|
MORPHINE (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$134.55
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.82 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$67.28
|
| Rate for Payer: Aetna Medicare |
$21.23
|
| Rate for Payer: ASR ASR |
$130.51
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: ASR Commercial |
$130.51
|
| Rate for Payer: BCBS Complete |
$53.82
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$110.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Commercial |
$104.32
|
| Rate for Payer: Cash Price |
$107.64
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$126.48
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$134.55
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$130.51
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$121.09
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.37
|
| Rate for Payer: Nomi Health Commercial |
$110.33
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: Priority Health Narrow Network |
$94.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.40
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
IP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.55 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.47
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Whirlpool |
$11.27
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MORPHINE VARIABLE DOSE
|
Facility
|
OP
|
$11.62
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
150710
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.46
|
| Rate for Payer: Aetna Medicare |
$5.81
|
| Rate for Payer: ASR ASR |
$11.27
|
| Rate for Payer: ASR Commercial |
$11.27
|
| Rate for Payer: BCBS Complete |
$4.65
|
| Rate for Payer: BCBS Trust/PPO |
$9.52
|
| Rate for Payer: BCN Commercial |
$9.01
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cofinity Commercial |
$10.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.30
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Whirlpool |
$11.27
|
| Rate for Payer: Mclaren Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.88
|
| Rate for Payer: Nomi Health Commercial |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.18
|
| Rate for Payer: Priority Health Narrow Network |
$8.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.23
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$48.79
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Trust/PPO |
$39.76
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.92
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$102.53
|
| Rate for Payer: Aetna Medicare |
$56.96
|
| Rate for Payer: ASR ASR |
$110.50
|
| Rate for Payer: ASR Commercial |
$110.50
|
| Rate for Payer: BCBS Complete |
$45.57
|
| Rate for Payer: BCBS Trust/PPO |
$93.29
|
| Rate for Payer: BCN Commercial |
$88.32
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$107.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.14
|
| Rate for Payer: Healthscope Commercial |
$113.92
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Mclaren Commercial |
$102.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.83
|
| Rate for Payer: Nomi Health Commercial |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.82
|
| Rate for Payer: Priority Health Narrow Network |
$79.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.25
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$48.79
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$48.79 |
| Rate for Payer: Aetna Commercial |
$43.91
|
| Rate for Payer: Aetna Medicare |
$24.39
|
| Rate for Payer: ASR ASR |
$47.33
|
| Rate for Payer: ASR Commercial |
$47.33
|
| Rate for Payer: BCBS Complete |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$39.95
|
| Rate for Payer: BCN Commercial |
$37.83
|
| Rate for Payer: Cash Price |
$39.04
|
| Rate for Payer: Cofinity Commercial |
$45.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.03
|
| Rate for Payer: Healthscope Commercial |
$48.79
|
| Rate for Payer: Healthscope Whirlpool |
$47.33
|
| Rate for Payer: Mclaren Commercial |
$43.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$40.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.94
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.62 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: ASR Commercial |
$211.34
|
| Rate for Payer: BCBS Trust/PPO |
$177.55
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: ASR Commercial |
$105.69
|
| Rate for Payer: BCBS Trust/PPO |
$88.79
|
| Rate for Payer: BCN Commercial |
$84.48
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$108.96
|
| Rate for Payer: Healthscope Whirlpool |
$105.69
|
| Rate for Payer: Mclaren Commercial |
$98.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Nomi Health Commercial |
$89.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$108.96 |
| Rate for Payer: Aetna Commercial |
$98.06
|
| Rate for Payer: Aetna Medicare |
$54.48
|
| Rate for Payer: ASR ASR |
$105.69
|
| Rate for Payer: ASR Commercial |
$105.69
|
| Rate for Payer: BCBS Complete |
$43.58
|
| Rate for Payer: BCBS Trust/PPO |
$89.23
|
| Rate for Payer: BCN Commercial |
$84.48
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$108.96
|
| Rate for Payer: Healthscope Whirlpool |
$105.69
|
| Rate for Payer: Mclaren Commercial |
$98.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Nomi Health Commercial |
$89.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.47
|
| Rate for Payer: Priority Health Narrow Network |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.88
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.92
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.05 |
| Max. Negotiated Rate |
$113.92 |
| Rate for Payer: Aetna Commercial |
$102.53
|
| Rate for Payer: ASR ASR |
$110.50
|
| Rate for Payer: ASR Commercial |
$110.50
|
| Rate for Payer: BCBS Trust/PPO |
$92.83
|
| Rate for Payer: BCN Commercial |
$88.32
|
| Rate for Payer: Cash Price |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$107.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.14
|
| Rate for Payer: Healthscope Commercial |
$113.92
|
| Rate for Payer: Healthscope Whirlpool |
$110.50
|
| Rate for Payer: Mclaren Commercial |
$102.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.83
|
| Rate for Payer: Nomi Health Commercial |
$93.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.25
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$217.88 |
| Rate for Payer: Aetna Commercial |
$196.09
|
| Rate for Payer: Aetna Medicare |
$108.94
|
| Rate for Payer: ASR ASR |
$211.34
|
| Rate for Payer: ASR Commercial |
$211.34
|
| Rate for Payer: BCBS Complete |
$87.15
|
| Rate for Payer: BCBS Trust/PPO |
$178.42
|
| Rate for Payer: BCN Commercial |
$168.92
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Commercial |
$204.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$217.88
|
| Rate for Payer: Healthscope Whirlpool |
$211.34
|
| Rate for Payer: Mclaren Commercial |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Nomi Health Commercial |
$178.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.91
|
| Rate for Payer: Priority Health Narrow Network |
$152.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.73
|
|
|
MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$17,479.18
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$10,713.05 |
| Max. Negotiated Rate |
$17,479.18 |
| Rate for Payer: Aetna Medicare |
$11,276.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,096.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,096.11
|
| Rate for Payer: BCBS MAPPO |
$11,276.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,276.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,276.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,276.89
|
| Rate for Payer: Mclaren Medicare |
$11,276.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,840.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,968.42
|
| Rate for Payer: PACE Medicare |
$10,713.05
|
| Rate for Payer: PACE SWMI |
$11,276.89
|
| Rate for Payer: PHP Commercial |
$12,404.58
|
| Rate for Payer: PHP Medicare Advantage |
$11,276.89
|
| Rate for Payer: Priority Health Medicare |
$11,276.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,276.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,276.89
|
| Rate for Payer: UHC Exchange |
$17,479.18
|
| Rate for Payer: UHC Medicare Advantage |
$11,276.89
|
| Rate for Payer: UHCCP DNSP |
$11,276.89
|
| Rate for Payer: VA VA |
$11,276.89
|
|
|
MS-DRG 42.00: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$15,526.26
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$9,516.09 |
| Max. Negotiated Rate |
$15,526.26 |
| Rate for Payer: Aetna Medicare |
$10,016.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,521.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,521.17
|
| Rate for Payer: BCBS MAPPO |
$10,016.94
|
| Rate for Payer: BCN Medicare Advantage |
$10,016.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,016.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,016.94
|
| Rate for Payer: Mclaren Medicare |
$10,016.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,517.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,519.48
|
| Rate for Payer: PACE Medicare |
$9,516.09
|
| Rate for Payer: PACE SWMI |
$10,016.94
|
| Rate for Payer: PHP Commercial |
$11,018.63
|
| Rate for Payer: PHP Medicare Advantage |
$10,016.94
|
| Rate for Payer: Priority Health Medicare |
$10,016.94
|
| Rate for Payer: Railroad Medicare Medicare |
$10,016.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,016.94
|
| Rate for Payer: UHC Exchange |
$15,526.26
|
| Rate for Payer: UHC Medicare Advantage |
$10,016.94
|
| Rate for Payer: UHCCP DNSP |
$10,016.94
|
| Rate for Payer: VA VA |
$10,016.94
|
|
|
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$15,855.43
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$9,717.84 |
| Max. Negotiated Rate |
$15,855.43 |
| Rate for Payer: Aetna Medicare |
$10,229.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,786.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,786.64
|
| Rate for Payer: BCBS MAPPO |
$10,229.31
|
| Rate for Payer: BCN Medicare Advantage |
$10,229.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,229.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,229.31
|
| Rate for Payer: Mclaren Medicare |
$10,229.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,740.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,763.71
|
| Rate for Payer: PACE Medicare |
$9,717.84
|
| Rate for Payer: PACE SWMI |
$10,229.31
|
| Rate for Payer: PHP Commercial |
$11,252.24
|
| Rate for Payer: PHP Medicare Advantage |
$10,229.31
|
| Rate for Payer: Priority Health Medicare |
$10,229.31
|
| Rate for Payer: Railroad Medicare Medicare |
$10,229.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,229.31
|
| Rate for Payer: UHC Exchange |
$15,855.43
|
| Rate for Payer: UHC Medicare Advantage |
$10,229.31
|
| Rate for Payer: UHCCP DNSP |
$10,229.31
|
| Rate for Payer: VA VA |
$10,229.31
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$24,404.28
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$14,957.47 |
| Max. Negotiated Rate |
$24,404.28 |
| Rate for Payer: Aetna Medicare |
$15,744.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,680.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,680.88
|
| Rate for Payer: BCBS MAPPO |
$15,744.70
|
| Rate for Payer: BCN Medicare Advantage |
$15,744.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,744.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,744.70
|
| Rate for Payer: Mclaren Medicare |
$15,744.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,531.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,106.40
|
| Rate for Payer: PACE Medicare |
$14,957.47
|
| Rate for Payer: PACE SWMI |
$15,744.70
|
| Rate for Payer: PHP Commercial |
$17,319.17
|
| Rate for Payer: PHP Medicare Advantage |
$15,744.70
|
| Rate for Payer: Priority Health Medicare |
$15,744.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,744.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,744.70
|
| Rate for Payer: UHC Exchange |
$24,404.28
|
| Rate for Payer: UHC Medicare Advantage |
$15,744.70
|
| Rate for Payer: UHCCP DNSP |
$15,744.70
|
| Rate for Payer: VA VA |
$15,744.70
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$40,376.12
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$24,746.65 |
| Max. Negotiated Rate |
$40,376.12 |
| Rate for Payer: Aetna Medicare |
$26,049.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,561.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,561.39
|
| Rate for Payer: BCBS MAPPO |
$26,049.11
|
| Rate for Payer: BCN Medicare Advantage |
$26,049.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,049.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,049.11
|
| Rate for Payer: Mclaren Medicare |
$26,049.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,351.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,956.48
|
| Rate for Payer: PACE Medicare |
$24,746.65
|
| Rate for Payer: PACE SWMI |
$26,049.11
|
| Rate for Payer: PHP Commercial |
$28,654.02
|
| Rate for Payer: PHP Medicare Advantage |
$26,049.11
|
| Rate for Payer: Priority Health Medicare |
$26,049.11
|
| Rate for Payer: Railroad Medicare Medicare |
$26,049.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,049.11
|
| Rate for Payer: UHC Exchange |
$40,376.12
|
| Rate for Payer: UHC Medicare Advantage |
$26,049.11
|
| Rate for Payer: UHCCP DNSP |
$26,049.11
|
| Rate for Payer: VA VA |
$26,049.11
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,137.58
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$9,890.77 |
| Max. Negotiated Rate |
$16,137.58 |
| Rate for Payer: Aetna Medicare |
$10,411.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,014.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,014.17
|
| Rate for Payer: BCBS MAPPO |
$10,411.34
|
| Rate for Payer: BCN Medicare Advantage |
$10,411.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,411.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,411.34
|
| Rate for Payer: Mclaren Medicare |
$10,411.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,931.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,973.04
|
| Rate for Payer: PACE Medicare |
$9,890.77
|
| Rate for Payer: PACE SWMI |
$10,411.34
|
| Rate for Payer: PHP Commercial |
$11,452.47
|
| Rate for Payer: PHP Medicare Advantage |
$10,411.34
|
| Rate for Payer: Priority Health Medicare |
$10,411.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10,411.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,411.34
|
| Rate for Payer: UHC Exchange |
$16,137.58
|
| Rate for Payer: UHC Medicare Advantage |
$10,411.34
|
| Rate for Payer: UHCCP DNSP |
$10,411.34
|
| Rate for Payer: VA VA |
$10,411.34
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$32,138.49
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$19,697.78 |
| Max. Negotiated Rate |
$32,138.49 |
| Rate for Payer: Aetna Medicare |
$20,734.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,918.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,918.14
|
| Rate for Payer: BCBS MAPPO |
$20,734.51
|
| Rate for Payer: BCN Medicare Advantage |
$20,734.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,734.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,734.51
|
| Rate for Payer: Mclaren Medicare |
$20,734.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,771.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,844.69
|
| Rate for Payer: PACE Medicare |
$19,697.78
|
| Rate for Payer: PACE SWMI |
$20,734.51
|
| Rate for Payer: PHP Commercial |
$22,807.96
|
| Rate for Payer: PHP Medicare Advantage |
$20,734.51
|
| Rate for Payer: Priority Health Medicare |
$20,734.51
|
| Rate for Payer: Railroad Medicare Medicare |
$20,734.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,734.51
|
| Rate for Payer: UHC Exchange |
$32,138.49
|
| Rate for Payer: UHC Medicare Advantage |
$20,734.51
|
| Rate for Payer: UHCCP DNSP |
$20,734.51
|
| Rate for Payer: VA VA |
$20,734.51
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$79,044.42
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$48,446.58 |
| Max. Negotiated Rate |
$79,044.42 |
| Rate for Payer: Aetna Medicare |
$50,996.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63,745.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63,745.50
|
| Rate for Payer: BCBS MAPPO |
$50,996.40
|
| Rate for Payer: BCN Medicare Advantage |
$50,996.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,996.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$50,996.40
|
| Rate for Payer: Mclaren Medicare |
$50,996.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53,546.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,645.86
|
| Rate for Payer: PACE Medicare |
$48,446.58
|
| Rate for Payer: PACE SWMI |
$50,996.40
|
| Rate for Payer: PHP Commercial |
$56,096.04
|
| Rate for Payer: PHP Medicare Advantage |
$50,996.40
|
| Rate for Payer: Priority Health Medicare |
$50,996.40
|
| Rate for Payer: Railroad Medicare Medicare |
$50,996.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$50,996.40
|
| Rate for Payer: UHC Exchange |
$79,044.42
|
| Rate for Payer: UHC Medicare Advantage |
$50,996.40
|
| Rate for Payer: UHCCP DNSP |
$50,996.40
|
| Rate for Payer: VA VA |
$50,996.40
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH OTHER PROCEDURES
|
Facility
|
IP
|
$130,005.54
|
|
|
Service Code
|
MSDRG 850
|
| Min. Negotiated Rate |
$79,680.81 |
| Max. Negotiated Rate |
$130,005.54 |
| Rate for Payer: Aetna Medicare |
$83,874.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104,843.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104,843.18
|
| Rate for Payer: BCBS MAPPO |
$83,874.54
|
| Rate for Payer: BCN Medicare Advantage |
$83,874.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83,874.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$83,874.54
|
| Rate for Payer: Mclaren Medicare |
$83,874.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88,068.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96,455.72
|
| Rate for Payer: PACE Medicare |
$79,680.81
|
| Rate for Payer: PACE SWMI |
$83,874.54
|
| Rate for Payer: PHP Commercial |
$92,261.99
|
| Rate for Payer: PHP Medicare Advantage |
$83,874.54
|
| Rate for Payer: Priority Health Medicare |
$83,874.54
|
| Rate for Payer: Railroad Medicare Medicare |
$83,874.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$83,874.54
|
| Rate for Payer: UHC Exchange |
$130,005.54
|
| Rate for Payer: UHC Medicare Advantage |
$83,874.54
|
| Rate for Payer: UHCCP DNSP |
$83,874.54
|
| Rate for Payer: VA VA |
$83,874.54
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$20,172.03
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$12,363.50 |
| Max. Negotiated Rate |
$20,172.03 |
| Rate for Payer: Aetna Medicare |
$13,014.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,267.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,267.76
|
| Rate for Payer: BCBS MAPPO |
$13,014.21
|
| Rate for Payer: BCN Medicare Advantage |
$13,014.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,014.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,014.21
|
| Rate for Payer: Mclaren Medicare |
$13,014.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,664.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,966.34
|
| Rate for Payer: PACE Medicare |
$12,363.50
|
| Rate for Payer: PACE SWMI |
$13,014.21
|
| Rate for Payer: PHP Commercial |
$14,315.63
|
| Rate for Payer: PHP Medicare Advantage |
$13,014.21
|
| Rate for Payer: Priority Health Medicare |
$13,014.21
|
| Rate for Payer: Railroad Medicare Medicare |
$13,014.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,014.21
|
| Rate for Payer: UHC Exchange |
$20,172.03
|
| Rate for Payer: UHC Medicare Advantage |
$13,014.21
|
| Rate for Payer: UHCCP DNSP |
$13,014.21
|
| Rate for Payer: VA VA |
$13,014.21
|
|
|
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$18,685.23
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$11,452.24 |
| Max. Negotiated Rate |
$18,685.23 |
| Rate for Payer: Aetna Medicare |
$12,054.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,068.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,068.74
|
| Rate for Payer: BCBS MAPPO |
$12,054.99
|
| Rate for Payer: BCN Medicare Advantage |
$12,054.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,054.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,054.99
|
| Rate for Payer: Mclaren Medicare |
$12,054.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,657.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,863.24
|
| Rate for Payer: PACE Medicare |
$11,452.24
|
| Rate for Payer: PACE SWMI |
$12,054.99
|
| Rate for Payer: PHP Commercial |
$13,260.49
|
| Rate for Payer: PHP Medicare Advantage |
$12,054.99
|
| Rate for Payer: Priority Health Medicare |
$12,054.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12,054.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,054.99
|
| Rate for Payer: UHC Exchange |
$18,685.23
|
| Rate for Payer: UHC Medicare Advantage |
$12,054.99
|
| Rate for Payer: UHCCP DNSP |
$12,054.99
|
| Rate for Payer: VA VA |
$12,054.99
|
|
|
MS-DRG 42.00: ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,978.68
|
|
|
Service Code
|
MSDRG 122
|
| Min. Negotiated Rate |
$7,341.77 |
| Max. Negotiated Rate |
$11,978.68 |
| Rate for Payer: Aetna Medicare |
$7,728.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,660.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,660.23
|
| Rate for Payer: BCBS MAPPO |
$7,728.18
|
| Rate for Payer: BCN Medicare Advantage |
$7,728.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,728.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,728.18
|
| Rate for Payer: Mclaren Medicare |
$7,728.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,114.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,887.41
|
| Rate for Payer: PACE Medicare |
$7,341.77
|
| Rate for Payer: PACE SWMI |
$7,728.18
|
| Rate for Payer: PHP Commercial |
$8,501.00
|
| Rate for Payer: PHP Medicare Advantage |
$7,728.18
|
| Rate for Payer: Priority Health Medicare |
$7,728.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,728.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,728.18
|
| Rate for Payer: UHC Exchange |
$11,978.68
|
| Rate for Payer: UHC Medicare Advantage |
$7,728.18
|
| Rate for Payer: UHCCP DNSP |
$7,728.18
|
| Rate for Payer: VA VA |
$7,728.18
|
|
|
MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$15,346.47
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$9,405.90 |
| Max. Negotiated Rate |
$15,346.47 |
| Rate for Payer: Aetna Medicare |
$9,900.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,376.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,376.19
|
| Rate for Payer: BCBS MAPPO |
$9,900.95
|
| Rate for Payer: BCN Medicare Advantage |
$9,900.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,900.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,900.95
|
| Rate for Payer: Mclaren Medicare |
$9,900.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,396.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,386.09
|
| Rate for Payer: PACE Medicare |
$9,405.90
|
| Rate for Payer: PACE SWMI |
$9,900.95
|
| Rate for Payer: PHP Commercial |
$10,891.05
|
| Rate for Payer: PHP Medicare Advantage |
$9,900.95
|
| Rate for Payer: Priority Health Medicare |
$9,900.95
|
| Rate for Payer: Railroad Medicare Medicare |
$9,900.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,900.95
|
| Rate for Payer: UHC Exchange |
$15,346.47
|
| Rate for Payer: UHC Medicare Advantage |
$9,900.95
|
| Rate for Payer: UHCCP DNSP |
$9,900.95
|
| Rate for Payer: VA VA |
$9,900.95
|
|
|
MS-DRG 42.00: ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$25,299.16
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$15,505.94 |
| Max. Negotiated Rate |
$25,299.16 |
| Rate for Payer: Aetna Medicare |
$16,322.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,402.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,402.55
|
| Rate for Payer: BCBS MAPPO |
$16,322.04
|
| Rate for Payer: BCN Medicare Advantage |
$16,322.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,322.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,322.04
|
| Rate for Payer: Mclaren Medicare |
$16,322.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,138.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,770.35
|
| Rate for Payer: PACE Medicare |
$15,505.94
|
| Rate for Payer: PACE SWMI |
$16,322.04
|
| Rate for Payer: PHP Commercial |
$17,954.24
|
| Rate for Payer: PHP Medicare Advantage |
$16,322.04
|
| Rate for Payer: Priority Health Medicare |
$16,322.04
|
| Rate for Payer: Railroad Medicare Medicare |
$16,322.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,322.04
|
| Rate for Payer: UHC Exchange |
$25,299.16
|
| Rate for Payer: UHC Medicare Advantage |
$16,322.04
|
| Rate for Payer: UHCCP DNSP |
$16,322.04
|
| Rate for Payer: VA VA |
$16,322.04
|
|
