|
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,243.88
|
|
|
Service Code
|
MSDRG 437
|
| Min. Negotiated Rate |
$7,504.32 |
| Max. Negotiated Rate |
$12,243.88 |
| Rate for Payer: Aetna Medicare |
$7,899.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,874.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,874.10
|
| Rate for Payer: BCBS MAPPO |
$7,899.28
|
| Rate for Payer: BCN Medicare Advantage |
$7,899.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,899.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,899.28
|
| Rate for Payer: Mclaren Medicare |
$7,899.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,294.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,084.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,689.21
|
| Rate for Payer: PACE Medicare |
$7,504.32
|
| Rate for Payer: PACE SWMI |
$7,899.28
|
| Rate for Payer: PHP Commercial |
$8,689.21
|
| Rate for Payer: PHP Medicare Advantage |
$7,899.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,723.32
|
| Rate for Payer: Priority Health Medicare |
$7,899.28
|
| Rate for Payer: Priority Health Narrow Network |
$9,378.65
|
| Rate for Payer: Railroad Medicare Medicare |
$7,899.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,899.28
|
| Rate for Payer: UHC Exchange |
$12,243.88
|
| Rate for Payer: UHCCP DNSP |
$7,899.28
|
| Rate for Payer: VA VA |
$7,899.28
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$15,793.74
|
|
|
Service Code
|
APR-DRG 3824
|
| Min. Negotiated Rate |
$14,279.43 |
| Max. Negotiated Rate |
$15,793.74 |
| Rate for Payer: BCBS Complete |
$15,793.74
|
| Rate for Payer: Mclaren Medicaid |
$15,041.66
|
| Rate for Payer: Meridian Medicaid |
$15,793.74
|
| Rate for Payer: PHP Medicaid |
$14,279.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,041.66
|
| Rate for Payer: UHC Medicaid |
$15,041.66
|
| Rate for Payer: UHCCP Medicaid |
$15,041.66
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$4,409.19
|
|
|
Service Code
|
APR-DRG 3821
|
| Min. Negotiated Rate |
$3,986.44 |
| Max. Negotiated Rate |
$4,409.19 |
| Rate for Payer: BCBS Complete |
$4,409.19
|
| Rate for Payer: Mclaren Medicaid |
$4,199.23
|
| Rate for Payer: Meridian Medicaid |
$4,409.19
|
| Rate for Payer: PHP Medicaid |
$3,986.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,199.23
|
| Rate for Payer: UHC Medicaid |
$4,199.23
|
| Rate for Payer: UHCCP Medicaid |
$4,199.23
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$8,936.64
|
|
|
Service Code
|
APR-DRG 3823
|
| Min. Negotiated Rate |
$8,079.79 |
| Max. Negotiated Rate |
$8,936.64 |
| Rate for Payer: BCBS Complete |
$8,936.64
|
| Rate for Payer: Mclaren Medicaid |
$8,511.08
|
| Rate for Payer: Meridian Medicaid |
$8,936.64
|
| Rate for Payer: PHP Medicaid |
$8,079.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,511.08
|
| Rate for Payer: UHC Medicaid |
$8,511.08
|
| Rate for Payer: UHCCP Medicaid |
$8,511.08
|
|
|
MALIGNANT BREAST DISORDERS
|
Facility
|
IP
|
$4,931.80
|
|
|
Service Code
|
APR-DRG 3822
|
| Min. Negotiated Rate |
$4,458.94 |
| Max. Negotiated Rate |
$4,931.80 |
| Rate for Payer: BCBS Complete |
$4,931.80
|
| Rate for Payer: Mclaren Medicaid |
$4,696.95
|
| Rate for Payer: Meridian Medicaid |
$4,931.80
|
| Rate for Payer: PHP Medicaid |
$4,458.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,696.95
|
| Rate for Payer: UHC Medicaid |
$4,696.95
|
| Rate for Payer: UHCCP Medicaid |
$4,696.95
|
|
|
MALIGNANT BREAST DISORDERS WITH CC
|
Facility
|
IP
|
$15,542.70
|
|
|
Service Code
|
MSDRG 598
|
| Min. Negotiated Rate |
$9,406.17 |
| Max. Negotiated Rate |
$15,542.70 |
| Rate for Payer: Aetna Medicare |
$9,901.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,376.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,376.54
|
| Rate for Payer: BCBS MAPPO |
$9,901.23
|
| Rate for Payer: BCN Medicare Advantage |
$9,901.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,901.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,901.23
|
| Rate for Payer: Mclaren Medicare |
$9,901.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,396.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,386.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,891.35
|
| Rate for Payer: PACE Medicare |
$9,406.17
|
| Rate for Payer: PACE SWMI |
$9,901.23
|
| Rate for Payer: PHP Commercial |
$10,891.35
|
| Rate for Payer: PHP Medicare Advantage |
$9,901.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,542.70
|
| Rate for Payer: Priority Health Medicare |
$9,901.23
|
| Rate for Payer: Priority Health Narrow Network |
$12,434.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,901.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,901.23
|
| Rate for Payer: UHC Exchange |
$15,346.91
|
| Rate for Payer: UHCCP DNSP |
$9,901.23
|
| Rate for Payer: VA VA |
$9,901.23
|
|
|
MALIGNANT BREAST DISORDERS WITH MCC
|
Facility
|
IP
|
$22,903.95
|
|
|
Service Code
|
MSDRG 597
|
| Min. Negotiated Rate |
$13,071.68 |
| Max. Negotiated Rate |
$22,903.95 |
| Rate for Payer: Aetna Medicare |
$13,759.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,199.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,199.58
|
| Rate for Payer: BCBS MAPPO |
$13,759.66
|
| Rate for Payer: BCN Medicare Advantage |
$13,759.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,759.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,759.66
|
| Rate for Payer: Mclaren Medicare |
$13,759.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,447.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,823.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,135.63
|
| Rate for Payer: PACE Medicare |
$13,071.68
|
| Rate for Payer: PACE SWMI |
$13,759.66
|
| Rate for Payer: PHP Commercial |
$15,135.63
|
| Rate for Payer: PHP Medicare Advantage |
$13,759.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,903.95
|
| Rate for Payer: Priority Health Medicare |
$13,759.66
|
| Rate for Payer: Priority Health Narrow Network |
$18,323.16
|
| Rate for Payer: Railroad Medicare Medicare |
$13,759.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,759.66
|
| Rate for Payer: UHC Exchange |
$21,327.47
|
| Rate for Payer: UHCCP DNSP |
$13,759.66
|
| Rate for Payer: VA VA |
$13,759.66
|
|
|
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,307.41
|
|
|
Service Code
|
MSDRG 599
|
| Min. Negotiated Rate |
$6,930.35 |
| Max. Negotiated Rate |
$11,307.41 |
| Rate for Payer: Aetna Medicare |
$7,295.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,118.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,118.88
|
| Rate for Payer: BCBS MAPPO |
$7,295.10
|
| Rate for Payer: BCN Medicare Advantage |
$7,295.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,295.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,295.10
|
| Rate for Payer: Mclaren Medicare |
$7,295.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,659.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,389.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,024.61
|
| Rate for Payer: PACE Medicare |
$6,930.35
|
| Rate for Payer: PACE SWMI |
$7,295.10
|
| Rate for Payer: PHP Commercial |
$8,024.61
|
| Rate for Payer: PHP Medicare Advantage |
$7,295.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,570.63
|
| Rate for Payer: Priority Health Medicare |
$7,295.10
|
| Rate for Payer: Priority Health Narrow Network |
$8,456.51
|
| Rate for Payer: Railroad Medicare Medicare |
$7,295.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,295.10
|
| Rate for Payer: UHC Exchange |
$11,307.41
|
| Rate for Payer: UHCCP DNSP |
$7,295.10
|
| Rate for Payer: VA VA |
$7,295.10
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$8,414.57
|
|
|
Service Code
|
APR-DRG 4213
|
| Min. Negotiated Rate |
$7,607.78 |
| Max. Negotiated Rate |
$8,414.57 |
| Rate for Payer: BCBS Complete |
$8,414.57
|
| Rate for Payer: Mclaren Medicaid |
$8,013.88
|
| Rate for Payer: Meridian Medicaid |
$8,414.57
|
| Rate for Payer: PHP Medicaid |
$7,607.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,013.88
|
| Rate for Payer: UHC Medicaid |
$8,013.88
|
| Rate for Payer: UHCCP Medicaid |
$8,013.88
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$2,693.69
|
|
|
Service Code
|
APR-DRG 4211
|
| Min. Negotiated Rate |
$2,435.42 |
| Max. Negotiated Rate |
$2,693.69 |
| Rate for Payer: BCBS Complete |
$2,693.69
|
| Rate for Payer: Mclaren Medicaid |
$2,565.42
|
| Rate for Payer: Meridian Medicaid |
$2,693.69
|
| Rate for Payer: PHP Medicaid |
$2,435.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,565.42
|
| Rate for Payer: UHC Medicaid |
$2,565.42
|
| Rate for Payer: UHCCP Medicaid |
$2,565.42
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$5,618.98
|
|
|
Service Code
|
APR-DRG 4212
|
| Min. Negotiated Rate |
$5,080.23 |
| Max. Negotiated Rate |
$5,618.98 |
| Rate for Payer: BCBS Complete |
$5,618.98
|
| Rate for Payer: Mclaren Medicaid |
$5,351.41
|
| Rate for Payer: Meridian Medicaid |
$5,618.98
|
| Rate for Payer: PHP Medicaid |
$5,080.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,351.41
|
| Rate for Payer: UHC Medicaid |
$5,351.41
|
| Rate for Payer: UHCCP Medicaid |
$5,351.41
|
|
|
MALNUTRITION, FAILURE TO THRIVE AND OTHER NUTRITIONAL DISORDERS
|
Facility
|
IP
|
$10,600.91
|
|
|
Service Code
|
APR-DRG 4214
|
| Min. Negotiated Rate |
$9,584.49 |
| Max. Negotiated Rate |
$10,600.91 |
| Rate for Payer: BCBS Complete |
$10,600.91
|
| Rate for Payer: Mclaren Medicaid |
$10,096.11
|
| Rate for Payer: Meridian Medicaid |
$10,600.91
|
| Rate for Payer: PHP Medicaid |
$9,584.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,096.11
|
| Rate for Payer: UHC Medicaid |
$10,096.11
|
| Rate for Payer: UHCCP Medicaid |
$10,096.11
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: Aetna Medicare |
$35.12
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: BCBS Trust/PPO |
$78.26
|
| Rate for Payer: BCN Commercial |
$78.26
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.17
|
| Rate for Payer: Priority Health Narrow Network |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$105.09
|
|
|
Service Code
|
NDC 990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.82 |
| Max. Negotiated Rate |
$105.09 |
| Rate for Payer: Aetna Commercial |
$94.58
|
| Rate for Payer: ASR ASR |
$101.94
|
| Rate for Payer: BCBS Trust/PPO |
$86.30
|
| Rate for Payer: BCN Commercial |
$86.30
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$101.94
|
| Rate for Payer: Healthscope Whirlpool |
$105.09
|
| Rate for Payer: Mclaren Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.48
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.88 |
| Max. Negotiated Rate |
$105.09 |
| Rate for Payer: Aetna Commercial |
$94.58
|
| Rate for Payer: Aetna Medicare |
$38.88
|
| Rate for Payer: ASR ASR |
$101.94
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$86.65
|
| Rate for Payer: BCN Commercial |
$86.65
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Commercial |
$98.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$101.94
|
| Rate for Payer: Healthscope Whirlpool |
$105.09
|
| Rate for Payer: Mclaren Commercial |
$94.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Nomi Health Commercial |
$86.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$73.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.48
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 338035702
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.19 |
| 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 |
$77.95
|
| Rate for Payer: BCN Commercial |
$77.95
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.19 |
| 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 |
$77.95
|
| Rate for Payer: BCN Commercial |
$77.95
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.19 |
| 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 |
$77.95
|
| Rate for Payer: BCN Commercial |
$77.95
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: Aetna Medicare |
$35.12
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: BCBS Trust/PPO |
$78.26
|
| Rate for Payer: BCN Commercial |
$78.26
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.17
|
| Rate for Payer: Priority Health Narrow Network |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
NDC 338035703
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$36.37
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: BCBS Trust/PPO |
$81.06
|
| Rate for Payer: BCN Commercial |
$81.06
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$95.36
|
| Rate for Payer: Healthscope Whirlpool |
$98.31
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$86.14
|
| Rate for Payer: Priority Health Narrow Network |
$68.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.12 |
| Max. Negotiated Rate |
$94.92 |
| Rate for Payer: Aetna Commercial |
$85.43
|
| Rate for Payer: Aetna Medicare |
$35.12
|
| Rate for Payer: ASR ASR |
$92.07
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: BCBS Trust/PPO |
$78.26
|
| Rate for Payer: BCN Commercial |
$78.26
|
| 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 |
$92.07
|
| Rate for Payer: Healthscope Whirlpool |
$94.92
|
| Rate for Payer: Mclaren Commercial |
$85.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Nomi Health Commercial |
$77.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83.17
|
| Rate for Payer: Priority Health Narrow Network |
$66.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.53
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$98.31
|
|
|
Service Code
|
NDC 338035703
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.73 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: ASR ASR |
$95.36
|
| Rate for Payer: BCBS Trust/PPO |
$80.73
|
| Rate for Payer: BCN Commercial |
$80.73
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Commercial |
$92.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$95.36
|
| Rate for Payer: Healthscope Whirlpool |
$98.31
|
| Rate for Payer: Mclaren Commercial |
$88.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Nomi Health Commercial |
$80.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.51
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$26,469.17
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$14,846.95 |
| Max. Negotiated Rate |
$26,469.17 |
| Rate for Payer: Aetna Medicare |
$15,628.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,535.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,535.46
|
| Rate for Payer: BCBS MAPPO |
$15,628.37
|
| Rate for Payer: BCN Medicare Advantage |
$15,628.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,628.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,628.37
|
| Rate for Payer: Mclaren Medicare |
$15,628.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,409.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,972.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,191.21
|
| Rate for Payer: PACE Medicare |
$14,846.95
|
| Rate for Payer: PACE SWMI |
$15,628.37
|
| Rate for Payer: PHP Commercial |
$17,191.21
|
| Rate for Payer: PHP Medicare Advantage |
$15,628.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,469.17
|
| Rate for Payer: Priority Health Medicare |
$15,628.37
|
| Rate for Payer: Priority Health Narrow Network |
$21,175.34
|
| Rate for Payer: Railroad Medicare Medicare |
$15,628.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,628.37
|
| Rate for Payer: UHC Exchange |
$24,223.97
|
| Rate for Payer: UHCCP DNSP |
$15,628.37
|
| Rate for Payer: VA VA |
$15,628.37
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$23,691.19
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$13,463.67 |
| Max. Negotiated Rate |
$23,691.19 |
| Rate for Payer: Aetna Medicare |
$14,172.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,715.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,715.35
|
| Rate for Payer: BCBS MAPPO |
$14,172.28
|
| Rate for Payer: BCN Medicare Advantage |
$14,172.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,172.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,172.28
|
| Rate for Payer: Mclaren Medicare |
$14,172.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,880.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,298.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,589.51
|
| Rate for Payer: PACE Medicare |
$13,463.67
|
| Rate for Payer: PACE SWMI |
$14,172.28
|
| Rate for Payer: PHP Commercial |
$15,589.51
|
| Rate for Payer: PHP Medicare Advantage |
$14,172.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,691.19
|
| Rate for Payer: Priority Health Medicare |
$14,172.28
|
| Rate for Payer: Priority Health Narrow Network |
$18,952.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14,172.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,172.28
|
| Rate for Payer: UHC Exchange |
$21,967.03
|
| Rate for Payer: UHCCP DNSP |
$14,172.28
|
| Rate for Payer: VA VA |
$14,172.28
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$10,664.67
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$9,642.14 |
| Max. Negotiated Rate |
$10,664.67 |
| Rate for Payer: BCBS Complete |
$10,664.67
|
| Rate for Payer: Mclaren Medicaid |
$10,156.83
|
| Rate for Payer: Meridian Medicaid |
$10,664.67
|
| Rate for Payer: PHP Medicaid |
$9,642.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,156.83
|
| Rate for Payer: UHC Medicaid |
$10,156.83
|
| Rate for Payer: UHCCP Medicaid |
$10,156.83
|
|
