|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
NDC 0378-9112-16
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: ASR ASR |
$3.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.51
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Healthscope Whirlpool |
$3.14
|
| Rate for Payer: Mclaren Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.85
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$110.02
|
|
|
Service Code
|
NDC 68382-310-30
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Aetna Commercial |
$99.02
|
| Rate for Payer: ASR ASR |
$106.72
|
| Rate for Payer: BCBS Trust/PPO |
$85.30
|
| Rate for Payer: BCN Commercial |
$85.30
|
| Rate for Payer: Cash Price |
$88.01
|
| Rate for Payer: Cofinity Commercial |
$103.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.02
|
| Rate for Payer: Healthscope Commercial |
$110.02
|
| Rate for Payer: Healthscope Whirlpool |
$106.72
|
| Rate for Payer: Mclaren Commercial |
$99.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.82
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$97.20
|
|
|
Service Code
|
NDC 0378-9112-93
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$97.20 |
| Rate for Payer: Aetna Commercial |
$87.48
|
| Rate for Payer: ASR ASR |
$94.28
|
| Rate for Payer: BCBS Trust/PPO |
$75.36
|
| Rate for Payer: BCN Commercial |
$75.36
|
| Rate for Payer: Cash Price |
$77.76
|
| Rate for Payer: Cofinity Commercial |
$91.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.76
|
| Rate for Payer: Healthscope Commercial |
$97.20
|
| Rate for Payer: Healthscope Whirlpool |
$94.28
|
| Rate for Payer: Mclaren Commercial |
$87.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.54
|
|
|
NITROGLYCERIN 0.4 MG/HR TRANSDERMAL 24 HOUR PATCH
|
Facility
|
IP
|
$109.44
|
|
|
Service Code
|
NDC 49730-112-30
|
| Hospital Charge Code |
27474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.61 |
| Max. Negotiated Rate |
$109.44 |
| Rate for Payer: Aetna Commercial |
$98.50
|
| Rate for Payer: ASR ASR |
$106.16
|
| Rate for Payer: BCBS Trust/PPO |
$84.85
|
| Rate for Payer: BCN Commercial |
$84.85
|
| Rate for Payer: Cash Price |
$87.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.55
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Whirlpool |
$106.16
|
| Rate for Payer: Mclaren Commercial |
$98.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$93.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.31
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598-436-35
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$57.66
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$74.37
|
|
|
Service Code
|
NDC 43598-436-11
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$74.37 |
| Rate for Payer: Aetna Commercial |
$66.93
|
| Rate for Payer: ASR ASR |
$72.14
|
| Rate for Payer: BCBS Trust/PPO |
$57.66
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$59.50
|
| Rate for Payer: Cofinity Commercial |
$69.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.50
|
| Rate for Payer: Healthscope Commercial |
$74.37
|
| Rate for Payer: Healthscope Whirlpool |
$72.14
|
| Rate for Payer: Mclaren Commercial |
$66.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.45
|
|
|
NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$132.46
|
|
|
Service Code
|
NDC 0071-0418-13
|
| Hospital Charge Code |
5604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.72 |
| Max. Negotiated Rate |
$132.46 |
| Rate for Payer: Aetna Commercial |
$119.21
|
| Rate for Payer: ASR ASR |
$128.49
|
| Rate for Payer: BCBS Trust/PPO |
$102.70
|
| Rate for Payer: BCN Commercial |
$102.70
|
| Rate for Payer: Cash Price |
$105.97
|
| Rate for Payer: Cofinity Commercial |
$124.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.97
|
| Rate for Payer: Healthscope Commercial |
$132.46
|
| Rate for Payer: Healthscope Whirlpool |
$128.49
|
| Rate for Payer: Mclaren Commercial |
$119.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.56
|
|
|
NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$87.21
|
|
|
Service Code
|
HCPCS J2305
|
| Hospital Charge Code |
15859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.05 |
| Max. Negotiated Rate |
$87.21 |
| Rate for Payer: Aetna Commercial |
$78.49
|
| Rate for Payer: ASR ASR |
$84.59
|
| Rate for Payer: BCBS Trust/PPO |
$67.61
|
| Rate for Payer: BCN Commercial |
$67.61
|
| Rate for Payer: Cash Price |
$69.77
|
| Rate for Payer: Cofinity Commercial |
$81.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.77
|
| Rate for Payer: Healthscope Commercial |
$87.21
|
| Rate for Payer: Healthscope Whirlpool |
$84.59
|
| Rate for Payer: Mclaren Commercial |
$78.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.74
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$27,663.78
|
|
|
Service Code
|
MS-DRG 098
|
| Min. Negotiated Rate |
$18,925.70 |
| Max. Negotiated Rate |
$27,663.78 |
| Rate for Payer: Aetna Medicare |
$19,921.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,902.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,902.24
|
| Rate for Payer: BCBS MAPPO |
$19,921.79
|
| Rate for Payer: BCN Medicare Advantage |
$19,921.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,921.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,921.79
|
| Rate for Payer: Mclaren Medicare |
$19,921.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,917.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,910.06
|
| Rate for Payer: PACE Medicare |
$18,925.70
|
| Rate for Payer: PACE SWMI |
$19,921.79
|
| Rate for Payer: PHP Commercial |
$21,913.97
|
| Rate for Payer: PHP Medicare Advantage |
$19,921.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,663.78
|
| Rate for Payer: Priority Health Medicare |
$19,921.79
|
| Rate for Payer: Priority Health Narrow Network |
$22,131.02
|
| Rate for Payer: Railroad Medicare Medicare |
$19,921.79
|
| Rate for Payer: UHC Medicare Advantage |
$20,519.44
|
| Rate for Payer: VA VA |
$19,921.79
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$46,697.80
|
|
|
Service Code
|
MS-DRG 097
|
| Min. Negotiated Rate |
$30,848.76 |
| Max. Negotiated Rate |
$46,697.80 |
| Rate for Payer: Aetna Medicare |
$32,472.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,590.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,590.48
|
| Rate for Payer: BCBS MAPPO |
$32,472.38
|
| Rate for Payer: BCN Medicare Advantage |
$32,472.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,472.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,472.38
|
| Rate for Payer: Mclaren Medicare |
$32,472.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,096.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,343.24
|
| Rate for Payer: PACE Medicare |
$30,848.76
|
| Rate for Payer: PACE SWMI |
$32,472.38
|
| Rate for Payer: PHP Commercial |
$35,719.62
|
| Rate for Payer: PHP Medicare Advantage |
$32,472.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,697.80
|
| Rate for Payer: Priority Health Medicare |
$32,472.38
|
| Rate for Payer: Priority Health Narrow Network |
$37,358.24
|
| Rate for Payer: Railroad Medicare Medicare |
$32,472.38
|
| Rate for Payer: UHC Medicare Advantage |
$33,446.55
|
| Rate for Payer: VA VA |
$32,472.38
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,951.37
|
|
|
Service Code
|
MS-DRG 099
|
| Min. Negotiated Rate |
$12,215.38 |
| Max. Negotiated Rate |
$16,951.37 |
| Rate for Payer: Aetna Medicare |
$12,858.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,072.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,072.86
|
| Rate for Payer: BCBS MAPPO |
$12,858.29
|
| Rate for Payer: BCN Medicare Advantage |
$12,858.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,858.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,858.29
|
| Rate for Payer: Mclaren Medicare |
$12,858.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,501.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,787.03
|
| Rate for Payer: PACE Medicare |
$12,215.38
|
| Rate for Payer: PACE SWMI |
$12,858.29
|
| Rate for Payer: PHP Commercial |
$14,144.12
|
| Rate for Payer: PHP Medicare Advantage |
$12,858.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,951.37
|
| Rate for Payer: Priority Health Medicare |
$12,858.29
|
| Rate for Payer: Priority Health Narrow Network |
$13,561.10
|
| Rate for Payer: Railroad Medicare Medicare |
$12,858.29
|
| Rate for Payer: UHC Medicare Advantage |
$13,244.04
|
| Rate for Payer: VA VA |
$12,858.29
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$26,207.72
|
|
|
Service Code
|
MS-DRG 935
|
| Min. Negotiated Rate |
$18,013.61 |
| Max. Negotiated Rate |
$26,207.72 |
| Rate for Payer: Aetna Medicare |
$18,961.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,702.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,702.11
|
| Rate for Payer: BCBS MAPPO |
$18,961.69
|
| Rate for Payer: BCN Medicare Advantage |
$18,961.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,961.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,961.69
|
| Rate for Payer: Mclaren Medicare |
$18,961.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,909.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,805.94
|
| Rate for Payer: PACE Medicare |
$18,013.61
|
| Rate for Payer: PACE SWMI |
$18,961.69
|
| Rate for Payer: PHP Commercial |
$20,857.86
|
| Rate for Payer: PHP Medicare Advantage |
$18,961.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,207.72
|
| Rate for Payer: Priority Health Medicare |
$18,961.69
|
| Rate for Payer: Priority Health Narrow Network |
$20,966.18
|
| Rate for Payer: Railroad Medicare Medicare |
$18,961.69
|
| Rate for Payer: UHC Medicare Advantage |
$19,530.54
|
| Rate for Payer: VA VA |
$18,961.69
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$21,789.48
|
|
|
Service Code
|
MS-DRG 988
|
| Min. Negotiated Rate |
$15,245.98 |
| Max. Negotiated Rate |
$21,789.48 |
| Rate for Payer: Aetna Medicare |
$16,048.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,060.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,060.50
|
| Rate for Payer: BCBS MAPPO |
$16,048.40
|
| Rate for Payer: BCN Medicare Advantage |
$16,048.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,048.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,048.40
|
| Rate for Payer: Mclaren Medicare |
$16,048.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,850.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,455.66
|
| Rate for Payer: PACE Medicare |
$15,245.98
|
| Rate for Payer: PACE SWMI |
$16,048.40
|
| Rate for Payer: PHP Commercial |
$17,653.24
|
| Rate for Payer: PHP Medicare Advantage |
$16,048.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,789.48
|
| Rate for Payer: Priority Health Medicare |
$16,048.40
|
| Rate for Payer: Priority Health Narrow Network |
$17,431.58
|
| Rate for Payer: Railroad Medicare Medicare |
$16,048.40
|
| Rate for Payer: UHC Medicare Advantage |
$16,529.85
|
| Rate for Payer: VA VA |
$16,048.40
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$43,356.83
|
|
|
Service Code
|
MS-DRG 987
|
| Min. Negotiated Rate |
$28,755.96 |
| Max. Negotiated Rate |
$43,356.83 |
| Rate for Payer: Aetna Medicare |
$30,269.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,836.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,836.79
|
| Rate for Payer: BCBS MAPPO |
$30,269.43
|
| Rate for Payer: BCN Medicare Advantage |
$30,269.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,269.43
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,269.43
|
| Rate for Payer: Mclaren Medicare |
$30,269.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,782.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,809.84
|
| Rate for Payer: PACE Medicare |
$28,755.96
|
| Rate for Payer: PACE SWMI |
$30,269.43
|
| Rate for Payer: PHP Commercial |
$33,296.37
|
| Rate for Payer: PHP Medicare Advantage |
$30,269.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,356.83
|
| Rate for Payer: Priority Health Medicare |
$30,269.43
|
| Rate for Payer: Priority Health Narrow Network |
$34,685.46
|
| Rate for Payer: Railroad Medicare Medicare |
$30,269.43
|
| Rate for Payer: UHC Medicare Advantage |
$31,177.51
|
| Rate for Payer: VA VA |
$30,269.43
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$13,871.05
|
|
|
Service Code
|
MS-DRG 989
|
| Min. Negotiated Rate |
$10,285.83 |
| Max. Negotiated Rate |
$13,871.05 |
| Rate for Payer: Aetna Medicare |
$10,827.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,533.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,533.99
|
| Rate for Payer: BCBS MAPPO |
$10,827.19
|
| Rate for Payer: BCN Medicare Advantage |
$10,827.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,827.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,827.19
|
| Rate for Payer: Mclaren Medicare |
$10,827.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,368.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,451.27
|
| Rate for Payer: PACE Medicare |
$10,285.83
|
| Rate for Payer: PACE SWMI |
$10,827.19
|
| Rate for Payer: PHP Commercial |
$11,909.91
|
| Rate for Payer: PHP Medicare Advantage |
$10,827.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,871.05
|
| Rate for Payer: Priority Health Medicare |
$10,827.19
|
| Rate for Payer: Priority Health Narrow Network |
$11,096.84
|
| Rate for Payer: Railroad Medicare Medicare |
$10,827.19
|
| Rate for Payer: UHC Medicare Advantage |
$11,152.01
|
| Rate for Payer: VA VA |
$10,827.19
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$13,167.42
|
|
|
Service Code
|
MS-DRG 600
|
| Min. Negotiated Rate |
$9,845.07 |
| Max. Negotiated Rate |
$13,167.42 |
| Rate for Payer: Aetna Medicare |
$10,363.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,954.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,954.04
|
| Rate for Payer: BCBS MAPPO |
$10,363.23
|
| Rate for Payer: BCN Medicare Advantage |
$10,363.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,363.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,363.23
|
| Rate for Payer: Mclaren Medicare |
$10,363.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,881.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,917.71
|
| Rate for Payer: PACE Medicare |
$9,845.07
|
| Rate for Payer: PACE SWMI |
$10,363.23
|
| Rate for Payer: PHP Commercial |
$11,399.55
|
| Rate for Payer: PHP Medicare Advantage |
$10,363.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,167.42
|
| Rate for Payer: Priority Health Medicare |
$10,363.23
|
| Rate for Payer: Priority Health Narrow Network |
$10,533.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10,363.23
|
| Rate for Payer: UHC Medicare Advantage |
$10,674.13
|
| Rate for Payer: VA VA |
$10,363.23
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$8,805.50
|
|
|
Service Code
|
MS-DRG 601
|
| Min. Negotiated Rate |
$6,395.34 |
| Max. Negotiated Rate |
$8,805.50 |
| Rate for Payer: Aetna Medicare |
$7,044.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,805.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,805.50
|
| Rate for Payer: BCBS MAPPO |
$7,044.40
|
| Rate for Payer: BCN Medicare Advantage |
$7,044.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,044.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,044.40
|
| Rate for Payer: Mclaren Medicare |
$7,044.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,396.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,101.06
|
| Rate for Payer: PACE Medicare |
$6,692.18
|
| Rate for Payer: PACE SWMI |
$7,044.40
|
| Rate for Payer: PHP Commercial |
$7,748.84
|
| Rate for Payer: PHP Medicare Advantage |
$7,044.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,994.18
|
| Rate for Payer: Priority Health Medicare |
$7,044.40
|
| Rate for Payer: Priority Health Narrow Network |
$6,395.34
|
| Rate for Payer: Railroad Medicare Medicare |
$7,044.40
|
| Rate for Payer: UHC Medicare Advantage |
$7,255.73
|
| Rate for Payer: VA VA |
$7,044.40
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$13,633.51
|
|
|
Service Code
|
MS-DRG 071
|
| Min. Negotiated Rate |
$10,137.02 |
| Max. Negotiated Rate |
$13,633.51 |
| Rate for Payer: Aetna Medicare |
$10,670.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,338.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,338.19
|
| Rate for Payer: BCBS MAPPO |
$10,670.55
|
| Rate for Payer: BCN Medicare Advantage |
$10,670.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,670.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,670.55
|
| Rate for Payer: Mclaren Medicare |
$10,670.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,204.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,271.13
|
| Rate for Payer: PACE Medicare |
$10,137.02
|
| Rate for Payer: PACE SWMI |
$10,670.55
|
| Rate for Payer: PHP Commercial |
$11,737.60
|
| Rate for Payer: PHP Medicare Advantage |
$10,670.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,633.51
|
| Rate for Payer: Priority Health Medicare |
$10,670.55
|
| Rate for Payer: Priority Health Narrow Network |
$10,906.81
|
| Rate for Payer: Railroad Medicare Medicare |
$10,670.55
|
| Rate for Payer: UHC Medicare Advantage |
$10,990.67
|
| Rate for Payer: VA VA |
$10,670.55
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$22,977.18
|
|
|
Service Code
|
MS-DRG 070
|
| Min. Negotiated Rate |
$15,989.97 |
| Max. Negotiated Rate |
$22,977.18 |
| Rate for Payer: Aetna Medicare |
$16,831.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,039.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,039.44
|
| Rate for Payer: BCBS MAPPO |
$16,831.55
|
| Rate for Payer: BCN Medicare Advantage |
$16,831.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,831.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,831.55
|
| Rate for Payer: Mclaren Medicare |
$16,831.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,673.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,356.28
|
| Rate for Payer: PACE Medicare |
$15,989.97
|
| Rate for Payer: PACE SWMI |
$16,831.55
|
| Rate for Payer: PHP Commercial |
$18,514.70
|
| Rate for Payer: PHP Medicare Advantage |
$16,831.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,977.18
|
| Rate for Payer: Priority Health Medicare |
$16,831.55
|
| Rate for Payer: Priority Health Narrow Network |
$18,381.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16,831.55
|
| Rate for Payer: UHC Medicare Advantage |
$17,336.50
|
| Rate for Payer: VA VA |
$16,831.55
|
|
|
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,387.66
|
|
|
Service Code
|
MS-DRG 072
|
| Min. Negotiated Rate |
$7,894.62 |
| Max. Negotiated Rate |
$10,387.66 |
| Rate for Payer: Aetna Medicare |
$8,310.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,387.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,387.66
|
| Rate for Payer: BCBS MAPPO |
$8,310.13
|
| Rate for Payer: BCN Medicare Advantage |
$8,310.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,310.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,310.13
|
| Rate for Payer: Mclaren Medicare |
$8,310.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,725.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,556.65
|
| Rate for Payer: PACE Medicare |
$7,894.62
|
| Rate for Payer: PACE SWMI |
$8,310.13
|
| Rate for Payer: PHP Commercial |
$9,141.14
|
| Rate for Payer: PHP Medicare Advantage |
$8,310.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,053.72
|
| Rate for Payer: Priority Health Medicare |
$8,310.13
|
| Rate for Payer: Priority Health Narrow Network |
$8,042.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8,310.13
|
| Rate for Payer: UHC Medicare Advantage |
$8,559.43
|
| Rate for Payer: VA VA |
$8,310.13
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$18,193.00
|
|
|
Service Code
|
MS-DRG 067
|
| Min. Negotiated Rate |
$12,993.13 |
| Max. Negotiated Rate |
$18,193.00 |
| Rate for Payer: Aetna Medicare |
$13,676.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,096.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,096.22
|
| Rate for Payer: BCBS MAPPO |
$13,676.98
|
| Rate for Payer: BCN Medicare Advantage |
$13,676.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,676.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,676.98
|
| Rate for Payer: Mclaren Medicare |
$13,676.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,360.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,728.53
|
| Rate for Payer: PACE Medicare |
$12,993.13
|
| Rate for Payer: PACE SWMI |
$13,676.98
|
| Rate for Payer: PHP Commercial |
$15,044.68
|
| Rate for Payer: PHP Medicare Advantage |
$13,676.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,193.00
|
| Rate for Payer: Priority Health Medicare |
$13,676.98
|
| Rate for Payer: Priority Health Narrow Network |
$14,554.40
|
| Rate for Payer: Railroad Medicare Medicare |
$13,676.98
|
| Rate for Payer: UHC Medicare Advantage |
$14,087.29
|
| Rate for Payer: VA VA |
$13,676.98
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$11,318.98
|
|
|
Service Code
|
MS-DRG 068
|
| Min. Negotiated Rate |
$8,602.42 |
| Max. Negotiated Rate |
$11,318.98 |
| Rate for Payer: Aetna Medicare |
$9,055.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,318.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,318.98
|
| Rate for Payer: BCBS MAPPO |
$9,055.18
|
| Rate for Payer: BCN Medicare Advantage |
$9,055.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,055.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,055.18
|
| Rate for Payer: Mclaren Medicare |
$9,055.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,507.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,413.46
|
| Rate for Payer: PACE Medicare |
$8,602.42
|
| Rate for Payer: PACE SWMI |
$9,055.18
|
| Rate for Payer: PHP Commercial |
$9,960.70
|
| Rate for Payer: PHP Medicare Advantage |
$9,055.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,183.64
|
| Rate for Payer: Priority Health Medicare |
$9,055.18
|
| Rate for Payer: Priority Health Narrow Network |
$8,946.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9,055.18
|
| Rate for Payer: UHC Medicare Advantage |
$9,326.84
|
| Rate for Payer: VA VA |
$9,055.18
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$28,359.71
|
|
|
Service Code
|
MS-DRG 080
|
| Min. Negotiated Rate |
$19,361.63 |
| Max. Negotiated Rate |
$28,359.71 |
| Rate for Payer: Aetna Medicare |
$20,380.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,475.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,475.82
|
| Rate for Payer: BCBS MAPPO |
$20,380.66
|
| Rate for Payer: BCN Medicare Advantage |
$20,380.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,380.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,380.66
|
| Rate for Payer: Mclaren Medicare |
$20,380.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,399.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,437.76
|
| Rate for Payer: PACE Medicare |
$19,361.63
|
| Rate for Payer: PACE SWMI |
$20,380.66
|
| Rate for Payer: PHP Commercial |
$22,418.73
|
| Rate for Payer: PHP Medicare Advantage |
$20,380.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,359.71
|
| Rate for Payer: Priority Health Medicare |
$20,380.66
|
| Rate for Payer: Priority Health Narrow Network |
$22,687.77
|
| Rate for Payer: Railroad Medicare Medicare |
$20,380.66
|
| Rate for Payer: UHC Medicare Advantage |
$20,992.08
|
| Rate for Payer: VA VA |
$20,380.66
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$11,726.42
|
|
|
Service Code
|
MS-DRG 081
|
| Min. Negotiated Rate |
$8,912.08 |
| Max. Negotiated Rate |
$11,726.42 |
| Rate for Payer: Aetna Medicare |
$9,381.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,726.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,726.42
|
| Rate for Payer: BCBS MAPPO |
$9,381.14
|
| Rate for Payer: BCN Medicare Advantage |
$9,381.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,381.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,381.14
|
| Rate for Payer: Mclaren Medicare |
$9,381.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,850.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,788.31
|
| Rate for Payer: PACE Medicare |
$8,912.08
|
| Rate for Payer: PACE SWMI |
$9,381.14
|
| Rate for Payer: PHP Commercial |
$10,319.25
|
| Rate for Payer: PHP Medicare Advantage |
$9,381.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,677.98
|
| Rate for Payer: Priority Health Medicare |
$9,381.14
|
| Rate for Payer: Priority Health Narrow Network |
$9,342.38
|
| Rate for Payer: Railroad Medicare Medicare |
$9,381.14
|
| Rate for Payer: UHC Medicare Advantage |
$9,662.57
|
| Rate for Payer: VA VA |
$9,381.14
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.45
|
|
|
Service Code
|
NDC 0143-9318-01
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$25.45 |
| Rate for Payer: Aetna Commercial |
$22.90
|
| Rate for Payer: ASR ASR |
$24.69
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$20.36
|
| Rate for Payer: Cofinity Commercial |
$23.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$25.45
|
| Rate for Payer: Healthscope Whirlpool |
$24.69
|
| Rate for Payer: Mclaren Commercial |
$22.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.40
|
|
