|
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,414.89
|
|
|
Service Code
|
MS-DRG 909
|
| Min. Negotiated Rate |
$12,505.70 |
| Max. Negotiated Rate |
$17,414.89 |
| Rate for Payer: Aetna Medicare |
$13,163.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,454.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,454.88
|
| Rate for Payer: BCBS MAPPO |
$13,163.90
|
| Rate for Payer: BCN Medicare Advantage |
$13,163.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,163.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,163.90
|
| Rate for Payer: Mclaren Medicare |
$13,163.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,822.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,138.48
|
| Rate for Payer: PACE Medicare |
$12,505.70
|
| Rate for Payer: PACE SWMI |
$13,163.90
|
| Rate for Payer: PHP Commercial |
$14,480.29
|
| Rate for Payer: PHP Medicare Advantage |
$13,163.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,414.89
|
| Rate for Payer: Priority Health Medicare |
$13,163.90
|
| Rate for Payer: Priority Health Narrow Network |
$13,931.91
|
| Rate for Payer: Railroad Medicare Medicare |
$13,163.90
|
| Rate for Payer: UHC Medicare Advantage |
$13,558.82
|
| Rate for Payer: VA VA |
$13,163.90
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$51,935.23
|
|
|
Service Code
|
MS-DRG 958
|
| Min. Negotiated Rate |
$34,129.52 |
| Max. Negotiated Rate |
$51,935.23 |
| Rate for Payer: Aetna Medicare |
$35,925.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,907.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,907.26
|
| Rate for Payer: BCBS MAPPO |
$35,925.81
|
| Rate for Payer: BCN Medicare Advantage |
$35,925.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,925.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$35,925.81
|
| Rate for Payer: Mclaren Medicare |
$35,925.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,722.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,314.68
|
| Rate for Payer: PACE Medicare |
$34,129.52
|
| Rate for Payer: PACE SWMI |
$35,925.81
|
| Rate for Payer: PHP Commercial |
$39,518.39
|
| Rate for Payer: PHP Medicare Advantage |
$35,925.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,935.23
|
| Rate for Payer: Priority Health Medicare |
$35,925.81
|
| Rate for Payer: Priority Health Narrow Network |
$41,548.18
|
| Rate for Payer: Railroad Medicare Medicare |
$35,925.81
|
| Rate for Payer: UHC Medicare Advantage |
$37,003.58
|
| Rate for Payer: VA VA |
$35,925.81
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$92,865.30
|
|
|
Service Code
|
MS-DRG 957
|
| Min. Negotiated Rate |
$59,768.44 |
| Max. Negotiated Rate |
$92,865.30 |
| Rate for Payer: Aetna Medicare |
$62,914.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78,642.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78,642.69
|
| Rate for Payer: BCBS MAPPO |
$62,914.15
|
| Rate for Payer: BCN Medicare Advantage |
$62,914.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62,914.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$62,914.15
|
| Rate for Payer: Mclaren Medicare |
$62,914.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66,059.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72,351.27
|
| Rate for Payer: PACE Medicare |
$59,768.44
|
| Rate for Payer: PACE SWMI |
$62,914.15
|
| Rate for Payer: PHP Commercial |
$69,205.56
|
| Rate for Payer: PHP Medicare Advantage |
$62,914.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92,865.30
|
| Rate for Payer: Priority Health Medicare |
$62,914.15
|
| Rate for Payer: Priority Health Narrow Network |
$74,292.24
|
| Rate for Payer: Railroad Medicare Medicare |
$62,914.15
|
| Rate for Payer: UHC Medicare Advantage |
$64,801.57
|
| Rate for Payer: VA VA |
$62,914.15
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$32,516.02
|
|
|
Service Code
|
MS-DRG 959
|
| Min. Negotiated Rate |
$21,965.19 |
| Max. Negotiated Rate |
$32,516.02 |
| Rate for Payer: Aetna Medicare |
$23,121.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,901.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,901.56
|
| Rate for Payer: BCBS MAPPO |
$23,121.25
|
| Rate for Payer: BCN Medicare Advantage |
$23,121.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,121.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,121.25
|
| Rate for Payer: Mclaren Medicare |
$23,121.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,277.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,589.44
|
| Rate for Payer: PACE Medicare |
$21,965.19
|
| Rate for Payer: PACE SWMI |
$23,121.25
|
| Rate for Payer: PHP Commercial |
$25,433.38
|
| Rate for Payer: PHP Medicare Advantage |
$23,121.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,516.02
|
| Rate for Payer: Priority Health Medicare |
$23,121.25
|
| Rate for Payer: Priority Health Narrow Network |
$26,012.82
|
| Rate for Payer: Railroad Medicare Medicare |
$23,121.25
|
| Rate for Payer: UHC Medicare Advantage |
$23,814.89
|
| Rate for Payer: VA VA |
$23,121.25
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$23,859.29
|
|
|
Service Code
|
MS-DRG 803
|
| Min. Negotiated Rate |
$16,542.54 |
| Max. Negotiated Rate |
$23,859.29 |
| Rate for Payer: Aetna Medicare |
$17,413.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,766.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,766.50
|
| Rate for Payer: BCBS MAPPO |
$17,413.20
|
| Rate for Payer: BCN Medicare Advantage |
$17,413.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,413.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,413.20
|
| Rate for Payer: Mclaren Medicare |
$17,413.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,283.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,025.18
|
| Rate for Payer: PACE Medicare |
$16,542.54
|
| Rate for Payer: PACE SWMI |
$17,413.20
|
| Rate for Payer: PHP Commercial |
$19,154.52
|
| Rate for Payer: PHP Medicare Advantage |
$17,413.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,859.29
|
| Rate for Payer: Priority Health Medicare |
$17,413.20
|
| Rate for Payer: Priority Health Narrow Network |
$19,087.43
|
| Rate for Payer: Railroad Medicare Medicare |
$17,413.20
|
| Rate for Payer: UHC Medicare Advantage |
$17,935.60
|
| Rate for Payer: VA VA |
$17,413.20
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$43,531.45
|
|
|
Service Code
|
MS-DRG 802
|
| Min. Negotiated Rate |
$29,191.09 |
| Max. Negotiated Rate |
$43,531.45 |
| Rate for Payer: Aetna Medicare |
$30,727.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,409.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,409.32
|
| Rate for Payer: BCBS MAPPO |
$30,727.46
|
| Rate for Payer: BCN Medicare Advantage |
$30,727.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,727.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,727.46
|
| Rate for Payer: Mclaren Medicare |
$30,727.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,263.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,336.58
|
| Rate for Payer: PACE Medicare |
$29,191.09
|
| Rate for Payer: PACE SWMI |
$30,727.46
|
| Rate for Payer: PHP Commercial |
$33,800.21
|
| Rate for Payer: PHP Medicare Advantage |
$30,727.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,531.45
|
| Rate for Payer: Priority Health Medicare |
$30,727.46
|
| Rate for Payer: Priority Health Narrow Network |
$34,825.16
|
| Rate for Payer: Railroad Medicare Medicare |
$30,727.46
|
| Rate for Payer: UHC Medicare Advantage |
$31,649.28
|
| Rate for Payer: VA VA |
$30,727.46
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,541.54
|
|
|
Service Code
|
MS-DRG 804
|
| Min. Negotiated Rate |
$11,332.23 |
| Max. Negotiated Rate |
$15,541.54 |
| Rate for Payer: Aetna Medicare |
$11,928.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,910.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,910.82
|
| Rate for Payer: BCBS MAPPO |
$11,928.66
|
| Rate for Payer: BCN Medicare Advantage |
$11,928.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,928.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,928.66
|
| Rate for Payer: Mclaren Medicare |
$11,928.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,525.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,717.96
|
| Rate for Payer: PACE Medicare |
$11,332.23
|
| Rate for Payer: PACE SWMI |
$11,928.66
|
| Rate for Payer: PHP Commercial |
$13,121.53
|
| Rate for Payer: PHP Medicare Advantage |
$11,928.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,541.54
|
| Rate for Payer: Priority Health Medicare |
$11,928.66
|
| Rate for Payer: Priority Health Narrow Network |
$12,433.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,928.66
|
| Rate for Payer: UHC Medicare Advantage |
$12,286.52
|
| Rate for Payer: VA VA |
$11,928.66
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$23,244.25
|
|
|
Service Code
|
MS-DRG 205
|
| Min. Negotiated Rate |
$16,157.27 |
| Max. Negotiated Rate |
$23,244.25 |
| Rate for Payer: Aetna Medicare |
$17,007.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,259.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,259.56
|
| Rate for Payer: BCBS MAPPO |
$17,007.65
|
| Rate for Payer: BCN Medicare Advantage |
$17,007.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,007.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,007.65
|
| Rate for Payer: Mclaren Medicare |
$17,007.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,858.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,558.80
|
| Rate for Payer: PACE Medicare |
$16,157.27
|
| Rate for Payer: PACE SWMI |
$17,007.65
|
| Rate for Payer: PHP Commercial |
$18,708.42
|
| Rate for Payer: PHP Medicare Advantage |
$17,007.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,244.25
|
| Rate for Payer: Priority Health Medicare |
$17,007.65
|
| Rate for Payer: Priority Health Narrow Network |
$18,595.40
|
| Rate for Payer: Railroad Medicare Medicare |
$17,007.65
|
| Rate for Payer: UHC Medicare Advantage |
$17,517.88
|
| Rate for Payer: VA VA |
$17,007.65
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$11,768.74
|
|
|
Service Code
|
MS-DRG 206
|
| Min. Negotiated Rate |
$8,944.24 |
| Max. Negotiated Rate |
$11,768.74 |
| Rate for Payer: Aetna Medicare |
$9,414.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,768.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,768.74
|
| Rate for Payer: BCBS MAPPO |
$9,414.99
|
| Rate for Payer: BCN Medicare Advantage |
$9,414.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,414.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,414.99
|
| Rate for Payer: Mclaren Medicare |
$9,414.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,885.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,827.24
|
| Rate for Payer: PACE Medicare |
$8,944.24
|
| Rate for Payer: PACE SWMI |
$9,414.99
|
| Rate for Payer: PHP Commercial |
$10,356.49
|
| Rate for Payer: PHP Medicare Advantage |
$9,414.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,729.34
|
| Rate for Payer: Priority Health Medicare |
$9,414.99
|
| Rate for Payer: Priority Health Narrow Network |
$9,383.47
|
| Rate for Payer: Railroad Medicare Medicare |
$9,414.99
|
| Rate for Payer: UHC Medicare Advantage |
$9,697.44
|
| Rate for Payer: VA VA |
$9,414.99
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$23,366.23
|
|
|
Service Code
|
MS-DRG 167
|
| Min. Negotiated Rate |
$16,233.69 |
| Max. Negotiated Rate |
$23,366.23 |
| Rate for Payer: Aetna Medicare |
$17,088.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,360.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,360.11
|
| Rate for Payer: BCBS MAPPO |
$17,088.09
|
| Rate for Payer: BCN Medicare Advantage |
$17,088.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,088.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,088.09
|
| Rate for Payer: Mclaren Medicare |
$17,088.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,942.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,651.30
|
| Rate for Payer: PACE Medicare |
$16,233.69
|
| Rate for Payer: PACE SWMI |
$17,088.09
|
| Rate for Payer: PHP Commercial |
$18,796.90
|
| Rate for Payer: PHP Medicare Advantage |
$17,088.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,366.23
|
| Rate for Payer: Priority Health Medicare |
$17,088.09
|
| Rate for Payer: Priority Health Narrow Network |
$18,692.98
|
| Rate for Payer: Railroad Medicare Medicare |
$17,088.09
|
| Rate for Payer: UHC Medicare Advantage |
$17,600.73
|
| Rate for Payer: VA VA |
$17,088.09
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$52,102.15
|
|
|
Service Code
|
MS-DRG 166
|
| Min. Negotiated Rate |
$34,234.10 |
| Max. Negotiated Rate |
$52,102.15 |
| Rate for Payer: Aetna Medicare |
$36,035.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,044.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,044.86
|
| Rate for Payer: BCBS MAPPO |
$36,035.89
|
| Rate for Payer: BCN Medicare Advantage |
$36,035.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,035.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,035.89
|
| Rate for Payer: Mclaren Medicare |
$36,035.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,837.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,441.27
|
| Rate for Payer: PACE Medicare |
$34,234.10
|
| Rate for Payer: PACE SWMI |
$36,035.89
|
| Rate for Payer: PHP Commercial |
$39,639.48
|
| Rate for Payer: PHP Medicare Advantage |
$36,035.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,102.15
|
| Rate for Payer: Priority Health Medicare |
$36,035.89
|
| Rate for Payer: Priority Health Narrow Network |
$41,681.72
|
| Rate for Payer: Railroad Medicare Medicare |
$36,035.89
|
| Rate for Payer: UHC Medicare Advantage |
$37,116.97
|
| Rate for Payer: VA VA |
$36,035.89
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,407.19
|
|
|
Service Code
|
MS-DRG 168
|
| Min. Negotiated Rate |
$12,500.89 |
| Max. Negotiated Rate |
$17,407.19 |
| Rate for Payer: Aetna Medicare |
$13,158.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,448.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,448.54
|
| Rate for Payer: BCBS MAPPO |
$13,158.83
|
| Rate for Payer: BCN Medicare Advantage |
$13,158.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,158.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,158.83
|
| Rate for Payer: Mclaren Medicare |
$13,158.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,816.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,132.65
|
| Rate for Payer: PACE Medicare |
$12,500.89
|
| Rate for Payer: PACE SWMI |
$13,158.83
|
| Rate for Payer: PHP Commercial |
$14,474.71
|
| Rate for Payer: PHP Medicare Advantage |
$13,158.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,407.19
|
| Rate for Payer: Priority Health Medicare |
$13,158.83
|
| Rate for Payer: Priority Health Narrow Network |
$13,925.75
|
| Rate for Payer: Railroad Medicare Medicare |
$13,158.83
|
| Rate for Payer: UHC Medicare Advantage |
$13,553.59
|
| Rate for Payer: VA VA |
$13,158.83
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$22,426.34
|
|
|
Service Code
|
MS-DRG 580
|
| Min. Negotiated Rate |
$15,644.93 |
| Max. Negotiated Rate |
$22,426.34 |
| Rate for Payer: Aetna Medicare |
$16,468.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,585.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,585.44
|
| Rate for Payer: BCBS MAPPO |
$16,468.35
|
| Rate for Payer: BCN Medicare Advantage |
$16,468.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,468.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,468.35
|
| Rate for Payer: Mclaren Medicare |
$16,468.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,291.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,938.60
|
| Rate for Payer: PACE Medicare |
$15,644.93
|
| Rate for Payer: PACE SWMI |
$16,468.35
|
| Rate for Payer: PHP Commercial |
$18,115.18
|
| Rate for Payer: PHP Medicare Advantage |
$16,468.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,426.34
|
| Rate for Payer: Priority Health Medicare |
$16,468.35
|
| Rate for Payer: Priority Health Narrow Network |
$17,941.07
|
| Rate for Payer: Railroad Medicare Medicare |
$16,468.35
|
| Rate for Payer: UHC Medicare Advantage |
$16,962.40
|
| Rate for Payer: VA VA |
$16,468.35
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$42,913.85
|
|
|
Service Code
|
MS-DRG 579
|
| Min. Negotiated Rate |
$28,478.47 |
| Max. Negotiated Rate |
$42,913.85 |
| Rate for Payer: Aetna Medicare |
$29,977.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,471.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,471.68
|
| Rate for Payer: BCBS MAPPO |
$29,977.34
|
| Rate for Payer: BCN Medicare Advantage |
$29,977.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,977.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,977.34
|
| Rate for Payer: Mclaren Medicare |
$29,977.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,476.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,473.94
|
| Rate for Payer: PACE Medicare |
$28,478.47
|
| Rate for Payer: PACE SWMI |
$29,977.34
|
| Rate for Payer: PHP Commercial |
$32,975.07
|
| Rate for Payer: PHP Medicare Advantage |
$29,977.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42,913.85
|
| Rate for Payer: Priority Health Medicare |
$29,977.34
|
| Rate for Payer: Priority Health Narrow Network |
$34,331.08
|
| Rate for Payer: Railroad Medicare Medicare |
$29,977.34
|
| Rate for Payer: UHC Medicare Advantage |
$30,876.66
|
| Rate for Payer: VA VA |
$29,977.34
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,291.63
|
|
|
Service Code
|
MS-DRG 581
|
| Min. Negotiated Rate |
$12,428.50 |
| Max. Negotiated Rate |
$17,291.63 |
| Rate for Payer: Aetna Medicare |
$13,082.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,353.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,353.29
|
| Rate for Payer: BCBS MAPPO |
$13,082.63
|
| Rate for Payer: BCN Medicare Advantage |
$13,082.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,082.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,082.63
|
| Rate for Payer: Mclaren Medicare |
$13,082.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,736.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,045.02
|
| Rate for Payer: PACE Medicare |
$12,428.50
|
| Rate for Payer: PACE SWMI |
$13,082.63
|
| Rate for Payer: PHP Commercial |
$14,390.89
|
| Rate for Payer: PHP Medicare Advantage |
$13,082.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,291.63
|
| Rate for Payer: Priority Health Medicare |
$13,082.63
|
| Rate for Payer: Priority Health Narrow Network |
$13,833.30
|
| Rate for Payer: Railroad Medicare Medicare |
$13,082.63
|
| Rate for Payer: UHC Medicare Advantage |
$13,475.11
|
| Rate for Payer: VA VA |
$13,082.63
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$32,756.12
|
|
|
Service Code
|
MS-DRG 253
|
| Min. Negotiated Rate |
$22,115.58 |
| Max. Negotiated Rate |
$32,756.12 |
| Rate for Payer: Aetna Medicare |
$23,279.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,099.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,099.45
|
| Rate for Payer: BCBS MAPPO |
$23,279.56
|
| Rate for Payer: BCN Medicare Advantage |
$23,279.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,279.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,279.56
|
| Rate for Payer: Mclaren Medicare |
$23,279.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,443.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,771.49
|
| Rate for Payer: PACE Medicare |
$22,115.58
|
| Rate for Payer: PACE SWMI |
$23,279.56
|
| Rate for Payer: PHP Commercial |
$25,607.52
|
| Rate for Payer: PHP Medicare Advantage |
$23,279.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,756.12
|
| Rate for Payer: Priority Health Medicare |
$23,279.56
|
| Rate for Payer: Priority Health Narrow Network |
$26,204.90
|
| Rate for Payer: Railroad Medicare Medicare |
$23,279.56
|
| Rate for Payer: UHC Medicare Advantage |
$23,977.95
|
| Rate for Payer: VA VA |
$23,279.56
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$43,062.79
|
|
|
Service Code
|
MS-DRG 252
|
| Min. Negotiated Rate |
$28,571.76 |
| Max. Negotiated Rate |
$43,062.79 |
| Rate for Payer: Aetna Medicare |
$30,075.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,594.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,594.42
|
| Rate for Payer: BCBS MAPPO |
$30,075.54
|
| Rate for Payer: BCN Medicare Advantage |
$30,075.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,075.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,075.54
|
| Rate for Payer: Mclaren Medicare |
$30,075.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,579.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,586.87
|
| Rate for Payer: PACE Medicare |
$28,571.76
|
| Rate for Payer: PACE SWMI |
$30,075.54
|
| Rate for Payer: PHP Commercial |
$33,083.09
|
| Rate for Payer: PHP Medicare Advantage |
$30,075.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,062.79
|
| Rate for Payer: Priority Health Medicare |
$30,075.54
|
| Rate for Payer: Priority Health Narrow Network |
$34,450.23
|
| Rate for Payer: Railroad Medicare Medicare |
$30,075.54
|
| Rate for Payer: UHC Medicare Advantage |
$30,977.81
|
| Rate for Payer: VA VA |
$30,075.54
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,278.68
|
|
|
Service Code
|
MS-DRG 254
|
| Min. Negotiated Rate |
$15,552.44 |
| Max. Negotiated Rate |
$22,278.68 |
| Rate for Payer: Aetna Medicare |
$16,370.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,463.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,463.74
|
| Rate for Payer: BCBS MAPPO |
$16,370.99
|
| Rate for Payer: BCN Medicare Advantage |
$16,370.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,370.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,370.99
|
| Rate for Payer: Mclaren Medicare |
$16,370.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,189.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,826.64
|
| Rate for Payer: PACE Medicare |
$15,552.44
|
| Rate for Payer: PACE SWMI |
$16,370.99
|
| Rate for Payer: PHP Commercial |
$18,008.09
|
| Rate for Payer: PHP Medicare Advantage |
$16,370.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,278.68
|
| Rate for Payer: Priority Health Medicare |
$16,370.99
|
| Rate for Payer: Priority Health Narrow Network |
$17,822.94
|
| Rate for Payer: Railroad Medicare Medicare |
$16,370.99
|
| Rate for Payer: UHC Medicare Advantage |
$16,862.12
|
| Rate for Payer: VA VA |
$16,370.99
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$15,256.49
|
|
|
Service Code
|
MS-DRG 152
|
| Min. Negotiated Rate |
$11,153.67 |
| Max. Negotiated Rate |
$15,256.49 |
| Rate for Payer: Aetna Medicare |
$11,740.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,675.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,675.89
|
| Rate for Payer: BCBS MAPPO |
$11,740.71
|
| Rate for Payer: BCN Medicare Advantage |
$11,740.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,740.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,740.71
|
| Rate for Payer: Mclaren Medicare |
$11,740.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,327.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,501.82
|
| Rate for Payer: PACE Medicare |
$11,153.67
|
| Rate for Payer: PACE SWMI |
$11,740.71
|
| Rate for Payer: PHP Commercial |
$12,914.78
|
| Rate for Payer: PHP Medicare Advantage |
$11,740.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,256.49
|
| Rate for Payer: Priority Health Medicare |
$11,740.71
|
| Rate for Payer: Priority Health Narrow Network |
$12,205.19
|
| Rate for Payer: Railroad Medicare Medicare |
$11,740.71
|
| Rate for Payer: UHC Medicare Advantage |
$12,092.93
|
| Rate for Payer: VA VA |
$11,740.71
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$9,877.55
|
|
|
Service Code
|
MS-DRG 153
|
| Min. Negotiated Rate |
$7,506.94 |
| Max. Negotiated Rate |
$9,877.55 |
| Rate for Payer: Aetna Medicare |
$7,902.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,877.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,877.55
|
| Rate for Payer: BCBS MAPPO |
$7,902.04
|
| Rate for Payer: BCN Medicare Advantage |
$7,902.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,902.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,902.04
|
| Rate for Payer: Mclaren Medicare |
$7,902.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,297.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,087.35
|
| Rate for Payer: PACE Medicare |
$7,506.94
|
| Rate for Payer: PACE SWMI |
$7,902.04
|
| Rate for Payer: PHP Commercial |
$8,692.24
|
| Rate for Payer: PHP Medicare Advantage |
$7,902.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,434.83
|
| Rate for Payer: Priority Health Medicare |
$7,902.04
|
| Rate for Payer: Priority Health Narrow Network |
$7,547.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7,902.04
|
| Rate for Payer: UHC Medicare Advantage |
$8,139.10
|
| Rate for Payer: VA VA |
$7,902.04
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
NDC 68084-853-11
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.99 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: ASR ASR |
$2.90
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.39
|
| Rate for Payer: Healthscope Commercial |
$2.99
|
| Rate for Payer: Healthscope Whirlpool |
$2.90
|
| Rate for Payer: Mclaren Commercial |
$2.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.63
|
|
|
OXCARBAZEPINE 300 MG TABLET
|
Facility
|
IP
|
$298.56
|
|
|
Service Code
|
NDC 68084-853-01
|
| Hospital Charge Code |
21061
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.99 |
| Max. Negotiated Rate |
$298.56 |
| Rate for Payer: Aetna Commercial |
$268.70
|
| Rate for Payer: ASR ASR |
$289.60
|
| Rate for Payer: BCBS Trust/PPO |
$231.47
|
| Rate for Payer: BCN Commercial |
$231.47
|
| Rate for Payer: Cash Price |
$238.85
|
| Rate for Payer: Cofinity Commercial |
$280.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.85
|
| Rate for Payer: Healthscope Commercial |
$298.56
|
| Rate for Payer: Healthscope Whirlpool |
$289.60
|
| Rate for Payer: Mclaren Commercial |
$268.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.73
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 0832-0038-89
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$3.23 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: ASR ASR |
$3.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.50
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$3.23
|
| Rate for Payer: Healthscope Whirlpool |
$3.13
|
| Rate for Payer: Mclaren Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.84
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$355.30
|
|
|
Service Code
|
NDC 68084-400-01
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.71 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna Commercial |
$319.77
|
| Rate for Payer: ASR ASR |
$344.64
|
| Rate for Payer: BCBS Trust/PPO |
$275.46
|
| Rate for Payer: BCN Commercial |
$275.46
|
| Rate for Payer: Cash Price |
$284.24
|
| Rate for Payer: Cofinity Commercial |
$333.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.24
|
| Rate for Payer: Healthscope Commercial |
$355.30
|
| Rate for Payer: Healthscope Whirlpool |
$344.64
|
| Rate for Payer: Mclaren Commercial |
$319.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.66
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET
|
Facility
|
IP
|
$325.85
|
|
|
Service Code
|
NDC 0904-2821-61
|
| Hospital Charge Code |
5938
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.10 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna Commercial |
$293.26
|
| Rate for Payer: ASR ASR |
$316.07
|
| Rate for Payer: BCBS Trust/PPO |
$252.63
|
| Rate for Payer: BCN Commercial |
$252.63
|
| Rate for Payer: Cash Price |
$260.68
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.68
|
| Rate for Payer: Healthscope Commercial |
$325.85
|
| Rate for Payer: Healthscope Whirlpool |
$316.07
|
| Rate for Payer: Mclaren Commercial |
$293.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$286.75
|
|
