|
MS-DRG 42.00: VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,808.43
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$9,689.04 |
| Max. Negotiated Rate |
$15,808.43 |
| Rate for Payer: Aetna Medicare |
$10,198.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,748.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,748.74
|
| Rate for Payer: BCBS MAPPO |
$10,198.99
|
| Rate for Payer: BCN Medicare Advantage |
$10,198.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,198.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,198.99
|
| Rate for Payer: Mclaren Medicare |
$10,198.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,708.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,728.84
|
| Rate for Payer: PACE Medicare |
$9,689.04
|
| Rate for Payer: PACE SWMI |
$10,198.99
|
| Rate for Payer: PHP Commercial |
$11,218.89
|
| Rate for Payer: PHP Medicare Advantage |
$10,198.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,121.93
|
| Rate for Payer: Priority Health Medicare |
$10,198.99
|
| Rate for Payer: Priority Health Narrow Network |
$10,497.54
|
| Rate for Payer: Railroad Medicare Medicare |
$10,198.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,198.99
|
| Rate for Payer: UHC Exchange |
$15,808.43
|
| Rate for Payer: UHC Medicare Advantage |
$10,198.99
|
| Rate for Payer: UHCCP DNSP |
$10,198.99
|
| Rate for Payer: VA VA |
$10,198.99
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$17,759.96
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$10,885.14 |
| Max. Negotiated Rate |
$17,759.96 |
| Rate for Payer: Aetna Medicare |
$11,458.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,322.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,322.55
|
| Rate for Payer: BCBS MAPPO |
$11,458.04
|
| Rate for Payer: BCN Medicare Advantage |
$11,458.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,458.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,458.04
|
| Rate for Payer: Mclaren Medicare |
$11,458.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,030.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,176.75
|
| Rate for Payer: PACE Medicare |
$10,885.14
|
| Rate for Payer: PACE SWMI |
$11,458.04
|
| Rate for Payer: PHP Commercial |
$12,603.84
|
| Rate for Payer: PHP Medicare Advantage |
$11,458.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,711.51
|
| Rate for Payer: Priority Health Medicare |
$11,458.04
|
| Rate for Payer: Priority Health Narrow Network |
$11,769.21
|
| Rate for Payer: Railroad Medicare Medicare |
$11,458.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,458.04
|
| Rate for Payer: UHC Exchange |
$17,759.96
|
| Rate for Payer: UHC Medicare Advantage |
$11,458.04
|
| Rate for Payer: UHCCP DNSP |
$11,458.04
|
| Rate for Payer: VA VA |
$11,458.04
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$12,605.20
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$4,836.06 |
| Max. Negotiated Rate |
$12,605.20 |
| Rate for Payer: Aetna Medicare |
$8,132.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,165.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,165.49
|
| Rate for Payer: BCBS MAPPO |
$8,132.39
|
| Rate for Payer: BCN Medicare Advantage |
$8,132.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,132.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,132.39
|
| Rate for Payer: Mclaren Medicare |
$8,132.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,539.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,352.25
|
| Rate for Payer: PACE Medicare |
$7,725.77
|
| Rate for Payer: PACE SWMI |
$8,132.39
|
| Rate for Payer: PHP Commercial |
$8,945.63
|
| Rate for Payer: PHP Medicare Advantage |
$8,132.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,045.07
|
| Rate for Payer: Priority Health Medicare |
$8,132.39
|
| Rate for Payer: Priority Health Narrow Network |
$4,836.06
|
| Rate for Payer: Railroad Medicare Medicare |
$8,132.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,132.39
|
| Rate for Payer: UHC Exchange |
$12,605.20
|
| Rate for Payer: UHC Medicare Advantage |
$8,132.39
|
| Rate for Payer: UHCCP DNSP |
$8,132.39
|
| Rate for Payer: VA VA |
$8,132.39
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$16,400.38
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$6,994.70 |
| Max. Negotiated Rate |
$16,400.38 |
| Rate for Payer: Aetna Medicare |
$10,580.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,226.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,226.11
|
| Rate for Payer: BCBS MAPPO |
$10,580.89
|
| Rate for Payer: BCN Medicare Advantage |
$10,580.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,580.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,580.89
|
| Rate for Payer: Mclaren Medicare |
$10,580.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,109.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,168.02
|
| Rate for Payer: PACE Medicare |
$10,051.85
|
| Rate for Payer: PACE SWMI |
$10,580.89
|
| Rate for Payer: PHP Commercial |
$11,638.98
|
| Rate for Payer: PHP Medicare Advantage |
$10,580.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,743.37
|
| Rate for Payer: Priority Health Medicare |
$10,580.89
|
| Rate for Payer: Priority Health Narrow Network |
$6,994.70
|
| Rate for Payer: Railroad Medicare Medicare |
$10,580.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,580.89
|
| Rate for Payer: UHC Exchange |
$16,400.38
|
| Rate for Payer: UHC Medicare Advantage |
$10,580.89
|
| Rate for Payer: UHCCP DNSP |
$10,580.89
|
| Rate for Payer: VA VA |
$10,580.89
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$11,411.61
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$4,197.48 |
| Max. Negotiated Rate |
$11,411.61 |
| Rate for Payer: Aetna Medicare |
$7,362.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,202.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,202.91
|
| Rate for Payer: BCBS MAPPO |
$7,362.33
|
| Rate for Payer: BCN Medicare Advantage |
$7,362.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,362.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,362.33
|
| Rate for Payer: Mclaren Medicare |
$7,362.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,730.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,466.68
|
| Rate for Payer: PACE Medicare |
$6,994.21
|
| Rate for Payer: PACE SWMI |
$7,362.33
|
| Rate for Payer: PHP Commercial |
$8,098.56
|
| Rate for Payer: PHP Medicare Advantage |
$7,362.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,246.85
|
| Rate for Payer: Priority Health Medicare |
$7,362.33
|
| Rate for Payer: Priority Health Narrow Network |
$4,197.48
|
| Rate for Payer: Railroad Medicare Medicare |
$7,362.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,362.33
|
| Rate for Payer: UHC Exchange |
$11,411.61
|
| Rate for Payer: UHC Medicare Advantage |
$7,362.33
|
| Rate for Payer: UHCCP DNSP |
$7,362.33
|
| Rate for Payer: VA VA |
$7,362.33
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$15,988.23
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$5,788.98 |
| Max. Negotiated Rate |
$15,988.23 |
| Rate for Payer: Aetna Medicare |
$10,314.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,893.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,893.74
|
| Rate for Payer: BCBS MAPPO |
$10,314.99
|
| Rate for Payer: BCN Medicare Advantage |
$10,314.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,314.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,314.99
|
| Rate for Payer: Mclaren Medicare |
$10,314.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,830.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,862.24
|
| Rate for Payer: PACE Medicare |
$9,799.24
|
| Rate for Payer: PACE SWMI |
$10,314.99
|
| Rate for Payer: PHP Commercial |
$11,346.49
|
| Rate for Payer: PHP Medicare Advantage |
$10,314.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,236.23
|
| Rate for Payer: Priority Health Medicare |
$10,314.99
|
| Rate for Payer: Priority Health Narrow Network |
$5,788.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10,314.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,314.99
|
| Rate for Payer: UHC Exchange |
$15,988.23
|
| Rate for Payer: UHC Medicare Advantage |
$10,314.99
|
| Rate for Payer: UHCCP DNSP |
$10,314.99
|
| Rate for Payer: VA VA |
$10,314.99
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$20,253.63
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$10,035.92 |
| Max. Negotiated Rate |
$20,253.63 |
| Rate for Payer: Aetna Medicare |
$13,066.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,333.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,333.58
|
| Rate for Payer: BCBS MAPPO |
$13,066.86
|
| Rate for Payer: BCN Medicare Advantage |
$13,066.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,066.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,066.86
|
| Rate for Payer: Mclaren Medicare |
$13,066.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,720.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,026.89
|
| Rate for Payer: PACE Medicare |
$12,413.52
|
| Rate for Payer: PACE SWMI |
$13,066.86
|
| Rate for Payer: PHP Commercial |
$14,373.55
|
| Rate for Payer: PHP Medicare Advantage |
$13,066.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,544.90
|
| Rate for Payer: Priority Health Medicare |
$13,066.86
|
| Rate for Payer: Priority Health Narrow Network |
$10,035.92
|
| Rate for Payer: Railroad Medicare Medicare |
$13,066.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,066.86
|
| Rate for Payer: UHC Exchange |
$20,253.63
|
| Rate for Payer: UHC Medicare Advantage |
$13,066.86
|
| Rate for Payer: UHCCP DNSP |
$13,066.86
|
| Rate for Payer: VA VA |
$13,066.86
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$15,988.23
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,788.98 |
| Max. Negotiated Rate |
$15,988.23 |
| Rate for Payer: Aetna Medicare |
$10,314.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,893.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,893.74
|
| Rate for Payer: BCBS MAPPO |
$10,314.99
|
| Rate for Payer: BCN Medicare Advantage |
$10,314.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,314.99
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,314.99
|
| Rate for Payer: Mclaren Medicare |
$10,314.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,830.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,862.24
|
| Rate for Payer: PACE Medicare |
$9,799.24
|
| Rate for Payer: PACE SWMI |
$10,314.99
|
| Rate for Payer: PHP Commercial |
$11,346.49
|
| Rate for Payer: PHP Medicare Advantage |
$10,314.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,236.23
|
| Rate for Payer: Priority Health Medicare |
$10,314.99
|
| Rate for Payer: Priority Health Narrow Network |
$5,788.98
|
| Rate for Payer: Railroad Medicare Medicare |
$10,314.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,314.99
|
| Rate for Payer: UHC Exchange |
$15,988.23
|
| Rate for Payer: UHC Medicare Advantage |
$10,314.99
|
| Rate for Payer: UHCCP DNSP |
$10,314.99
|
| Rate for Payer: VA VA |
$10,314.99
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$39,692.91
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$24,327.91 |
| Max. Negotiated Rate |
$39,692.91 |
| Rate for Payer: Aetna Medicare |
$25,608.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,010.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,010.41
|
| Rate for Payer: BCBS MAPPO |
$25,608.33
|
| Rate for Payer: BCN Medicare Advantage |
$25,608.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,608.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,608.33
|
| Rate for Payer: Mclaren Medicare |
$25,608.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,888.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,449.58
|
| Rate for Payer: PACE Medicare |
$24,327.91
|
| Rate for Payer: PACE SWMI |
$25,608.33
|
| Rate for Payer: PHP Commercial |
$28,169.16
|
| Rate for Payer: PHP Medicare Advantage |
$25,608.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,846.09
|
| Rate for Payer: Priority Health Medicare |
$25,608.33
|
| Rate for Payer: Priority Health Narrow Network |
$29,476.87
|
| Rate for Payer: Railroad Medicare Medicare |
$25,608.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,608.33
|
| Rate for Payer: UHC Exchange |
$39,692.91
|
| Rate for Payer: UHC Medicare Advantage |
$25,608.33
|
| Rate for Payer: UHCCP DNSP |
$25,608.33
|
| Rate for Payer: VA VA |
$25,608.33
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$32,134.35
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$19,695.25 |
| Max. Negotiated Rate |
$32,134.35 |
| Rate for Payer: Aetna Medicare |
$20,731.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,914.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,914.80
|
| Rate for Payer: BCBS MAPPO |
$20,731.84
|
| Rate for Payer: BCN Medicare Advantage |
$20,731.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,731.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,731.84
|
| Rate for Payer: Mclaren Medicare |
$20,731.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,768.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,841.62
|
| Rate for Payer: PACE Medicare |
$19,695.25
|
| Rate for Payer: PACE SWMI |
$20,731.84
|
| Rate for Payer: PHP Commercial |
$22,805.02
|
| Rate for Payer: PHP Medicare Advantage |
$20,731.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,339.21
|
| Rate for Payer: Priority Health Medicare |
$20,731.84
|
| Rate for Payer: Priority Health Narrow Network |
$23,471.37
|
| Rate for Payer: Railroad Medicare Medicare |
$20,731.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,731.84
|
| Rate for Payer: UHC Exchange |
$32,134.35
|
| Rate for Payer: UHC Medicare Advantage |
$20,731.84
|
| Rate for Payer: UHCCP DNSP |
$20,731.84
|
| Rate for Payer: VA VA |
$20,731.84
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,556.72
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$37,115.41 |
| Max. Negotiated Rate |
$60,556.72 |
| Rate for Payer: Aetna Medicare |
$39,068.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,836.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,836.06
|
| Rate for Payer: BCBS MAPPO |
$39,068.85
|
| Rate for Payer: BCN Medicare Advantage |
$39,068.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,068.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,068.85
|
| Rate for Payer: Mclaren Medicare |
$39,068.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,022.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,929.18
|
| Rate for Payer: PACE Medicare |
$37,115.41
|
| Rate for Payer: PACE SWMI |
$39,068.85
|
| Rate for Payer: PHP Commercial |
$42,975.74
|
| Rate for Payer: PHP Medicare Advantage |
$39,068.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,569.69
|
| Rate for Payer: Priority Health Medicare |
$39,068.85
|
| Rate for Payer: Priority Health Narrow Network |
$46,055.75
|
| Rate for Payer: Railroad Medicare Medicare |
$39,068.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$39,068.85
|
| Rate for Payer: UHC Exchange |
$60,556.72
|
| Rate for Payer: UHC Medicare Advantage |
$39,068.85
|
| Rate for Payer: UHCCP DNSP |
$39,068.85
|
| Rate for Payer: VA VA |
$39,068.85
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,664.30
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$15,116.83 |
| Max. Negotiated Rate |
$24,664.30 |
| Rate for Payer: Aetna Medicare |
$15,912.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,890.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,890.56
|
| Rate for Payer: BCBS MAPPO |
$15,912.45
|
| Rate for Payer: BCN Medicare Advantage |
$15,912.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,912.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,912.45
|
| Rate for Payer: Mclaren Medicare |
$15,912.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,708.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,299.32
|
| Rate for Payer: PACE Medicare |
$15,116.83
|
| Rate for Payer: PACE SWMI |
$15,912.45
|
| Rate for Payer: PHP Commercial |
$17,503.70
|
| Rate for Payer: PHP Medicare Advantage |
$15,912.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,918.88
|
| Rate for Payer: Priority Health Medicare |
$15,912.45
|
| Rate for Payer: Priority Health Narrow Network |
$17,535.11
|
| Rate for Payer: Railroad Medicare Medicare |
$15,912.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,912.45
|
| Rate for Payer: UHC Exchange |
$24,664.30
|
| Rate for Payer: UHC Medicare Advantage |
$15,912.45
|
| Rate for Payer: UHCCP DNSP |
$15,912.45
|
| Rate for Payer: VA VA |
$15,912.45
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$23,010.14
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$14,102.99 |
| Max. Negotiated Rate |
$23,010.14 |
| Rate for Payer: Aetna Medicare |
$14,845.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,556.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,556.56
|
| Rate for Payer: BCBS MAPPO |
$14,845.25
|
| Rate for Payer: BCN Medicare Advantage |
$14,845.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,845.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,845.25
|
| Rate for Payer: Mclaren Medicare |
$14,845.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,587.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,072.04
|
| Rate for Payer: PACE Medicare |
$14,102.99
|
| Rate for Payer: PACE SWMI |
$14,845.25
|
| Rate for Payer: PHP Commercial |
$16,329.78
|
| Rate for Payer: PHP Medicare Advantage |
$14,845.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,277.09
|
| Rate for Payer: Priority Health Medicare |
$14,845.25
|
| Rate for Payer: Priority Health Narrow Network |
$16,221.68
|
| Rate for Payer: Railroad Medicare Medicare |
$14,845.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,845.25
|
| Rate for Payer: UHC Exchange |
$23,010.14
|
| Rate for Payer: UHC Medicare Advantage |
$14,845.25
|
| Rate for Payer: UHCCP DNSP |
$14,845.25
|
| Rate for Payer: VA VA |
$14,845.25
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$14,834.74
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$9,092.26 |
| Max. Negotiated Rate |
$14,834.74 |
| Rate for Payer: Aetna Medicare |
$9,570.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,963.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,963.50
|
| Rate for Payer: BCBS MAPPO |
$9,570.80
|
| Rate for Payer: BCN Medicare Advantage |
$9,570.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,570.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,570.80
|
| Rate for Payer: Mclaren Medicare |
$9,570.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,049.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,006.42
|
| Rate for Payer: PACE Medicare |
$9,092.26
|
| Rate for Payer: PACE SWMI |
$9,570.80
|
| Rate for Payer: PHP Commercial |
$10,527.88
|
| Rate for Payer: PHP Medicare Advantage |
$9,570.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,154.72
|
| Rate for Payer: Priority Health Medicare |
$9,570.80
|
| Rate for Payer: Priority Health Narrow Network |
$9,723.77
|
| Rate for Payer: Railroad Medicare Medicare |
$9,570.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,570.80
|
| Rate for Payer: UHC Exchange |
$14,834.74
|
| Rate for Payer: UHC Medicare Advantage |
$9,570.80
|
| Rate for Payer: UHCCP DNSP |
$9,570.80
|
| Rate for Payer: VA VA |
$9,570.80
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$26,419.44
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$16,192.56 |
| Max. Negotiated Rate |
$26,419.44 |
| Rate for Payer: Aetna Medicare |
$17,044.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,306.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,306.00
|
| Rate for Payer: BCBS MAPPO |
$17,044.80
|
| Rate for Payer: BCN Medicare Advantage |
$17,044.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,044.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,044.80
|
| Rate for Payer: Mclaren Medicare |
$17,044.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,897.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,601.52
|
| Rate for Payer: PACE Medicare |
$16,192.56
|
| Rate for Payer: PACE SWMI |
$17,044.80
|
| Rate for Payer: PHP Commercial |
$18,749.28
|
| Rate for Payer: PHP Medicare Advantage |
$17,044.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,663.71
|
| Rate for Payer: Priority Health Medicare |
$17,044.80
|
| Rate for Payer: Priority Health Narrow Network |
$18,930.97
|
| Rate for Payer: Railroad Medicare Medicare |
$17,044.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,044.80
|
| Rate for Payer: UHC Exchange |
$26,419.44
|
| Rate for Payer: UHC Medicare Advantage |
$17,044.80
|
| Rate for Payer: UHCCP DNSP |
$17,044.80
|
| Rate for Payer: VA VA |
$17,044.80
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,278.72
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$9,364.38 |
| Max. Negotiated Rate |
$15,278.72 |
| Rate for Payer: Aetna Medicare |
$9,857.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,321.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,321.55
|
| Rate for Payer: BCBS MAPPO |
$9,857.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,857.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,857.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,857.24
|
| Rate for Payer: Mclaren Medicare |
$9,857.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,350.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,335.83
|
| Rate for Payer: PACE Medicare |
$9,364.38
|
| Rate for Payer: PACE SWMI |
$9,857.24
|
| Rate for Payer: PHP Commercial |
$10,842.96
|
| Rate for Payer: PHP Medicare Advantage |
$9,857.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,597.11
|
| Rate for Payer: Priority Health Medicare |
$9,857.24
|
| Rate for Payer: Priority Health Narrow Network |
$10,077.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9,857.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,857.24
|
| Rate for Payer: UHC Exchange |
$15,278.72
|
| Rate for Payer: UHC Medicare Advantage |
$9,857.24
|
| Rate for Payer: UHCCP DNSP |
$9,857.24
|
| Rate for Payer: VA VA |
$9,857.24
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$43,378.83
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$26,587.02 |
| Max. Negotiated Rate |
$43,378.83 |
| Rate for Payer: Aetna Medicare |
$27,986.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,982.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,982.92
|
| Rate for Payer: BCBS MAPPO |
$27,986.34
|
| Rate for Payer: BCN Medicare Advantage |
$27,986.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,986.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,986.34
|
| Rate for Payer: Mclaren Medicare |
$27,986.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,385.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,184.29
|
| Rate for Payer: PACE Medicare |
$26,587.02
|
| Rate for Payer: PACE SWMI |
$27,986.34
|
| Rate for Payer: PHP Commercial |
$30,784.97
|
| Rate for Payer: PHP Medicare Advantage |
$27,986.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,510.23
|
| Rate for Payer: Priority Health Medicare |
$27,986.34
|
| Rate for Payer: Priority Health Narrow Network |
$32,408.18
|
| Rate for Payer: Railroad Medicare Medicare |
$27,986.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,986.34
|
| Rate for Payer: UHC Exchange |
$43,378.83
|
| Rate for Payer: UHC Medicare Advantage |
$27,986.34
|
| Rate for Payer: UHCCP DNSP |
$27,986.34
|
| Rate for Payer: VA VA |
$27,986.34
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$77,297.57
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$47,375.93 |
| Max. Negotiated Rate |
$77,297.57 |
| Rate for Payer: Aetna Medicare |
$49,869.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,336.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,336.75
|
| Rate for Payer: BCBS MAPPO |
$49,869.40
|
| Rate for Payer: BCN Medicare Advantage |
$49,869.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,869.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,869.40
|
| Rate for Payer: Mclaren Medicare |
$49,869.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,362.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,349.81
|
| Rate for Payer: PACE Medicare |
$47,375.93
|
| Rate for Payer: PACE SWMI |
$49,869.40
|
| Rate for Payer: PHP Commercial |
$54,856.34
|
| Rate for Payer: PHP Medicare Advantage |
$49,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74,199.14
|
| Rate for Payer: Priority Health Medicare |
$49,869.40
|
| Rate for Payer: Priority Health Narrow Network |
$59,359.31
|
| Rate for Payer: Railroad Medicare Medicare |
$49,869.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$49,869.40
|
| Rate for Payer: UHC Exchange |
$77,297.57
|
| Rate for Payer: UHC Medicare Advantage |
$49,869.40
|
| Rate for Payer: UHCCP DNSP |
$49,869.40
|
| Rate for Payer: VA VA |
$49,869.40
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$26,608.93
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$16,308.70 |
| Max. Negotiated Rate |
$26,608.93 |
| Rate for Payer: Aetna Medicare |
$17,167.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,458.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,458.81
|
| Rate for Payer: BCBS MAPPO |
$17,167.05
|
| Rate for Payer: BCN Medicare Advantage |
$17,167.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,167.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,167.05
|
| Rate for Payer: Mclaren Medicare |
$17,167.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,025.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,742.11
|
| Rate for Payer: PACE Medicare |
$16,308.70
|
| Rate for Payer: PACE SWMI |
$17,167.05
|
| Rate for Payer: PHP Commercial |
$18,883.76
|
| Rate for Payer: PHP Medicare Advantage |
$17,167.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,849.18
|
| Rate for Payer: Priority Health Medicare |
$17,167.05
|
| Rate for Payer: Priority Health Narrow Network |
$19,079.35
|
| Rate for Payer: Railroad Medicare Medicare |
$17,167.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,167.05
|
| Rate for Payer: UHC Exchange |
$26,608.93
|
| Rate for Payer: UHC Medicare Advantage |
$17,167.05
|
| Rate for Payer: UHCCP DNSP |
$17,167.05
|
| Rate for Payer: VA VA |
$17,167.05
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$28,842.62
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$17,677.73 |
| Max. Negotiated Rate |
$28,842.62 |
| Rate for Payer: Aetna Medicare |
$18,608.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,260.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,260.18
|
| Rate for Payer: BCBS MAPPO |
$18,608.14
|
| Rate for Payer: BCN Medicare Advantage |
$18,608.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,608.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,608.14
|
| Rate for Payer: Mclaren Medicare |
$18,608.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,538.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,399.36
|
| Rate for Payer: PACE Medicare |
$17,677.73
|
| Rate for Payer: PACE SWMI |
$18,608.14
|
| Rate for Payer: PHP Commercial |
$20,468.95
|
| Rate for Payer: PHP Medicare Advantage |
$18,608.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,068.00
|
| Rate for Payer: Priority Health Medicare |
$18,608.14
|
| Rate for Payer: Priority Health Narrow Network |
$20,854.40
|
| Rate for Payer: Railroad Medicare Medicare |
$18,608.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,608.14
|
| Rate for Payer: UHC Exchange |
$28,842.62
|
| Rate for Payer: UHC Medicare Advantage |
$18,608.14
|
| Rate for Payer: UHCCP DNSP |
$18,608.14
|
| Rate for Payer: VA VA |
$18,608.14
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$63,874.72
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$39,149.02 |
| Max. Negotiated Rate |
$63,874.72 |
| Rate for Payer: Aetna Medicare |
$41,209.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,511.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,511.88
|
| Rate for Payer: BCBS MAPPO |
$41,209.50
|
| Rate for Payer: BCN Medicare Advantage |
$41,209.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,209.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,209.50
|
| Rate for Payer: Mclaren Medicare |
$41,209.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,269.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,390.92
|
| Rate for Payer: PACE Medicare |
$39,149.02
|
| Rate for Payer: PACE SWMI |
$41,209.50
|
| Rate for Payer: PHP Commercial |
$45,330.45
|
| Rate for Payer: PHP Medicare Advantage |
$41,209.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60,865.63
|
| Rate for Payer: Priority Health Medicare |
$41,209.50
|
| Rate for Payer: Priority Health Narrow Network |
$48,692.51
|
| Rate for Payer: Railroad Medicare Medicare |
$41,209.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$41,209.50
|
| Rate for Payer: UHC Exchange |
$63,874.72
|
| Rate for Payer: UHC Medicare Advantage |
$41,209.50
|
| Rate for Payer: UHCCP DNSP |
$41,209.50
|
| Rate for Payer: VA VA |
$41,209.50
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,458.39
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$11,926.11 |
| Max. Negotiated Rate |
$19,458.39 |
| Rate for Payer: Aetna Medicare |
$12,553.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,692.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,692.25
|
| Rate for Payer: BCBS MAPPO |
$12,553.80
|
| Rate for Payer: BCN Medicare Advantage |
$12,553.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,553.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,553.80
|
| Rate for Payer: Mclaren Medicare |
$12,553.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,181.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,436.87
|
| Rate for Payer: PACE Medicare |
$11,926.11
|
| Rate for Payer: PACE SWMI |
$12,553.80
|
| Rate for Payer: PHP Commercial |
$13,809.18
|
| Rate for Payer: PHP Medicare Advantage |
$12,553.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,747.60
|
| Rate for Payer: Priority Health Medicare |
$12,553.80
|
| Rate for Payer: Priority Health Narrow Network |
$13,398.08
|
| Rate for Payer: Railroad Medicare Medicare |
$12,553.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,553.80
|
| Rate for Payer: UHC Exchange |
$19,458.39
|
| Rate for Payer: UHC Medicare Advantage |
$12,553.80
|
| Rate for Payer: UHCCP DNSP |
$12,553.80
|
| Rate for Payer: VA VA |
$12,553.80
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: ASR Commercial |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.68
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.00
|
| Rate for Payer: Mclaren Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: ASR Commercial |
$2.00
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: BCBS Trust/PPO |
$1.69
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.00
|
| Rate for Payer: Mclaren Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: Nomi Health Commercial |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: ASR ASR |
$267.33
|
| Rate for Payer: ASR Commercial |
$267.33
|
| Rate for Payer: BCBS Trust/PPO |
$224.59
|
| Rate for Payer: BCN Commercial |
$213.67
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$259.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$275.60
|
| Rate for Payer: Healthscope Whirlpool |
$267.33
|
| Rate for Payer: Mclaren Commercial |
$248.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: Nomi Health Commercial |
$225.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.53
|
|
