|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$32,301.29
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$17,751.03 |
| Max. Negotiated Rate |
$32,301.29 |
| Rate for Payer: Aetna Medicare |
$18,685.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,356.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,356.62
|
| Rate for Payer: BCBS MAPPO |
$18,685.30
|
| Rate for Payer: BCN Medicare Advantage |
$18,685.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,685.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,685.30
|
| Rate for Payer: Mclaren Medicare |
$18,685.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,619.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,488.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,553.83
|
| Rate for Payer: PACE Medicare |
$17,751.03
|
| Rate for Payer: PACE SWMI |
$18,685.30
|
| Rate for Payer: PHP Commercial |
$20,553.83
|
| Rate for Payer: PHP Medicare Advantage |
$18,685.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32,301.29
|
| Rate for Payer: Priority Health Medicare |
$18,685.30
|
| Rate for Payer: Priority Health Narrow Network |
$25,841.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18,685.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,685.30
|
| Rate for Payer: UHC Exchange |
$28,962.22
|
| Rate for Payer: UHCCP DNSP |
$18,685.30
|
| Rate for Payer: VA VA |
$18,685.30
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$18,588.60
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$10,922.85 |
| Max. Negotiated Rate |
$18,588.60 |
| Rate for Payer: Aetna Medicare |
$11,497.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,372.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,372.17
|
| Rate for Payer: BCBS MAPPO |
$11,497.74
|
| Rate for Payer: BCN Medicare Advantage |
$11,497.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,497.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,497.74
|
| Rate for Payer: Mclaren Medicare |
$11,497.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,072.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,222.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,647.51
|
| Rate for Payer: PACE Medicare |
$10,922.85
|
| Rate for Payer: PACE SWMI |
$11,497.74
|
| Rate for Payer: PHP Commercial |
$12,647.51
|
| Rate for Payer: PHP Medicare Advantage |
$11,497.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,588.60
|
| Rate for Payer: Priority Health Medicare |
$11,497.74
|
| Rate for Payer: Priority Health Narrow Network |
$14,870.88
|
| Rate for Payer: Railroad Medicare Medicare |
$11,497.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,497.74
|
| Rate for Payer: UHC Exchange |
$17,821.50
|
| Rate for Payer: UHCCP DNSP |
$11,497.74
|
| Rate for Payer: VA VA |
$11,497.74
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$21,372.94
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$19,323.69 |
| Max. Negotiated Rate |
$21,372.94 |
| Rate for Payer: BCBS Complete |
$21,372.94
|
| Rate for Payer: Mclaren Medicaid |
$20,355.18
|
| Rate for Payer: Meridian Medicaid |
$21,372.94
|
| Rate for Payer: PHP Medicaid |
$19,323.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,355.18
|
| Rate for Payer: UHC Medicaid |
$20,355.18
|
| Rate for Payer: UHCCP Medicaid |
$20,355.18
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$12,069.01
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$10,911.83 |
| Max. Negotiated Rate |
$12,069.01 |
| Rate for Payer: BCBS Complete |
$12,069.01
|
| Rate for Payer: Mclaren Medicaid |
$11,494.29
|
| Rate for Payer: Meridian Medicaid |
$12,069.01
|
| Rate for Payer: PHP Medicaid |
$10,911.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,494.29
|
| Rate for Payer: UHC Medicaid |
$11,494.29
|
| Rate for Payer: UHCCP Medicaid |
$11,494.29
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$7,182.99
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$6,494.28 |
| Max. Negotiated Rate |
$7,182.99 |
| Rate for Payer: BCBS Complete |
$7,182.99
|
| Rate for Payer: Mclaren Medicaid |
$6,840.94
|
| Rate for Payer: Meridian Medicaid |
$7,182.99
|
| Rate for Payer: PHP Medicaid |
$6,494.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,840.94
|
| Rate for Payer: UHC Medicaid |
$6,840.94
|
| Rate for Payer: UHCCP Medicaid |
$6,840.94
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$8,878.33
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$8,027.07 |
| Max. Negotiated Rate |
$8,878.33 |
| Rate for Payer: BCBS Complete |
$8,878.33
|
| Rate for Payer: Mclaren Medicaid |
$8,455.55
|
| Rate for Payer: Meridian Medicaid |
$8,878.33
|
| Rate for Payer: PHP Medicaid |
$8,027.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,455.55
|
| Rate for Payer: UHC Medicaid |
$8,455.55
|
| Rate for Payer: UHCCP Medicaid |
$8,455.55
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$22,104.36
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$12,673.51 |
| Max. Negotiated Rate |
$22,104.36 |
| Rate for Payer: Aetna Medicare |
$13,340.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,675.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,675.67
|
| Rate for Payer: BCBS MAPPO |
$13,340.54
|
| Rate for Payer: BCN Medicare Advantage |
$13,340.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,340.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,340.54
|
| Rate for Payer: Mclaren Medicare |
$13,340.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,007.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,341.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,674.59
|
| Rate for Payer: PACE Medicare |
$12,673.51
|
| Rate for Payer: PACE SWMI |
$13,340.54
|
| Rate for Payer: PHP Commercial |
$14,674.59
|
| Rate for Payer: PHP Medicare Advantage |
$13,340.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,104.36
|
| Rate for Payer: Priority Health Medicare |
$13,340.54
|
| Rate for Payer: Priority Health Narrow Network |
$17,683.48
|
| Rate for Payer: Railroad Medicare Medicare |
$13,340.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,340.54
|
| Rate for Payer: UHC Exchange |
$20,677.84
|
| Rate for Payer: UHCCP DNSP |
$13,340.54
|
| Rate for Payer: VA VA |
$13,340.54
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$7,403.69
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$6,693.82 |
| Max. Negotiated Rate |
$7,403.69 |
| Rate for Payer: BCBS Complete |
$7,403.69
|
| Rate for Payer: Mclaren Medicaid |
$7,051.13
|
| Rate for Payer: Meridian Medicaid |
$7,403.69
|
| Rate for Payer: PHP Medicaid |
$6,693.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,051.13
|
| Rate for Payer: UHC Medicaid |
$7,051.13
|
| Rate for Payer: UHCCP Medicaid |
$7,051.13
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$6,105.07
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$5,519.72 |
| Max. Negotiated Rate |
$6,105.07 |
| Rate for Payer: BCBS Complete |
$6,105.07
|
| Rate for Payer: Mclaren Medicaid |
$5,814.36
|
| Rate for Payer: Meridian Medicaid |
$6,105.07
|
| Rate for Payer: PHP Medicaid |
$5,519.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,814.36
|
| Rate for Payer: UHC Medicaid |
$5,814.36
|
| Rate for Payer: UHCCP Medicaid |
$5,814.36
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$16,713.07
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$15,110.62 |
| Max. Negotiated Rate |
$16,713.07 |
| Rate for Payer: BCBS Complete |
$16,713.07
|
| Rate for Payer: Mclaren Medicaid |
$15,917.21
|
| Rate for Payer: Meridian Medicaid |
$16,713.07
|
| Rate for Payer: PHP Medicaid |
$15,110.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,917.21
|
| Rate for Payer: UHC Medicaid |
$15,917.21
|
| Rate for Payer: UHCCP Medicaid |
$15,917.21
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$4,300.75
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$3,888.39 |
| Max. Negotiated Rate |
$4,300.75 |
| Rate for Payer: BCBS Complete |
$4,300.75
|
| Rate for Payer: Mclaren Medicaid |
$4,095.95
|
| Rate for Payer: Meridian Medicaid |
$4,300.75
|
| Rate for Payer: PHP Medicaid |
$3,888.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,095.95
|
| Rate for Payer: UHC Medicaid |
$4,095.95
|
| Rate for Payer: UHCCP Medicaid |
$4,095.95
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$61.59
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$61.59 |
| Rate for Payer: Aetna Commercial |
$55.43
|
| Rate for Payer: Aetna Commercial |
$40.96
|
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: Aetna Commercial |
$39.65
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: Aetna Medicare |
$22.79
|
| Rate for Payer: Aetna Medicare |
$22.66
|
| Rate for Payer: Aetna Medicare |
$16.84
|
| Rate for Payer: ASR ASR |
$59.40
|
| Rate for Payer: ASR ASR |
$44.14
|
| Rate for Payer: ASR ASR |
$42.73
|
| Rate for Payer: ASR ASR |
$59.74
|
| Rate for Payer: BCBS Complete |
$24.49
|
| Rate for Payer: BCBS Complete |
$17.62
|
| Rate for Payer: BCBS Complete |
$24.64
|
| Rate for Payer: BCBS Complete |
$18.20
|
| Rate for Payer: BCBS Trust/PPO |
$37.52
|
| Rate for Payer: BCBS Trust/PPO |
$50.78
|
| Rate for Payer: BCBS Trust/PPO |
$50.49
|
| Rate for Payer: BCBS Trust/PPO |
$36.32
|
| Rate for Payer: BCN Commercial |
$50.78
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: BCN Commercial |
$36.32
|
| Rate for Payer: BCN Commercial |
$37.52
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$57.89
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$57.56
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.99
|
| Rate for Payer: Healthscope Commercial |
$59.74
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Healthscope Whirlpool |
$44.05
|
| Rate for Payer: Healthscope Whirlpool |
$61.23
|
| Rate for Payer: Healthscope Whirlpool |
$61.59
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$55.11
|
| Rate for Payer: Mclaren Commercial |
$40.96
|
| Rate for Payer: Mclaren Commercial |
$39.65
|
| Rate for Payer: Mclaren Commercial |
$55.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Nomi Health Commercial |
$36.12
|
| Rate for Payer: Nomi Health Commercial |
$50.21
|
| Rate for Payer: Nomi Health Commercial |
$50.50
|
| Rate for Payer: Nomi Health Commercial |
$37.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.63
|
| Rate for Payer: Priority Health Narrow Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.05
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$61.23
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.92 |
| Max. Negotiated Rate |
$61.23 |
| Rate for Payer: Aetna Commercial |
$55.11
|
| Rate for Payer: Aetna Commercial |
$40.96
|
| Rate for Payer: Aetna Commercial |
$55.43
|
| Rate for Payer: Aetna Commercial |
$39.65
|
| Rate for Payer: ASR ASR |
$59.74
|
| Rate for Payer: ASR ASR |
$59.40
|
| Rate for Payer: ASR ASR |
$44.14
|
| Rate for Payer: ASR ASR |
$42.73
|
| Rate for Payer: BCBS Trust/PPO |
$50.28
|
| Rate for Payer: BCBS Trust/PPO |
$36.17
|
| Rate for Payer: BCBS Trust/PPO |
$37.37
|
| Rate for Payer: BCBS Trust/PPO |
$50.58
|
| Rate for Payer: BCN Commercial |
$36.17
|
| Rate for Payer: BCN Commercial |
$50.58
|
| Rate for Payer: BCN Commercial |
$37.37
|
| Rate for Payer: BCN Commercial |
$50.28
|
| Rate for Payer: Cash Price |
$49.27
|
| Rate for Payer: Cash Price |
$36.40
|
| Rate for Payer: Cash Price |
$48.99
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cofinity Commercial |
$57.56
|
| Rate for Payer: Cofinity Commercial |
$41.41
|
| Rate for Payer: Cofinity Commercial |
$57.89
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Healthscope Commercial |
$59.40
|
| Rate for Payer: Healthscope Commercial |
$42.73
|
| Rate for Payer: Healthscope Commercial |
$44.14
|
| Rate for Payer: Healthscope Commercial |
$59.74
|
| Rate for Payer: Healthscope Whirlpool |
$61.23
|
| Rate for Payer: Healthscope Whirlpool |
$61.59
|
| Rate for Payer: Healthscope Whirlpool |
$44.05
|
| Rate for Payer: Healthscope Whirlpool |
$45.51
|
| Rate for Payer: Mclaren Commercial |
$39.65
|
| Rate for Payer: Mclaren Commercial |
$55.43
|
| Rate for Payer: Mclaren Commercial |
$40.96
|
| Rate for Payer: Mclaren Commercial |
$55.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.44
|
| Rate for Payer: Nomi Health Commercial |
$37.31
|
| Rate for Payer: Nomi Health Commercial |
$50.50
|
| Rate for Payer: Nomi Health Commercial |
$50.21
|
| Rate for Payer: Nomi Health Commercial |
$36.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.20
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$21,986.20
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$12,614.68 |
| Max. Negotiated Rate |
$21,986.20 |
| Rate for Payer: Aetna Medicare |
$13,278.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,598.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,598.26
|
| Rate for Payer: BCBS MAPPO |
$13,278.61
|
| Rate for Payer: BCN Medicare Advantage |
$13,278.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,278.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,278.61
|
| Rate for Payer: Mclaren Medicare |
$13,278.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,942.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,270.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,606.47
|
| Rate for Payer: PACE Medicare |
$12,614.68
|
| Rate for Payer: PACE SWMI |
$13,278.61
|
| Rate for Payer: PHP Commercial |
$14,606.47
|
| Rate for Payer: PHP Medicare Advantage |
$13,278.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21,986.20
|
| Rate for Payer: Priority Health Medicare |
$13,278.61
|
| Rate for Payer: Priority Health Narrow Network |
$17,588.96
|
| Rate for Payer: Railroad Medicare Medicare |
$13,278.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,278.61
|
| Rate for Payer: UHC Exchange |
$20,581.85
|
| Rate for Payer: UHCCP DNSP |
$13,278.61
|
| Rate for Payer: VA VA |
$13,278.61
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$39,669.41
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$21,419.96 |
| Max. Negotiated Rate |
$39,669.41 |
| Rate for Payer: Aetna Medicare |
$22,547.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,184.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,184.16
|
| Rate for Payer: BCBS MAPPO |
$22,547.33
|
| Rate for Payer: BCN Medicare Advantage |
$22,547.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,547.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,547.33
|
| Rate for Payer: Mclaren Medicare |
$22,547.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,674.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,929.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,802.06
|
| Rate for Payer: PACE Medicare |
$21,419.96
|
| Rate for Payer: PACE SWMI |
$22,547.33
|
| Rate for Payer: PHP Commercial |
$24,802.06
|
| Rate for Payer: PHP Medicare Advantage |
$22,547.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39,669.41
|
| Rate for Payer: Priority Health Medicare |
$22,547.33
|
| Rate for Payer: Priority Health Narrow Network |
$31,735.53
|
| Rate for Payer: Railroad Medicare Medicare |
$22,547.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,547.33
|
| Rate for Payer: UHC Exchange |
$34,948.36
|
| Rate for Payer: UHCCP DNSP |
$22,547.33
|
| Rate for Payer: VA VA |
$22,547.33
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$20,723.61
|
|
|
Service Code
|
MSDRG 621
|
| Min. Negotiated Rate |
$11,985.97 |
| Max. Negotiated Rate |
$20,723.61 |
| Rate for Payer: Aetna Medicare |
$12,616.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,771.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,771.01
|
| Rate for Payer: BCBS MAPPO |
$12,616.81
|
| Rate for Payer: BCN Medicare Advantage |
$12,616.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,616.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,616.81
|
| Rate for Payer: Mclaren Medicare |
$12,616.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,247.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,509.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,878.49
|
| Rate for Payer: PACE Medicare |
$11,985.97
|
| Rate for Payer: PACE SWMI |
$12,616.81
|
| Rate for Payer: PHP Commercial |
$13,878.49
|
| Rate for Payer: PHP Medicare Advantage |
$12,616.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,723.61
|
| Rate for Payer: Priority Health Medicare |
$12,616.81
|
| Rate for Payer: Priority Health Narrow Network |
$16,578.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,616.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,616.81
|
| Rate for Payer: UHC Exchange |
$19,556.06
|
| Rate for Payer: UHCCP DNSP |
$12,616.81
|
| Rate for Payer: VA VA |
$12,616.81
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$32,106.20
|
|
|
Service Code
|
MSDRG 940
|
| Min. Negotiated Rate |
$17,653.90 |
| Max. Negotiated Rate |
$32,106.20 |
| Rate for Payer: Aetna Medicare |
$18,583.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,228.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,228.81
|
| Rate for Payer: BCBS MAPPO |
$18,583.05
|
| Rate for Payer: BCN Medicare Advantage |
$18,583.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,583.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,583.05
|
| Rate for Payer: Mclaren Medicare |
$18,583.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,512.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,370.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,441.35
|
| Rate for Payer: PACE Medicare |
$17,653.90
|
| Rate for Payer: PACE SWMI |
$18,583.05
|
| Rate for Payer: PHP Commercial |
$20,441.35
|
| Rate for Payer: PHP Medicare Advantage |
$18,583.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$32,106.20
|
| Rate for Payer: Priority Health Medicare |
$18,583.05
|
| Rate for Payer: Priority Health Narrow Network |
$25,684.96
|
| Rate for Payer: Railroad Medicare Medicare |
$18,583.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,583.05
|
| Rate for Payer: UHC Exchange |
$28,803.73
|
| Rate for Payer: UHCCP DNSP |
$18,583.05
|
| Rate for Payer: VA VA |
$18,583.05
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC
|
Facility
|
IP
|
$49,851.24
|
|
|
Service Code
|
MSDRG 939
|
| Min. Negotiated Rate |
$26,489.96 |
| Max. Negotiated Rate |
$49,851.24 |
| Rate for Payer: Aetna Medicare |
$27,884.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,855.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,855.21
|
| Rate for Payer: BCBS MAPPO |
$27,884.17
|
| Rate for Payer: BCN Medicare Advantage |
$27,884.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,884.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,884.17
|
| Rate for Payer: Mclaren Medicare |
$27,884.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,278.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,066.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,672.59
|
| Rate for Payer: PACE Medicare |
$26,489.96
|
| Rate for Payer: PACE SWMI |
$27,884.17
|
| Rate for Payer: PHP Commercial |
$30,672.59
|
| Rate for Payer: PHP Medicare Advantage |
$27,884.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49,851.24
|
| Rate for Payer: Priority Health Medicare |
$27,884.17
|
| Rate for Payer: Priority Health Narrow Network |
$39,880.99
|
| Rate for Payer: Railroad Medicare Medicare |
$27,884.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,884.17
|
| Rate for Payer: UHC Exchange |
$43,220.46
|
| Rate for Payer: UHCCP DNSP |
$27,884.17
|
| Rate for Payer: VA VA |
$27,884.17
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,858.16
|
|
|
Service Code
|
MSDRG 941
|
| Min. Negotiated Rate |
$15,538.60 |
| Max. Negotiated Rate |
$27,858.16 |
| Rate for Payer: Aetna Medicare |
$16,356.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,445.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,445.53
|
| Rate for Payer: BCBS MAPPO |
$16,356.42
|
| Rate for Payer: BCN Medicare Advantage |
$16,356.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,356.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,356.42
|
| Rate for Payer: Mclaren Medicare |
$16,356.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,174.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,809.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,992.06
|
| Rate for Payer: PACE Medicare |
$15,538.60
|
| Rate for Payer: PACE SWMI |
$16,356.42
|
| Rate for Payer: PHP Commercial |
$17,992.06
|
| Rate for Payer: PHP Medicare Advantage |
$16,356.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,858.16
|
| Rate for Payer: Priority Health Medicare |
$16,356.42
|
| Rate for Payer: Priority Health Narrow Network |
$22,286.53
|
| Rate for Payer: Railroad Medicare Medicare |
$16,356.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,356.42
|
| Rate for Payer: UHC Exchange |
$25,352.45
|
| Rate for Payer: UHCCP DNSP |
$16,356.42
|
| Rate for Payer: VA VA |
$16,356.42
|
|
|
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS
|
Facility
|
IP
|
$53,099.09
|
|
|
Service Code
|
MSDRG 876
|
| Min. Negotiated Rate |
$28,107.22 |
| Max. Negotiated Rate |
$53,099.09 |
| Rate for Payer: Aetna Medicare |
$29,586.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,983.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,983.19
|
| Rate for Payer: BCBS MAPPO |
$29,586.55
|
| Rate for Payer: BCN Medicare Advantage |
$29,586.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,586.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$29,586.55
|
| Rate for Payer: Mclaren Medicare |
$29,586.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,065.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,024.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,545.21
|
| Rate for Payer: PACE Medicare |
$28,107.22
|
| Rate for Payer: PACE SWMI |
$29,586.55
|
| Rate for Payer: PHP Commercial |
$32,545.21
|
| Rate for Payer: PHP Medicare Advantage |
$29,586.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53,099.09
|
| Rate for Payer: Priority Health Medicare |
$29,586.55
|
| Rate for Payer: Priority Health Narrow Network |
$42,479.27
|
| Rate for Payer: Railroad Medicare Medicare |
$29,586.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,586.55
|
| Rate for Payer: UHC Exchange |
$45,859.15
|
| Rate for Payer: UHCCP DNSP |
$29,586.55
|
| Rate for Payer: VA VA |
$29,586.55
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$479.48
|
|
|
Service Code
|
NDC 4080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$359.61 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Aetna Commercial |
$431.53
|
| Rate for Payer: ASR ASR |
$465.10
|
| Rate for Payer: BCBS Trust/PPO |
$393.75
|
| Rate for Payer: BCN Commercial |
$393.75
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$450.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$465.10
|
| Rate for Payer: Healthscope Whirlpool |
$479.48
|
| Rate for Payer: Mclaren Commercial |
$431.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.56
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.95
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.54 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.84
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: BCBS Trust/PPO |
$264.47
|
| Rate for Payer: BCN Commercial |
$264.47
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$302.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$289.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
NDC 68180067511
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$63.70 |
| Rate for Payer: Aetna Commercial |
$57.33
|
| Rate for Payer: ASR ASR |
$61.79
|
| Rate for Payer: BCBS Trust/PPO |
$52.31
|
| Rate for Payer: BCN Commercial |
$52.31
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$59.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.96
|
| Rate for Payer: Healthscope Commercial |
$61.79
|
| Rate for Payer: Healthscope Whirlpool |
$63.70
|
| Rate for Payer: Mclaren Commercial |
$57.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.14
|
| Rate for Payer: Nomi Health Commercial |
$52.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.05
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$479.48
|
|
|
Service Code
|
NDC 4080285
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.41 |
| Max. Negotiated Rate |
$479.48 |
| Rate for Payer: Aetna Commercial |
$431.53
|
| Rate for Payer: Aetna Medicare |
$177.41
|
| Rate for Payer: ASR ASR |
$465.10
|
| Rate for Payer: BCBS Complete |
$191.79
|
| Rate for Payer: BCBS Trust/PPO |
$395.33
|
| Rate for Payer: BCN Commercial |
$395.33
|
| Rate for Payer: Cash Price |
$383.59
|
| Rate for Payer: Cofinity Commercial |
$450.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$383.59
|
| Rate for Payer: Healthscope Commercial |
$465.10
|
| Rate for Payer: Healthscope Whirlpool |
$479.48
|
| Rate for Payer: Mclaren Commercial |
$431.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$383.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$407.56
|
| Rate for Payer: Nomi Health Commercial |
$393.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$359.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$420.12
|
| Rate for Payer: Priority Health Narrow Network |
$336.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$421.95
|
|
|
OSELTAMIVIR 30 MG CAPSULE
|
Facility
|
OP
|
$322.05
|
|
|
Service Code
|
NDC 47781046813
|
| Hospital Charge Code |
88704
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.16 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$289.84
|
| Rate for Payer: Aetna Medicare |
$119.16
|
| Rate for Payer: ASR ASR |
$312.39
|
| Rate for Payer: BCBS Complete |
$128.82
|
| Rate for Payer: BCBS Trust/PPO |
$265.53
|
| Rate for Payer: BCN Commercial |
$265.53
|
| Rate for Payer: Cash Price |
$257.64
|
| Rate for Payer: Cofinity Commercial |
$302.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.64
|
| Rate for Payer: Healthscope Commercial |
$312.39
|
| Rate for Payer: Healthscope Whirlpool |
$322.05
|
| Rate for Payer: Mclaren Commercial |
$289.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$257.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.74
|
| Rate for Payer: Nomi Health Commercial |
$264.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.18
|
| Rate for Payer: Priority Health Narrow Network |
$225.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$283.40
|
|
