|
|
|
Service Code
|
NDC 0990-7715-12
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Aetna Commercial |
$123.56
|
| Rate for Payer: ASR ASR |
$133.17
|
| Rate for Payer: BCBS Trust/PPO |
$106.44
|
| Rate for Payer: BCN Commercial |
$106.44
|
| Rate for Payer: Cash Price |
$109.84
|
| Rate for Payer: Cofinity Commercial |
$129.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.83
|
| Rate for Payer: Healthscope Commercial |
$137.29
|
| Rate for Payer: Healthscope Whirlpool |
$133.17
|
| Rate for Payer: Mclaren Commercial |
$123.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.82
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$21,405.56
|
|
|
Service Code
|
MS-DRG 582
|
| Min. Negotiated Rate |
$15,602.29 |
| Max. Negotiated Rate |
$21,405.56 |
| Rate for Payer: Aetna Medicare |
$16,423.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,529.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,529.32
|
| Rate for Payer: BCBS MAPPO |
$16,423.46
|
| Rate for Payer: BCN Medicare Advantage |
$16,423.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,423.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,423.46
|
| Rate for Payer: Mclaren Medicare |
$16,423.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,244.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,886.98
|
| Rate for Payer: PACE Medicare |
$15,602.29
|
| Rate for Payer: PACE SWMI |
$16,423.46
|
| Rate for Payer: PHP Commercial |
$18,065.81
|
| Rate for Payer: PHP Medicare Advantage |
$16,423.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,405.56
|
| Rate for Payer: Priority Health Medicare |
$16,423.46
|
| Rate for Payer: Priority Health Narrow Network |
$17,124.45
|
| Rate for Payer: Railroad Medicare Medicare |
$16,423.46
|
| Rate for Payer: UHC Medicare Advantage |
$16,916.16
|
| Rate for Payer: VA VA |
$16,423.46
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$19,541.20
|
|
|
Service Code
|
MS-DRG 583
|
| Min. Negotiated Rate |
$13,837.64 |
| Max. Negotiated Rate |
$19,541.20 |
| Rate for Payer: Aetna Medicare |
$14,565.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,207.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,207.42
|
| Rate for Payer: BCBS MAPPO |
$14,565.94
|
| Rate for Payer: BCN Medicare Advantage |
$14,565.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,565.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,565.94
|
| Rate for Payer: Mclaren Medicare |
$14,565.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,294.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,750.83
|
| Rate for Payer: PACE Medicare |
$13,837.64
|
| Rate for Payer: PACE SWMI |
$14,565.94
|
| Rate for Payer: PHP Commercial |
$16,022.53
|
| Rate for Payer: PHP Medicare Advantage |
$14,565.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,541.20
|
| Rate for Payer: Priority Health Medicare |
$14,565.94
|
| Rate for Payer: Priority Health Narrow Network |
$15,632.96
|
| Rate for Payer: Railroad Medicare Medicare |
$14,565.94
|
| Rate for Payer: UHC Medicare Advantage |
$15,002.92
|
| Rate for Payer: VA VA |
$14,565.94
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 0904-6517-61
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.66 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$342.86
|
| Rate for Payer: ASR ASR |
$369.52
|
| Rate for Payer: BCBS Trust/PPO |
$295.35
|
| Rate for Payer: BCN Commercial |
$295.35
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Commercial |
$358.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$380.95
|
| Rate for Payer: Healthscope Whirlpool |
$369.52
|
| Rate for Payer: Mclaren Commercial |
$342.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.24
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$4.56
|
|
|
Service Code
|
NDC 50268-523-11
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$4.56 |
| Rate for Payer: Aetna Commercial |
$4.10
|
| Rate for Payer: ASR ASR |
$4.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.54
|
| Rate for Payer: BCN Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cofinity Commercial |
$4.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.65
|
| Rate for Payer: Healthscope Commercial |
$4.56
|
| Rate for Payer: Healthscope Whirlpool |
$4.42
|
| Rate for Payer: Mclaren Commercial |
$4.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.01
|
|
|
MECLIZINE 25 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 50268-523-15
|
| Hospital Charge Code |
12025
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: ASR ASR |
$221.16
|
| Rate for Payer: BCBS Trust/PPO |
$176.77
|
| Rate for Payer: BCN Commercial |
$176.77
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$214.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Healthscope Commercial |
$228.00
|
| Rate for Payer: Healthscope Whirlpool |
$221.16
|
| Rate for Payer: Mclaren Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.64
|
|
|
MEDICAL BACK PROBLEMS WITH MCC
|
Facility
|
IP
|
$21,852.40
|
|
|
Service Code
|
MS-DRG 551
|
| Min. Negotiated Rate |
$15,285.40 |
| Max. Negotiated Rate |
$21,852.40 |
| Rate for Payer: Aetna Medicare |
$16,089.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,112.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,112.38
|
| Rate for Payer: BCBS MAPPO |
$16,089.90
|
| Rate for Payer: BCN Medicare Advantage |
$16,089.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,089.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,089.90
|
| Rate for Payer: Mclaren Medicare |
$16,089.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,894.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,503.38
|
| Rate for Payer: PACE Medicare |
$15,285.40
|
| Rate for Payer: PACE SWMI |
$16,089.90
|
| Rate for Payer: PHP Commercial |
$17,698.89
|
| Rate for Payer: PHP Medicare Advantage |
$16,089.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,852.40
|
| Rate for Payer: Priority Health Medicare |
$16,089.90
|
| Rate for Payer: Priority Health Narrow Network |
$17,481.92
|
| Rate for Payer: Railroad Medicare Medicare |
$16,089.90
|
| Rate for Payer: UHC Medicare Advantage |
$16,572.60
|
| Rate for Payer: VA VA |
$16,089.90
|
|
|
MEDICAL BACK PROBLEMS WITHOUT MCC
|
Facility
|
IP
|
$12,407.29
|
|
|
Service Code
|
MS-DRG 552
|
| Min. Negotiated Rate |
$9,368.91 |
| Max. Negotiated Rate |
$12,407.29 |
| Rate for Payer: Aetna Medicare |
$9,862.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,327.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,327.51
|
| Rate for Payer: BCBS MAPPO |
$9,862.01
|
| Rate for Payer: BCN Medicare Advantage |
$9,862.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,862.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,862.01
|
| Rate for Payer: Mclaren Medicare |
$9,862.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,355.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,341.31
|
| Rate for Payer: PACE Medicare |
$9,368.91
|
| Rate for Payer: PACE SWMI |
$9,862.01
|
| Rate for Payer: PHP Commercial |
$10,848.21
|
| Rate for Payer: PHP Medicare Advantage |
$9,862.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,407.29
|
| Rate for Payer: Priority Health Medicare |
$9,862.01
|
| Rate for Payer: Priority Health Narrow Network |
$9,925.83
|
| Rate for Payer: Railroad Medicare Medicare |
$9,862.01
|
| Rate for Payer: UHC Medicare Advantage |
$10,157.87
|
| Rate for Payer: VA VA |
$9,862.01
|
|
|
MEDICAL MAGGOTS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS 97602
|
| Hospital Charge Code |
300255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$875.00 |
| Rate for Payer: Aetna Commercial |
$787.50
|
| Rate for Payer: ASR ASR |
$848.75
|
| Rate for Payer: BCBS Trust/PPO |
$678.39
|
| Rate for Payer: BCN Commercial |
$678.39
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$700.00
|
| Rate for Payer: Healthscope Commercial |
$875.00
|
| Rate for Payer: Healthscope Whirlpool |
$848.75
|
| Rate for Payer: Mclaren Commercial |
$787.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$770.00
|
|
|
MEDROXYPROGESTERONE 150 MG/ML INTRAMUSCULAR SUSPENSION
|
Facility
|
IP
|
$100.97
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
19736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$100.97 |
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Aetna Commercial |
$196.05
|
| Rate for Payer: Aetna Commercial |
$180.19
|
| Rate for Payer: Aetna Commercial |
$196.03
|
| Rate for Payer: Aetna Commercial |
$180.22
|
| Rate for Payer: ASR ASR |
$194.20
|
| Rate for Payer: ASR ASR |
$97.94
|
| Rate for Payer: ASR ASR |
$211.28
|
| Rate for Payer: ASR ASR |
$211.30
|
| Rate for Payer: ASR ASR |
$194.24
|
| Rate for Payer: BCBS Trust/PPO |
$155.25
|
| Rate for Payer: BCBS Trust/PPO |
$155.22
|
| Rate for Payer: BCBS Trust/PPO |
$168.87
|
| Rate for Payer: BCBS Trust/PPO |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$168.88
|
| Rate for Payer: BCN Commercial |
$78.28
|
| Rate for Payer: BCN Commercial |
$155.22
|
| Rate for Payer: BCN Commercial |
$168.88
|
| Rate for Payer: BCN Commercial |
$155.25
|
| Rate for Payer: BCN Commercial |
$168.87
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Cash Price |
$160.16
|
| Rate for Payer: Cash Price |
$174.26
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$174.25
|
| Rate for Payer: Cofinity Commercial |
$204.74
|
| Rate for Payer: Cofinity Commercial |
$188.24
|
| Rate for Payer: Cofinity Commercial |
$188.20
|
| Rate for Payer: Cofinity Commercial |
$204.76
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Healthscope Commercial |
$100.97
|
| Rate for Payer: Healthscope Commercial |
$217.83
|
| Rate for Payer: Healthscope Commercial |
$200.21
|
| Rate for Payer: Healthscope Commercial |
$200.25
|
| Rate for Payer: Healthscope Commercial |
$217.81
|
| Rate for Payer: Healthscope Whirlpool |
$194.24
|
| Rate for Payer: Healthscope Whirlpool |
$194.20
|
| Rate for Payer: Healthscope Whirlpool |
$97.94
|
| Rate for Payer: Healthscope Whirlpool |
$211.30
|
| Rate for Payer: Healthscope Whirlpool |
$211.28
|
| Rate for Payer: Mclaren Commercial |
$180.19
|
| Rate for Payer: Mclaren Commercial |
$90.87
|
| Rate for Payer: Mclaren Commercial |
$180.22
|
| Rate for Payer: Mclaren Commercial |
$196.03
|
| Rate for Payer: Mclaren Commercial |
$196.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$88.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.69
|
|
|
MEDROXYPROGESTERONE 2.5 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 0555-0872-02
|
| Hospital Charge Code |
4855
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.47 |
| Max. Negotiated Rate |
$202.10 |
| Rate for Payer: Aetna Commercial |
$181.89
|
| Rate for Payer: ASR ASR |
$196.04
|
| Rate for Payer: BCBS Trust/PPO |
$156.69
|
| Rate for Payer: BCN Commercial |
$156.69
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$202.10
|
| Rate for Payer: Healthscope Whirlpool |
$196.04
|
| Rate for Payer: Mclaren Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.85
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$212.68
|
|
|
Service Code
|
NDC 5026852415
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.88 |
| Max. Negotiated Rate |
$212.68 |
| Rate for Payer: Aetna Commercial |
$191.41
|
| Rate for Payer: ASR ASR |
$206.30
|
| Rate for Payer: BCBS Trust/PPO |
$164.89
|
| Rate for Payer: BCN Commercial |
$164.89
|
| Rate for Payer: Cash Price |
$170.14
|
| Rate for Payer: Cofinity Commercial |
$199.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.14
|
| Rate for Payer: Healthscope Commercial |
$212.68
|
| Rate for Payer: Healthscope Whirlpool |
$206.30
|
| Rate for Payer: Mclaren Commercial |
$191.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$180.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.16
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 2055503601
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.20 |
| Max. Negotiated Rate |
$303.15 |
| Rate for Payer: Aetna Commercial |
$272.84
|
| Rate for Payer: ASR ASR |
$294.06
|
| Rate for Payer: BCBS Trust/PPO |
$235.03
|
| Rate for Payer: BCN Commercial |
$235.03
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$303.15
|
| Rate for Payer: Healthscope Whirlpool |
$294.06
|
| Rate for Payer: Mclaren Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.77
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$123.38
|
|
|
Service Code
|
NDC 2055503600
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$123.38 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: ASR ASR |
$119.68
|
| Rate for Payer: BCBS Trust/PPO |
$95.66
|
| Rate for Payer: BCN Commercial |
$95.66
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cofinity Commercial |
$115.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.70
|
| Rate for Payer: Healthscope Commercial |
$123.38
|
| Rate for Payer: Healthscope Whirlpool |
$119.68
|
| Rate for Payer: Mclaren Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$104.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.57
|
|
|
MELATONIN 3 MG TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 5026852411
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.30
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.74
|
|
|
MEMANTINE 10 MG TABLET
|
Facility
|
IP
|
$1,530.47
|
|
|
Service Code
|
NDC 0456-3210-60
|
| Hospital Charge Code |
36966
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,071.33 |
| Max. Negotiated Rate |
$1,530.47 |
| Rate for Payer: Aetna Commercial |
$1,377.42
|
| Rate for Payer: ASR ASR |
$1,484.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.57
|
| Rate for Payer: BCN Commercial |
$1,186.57
|
| Rate for Payer: Cash Price |
$1,224.37
|
| Rate for Payer: Cofinity Commercial |
$1,438.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.38
|
| Rate for Payer: Healthscope Commercial |
$1,530.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.56
|
| Rate for Payer: Mclaren Commercial |
$1,377.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,346.81
|
|
