|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$11,655.66
|
|
|
Service Code
|
MSDRG 382
|
| Min. Negotiated Rate |
$7,143.79 |
| Max. Negotiated Rate |
$11,655.66 |
| Rate for Payer: Aetna Medicare |
$7,519.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,399.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,399.73
|
| Rate for Payer: BCBS MAPPO |
$7,519.78
|
| Rate for Payer: BCN Medicare Advantage |
$7,519.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,519.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,519.78
|
| Rate for Payer: Mclaren Medicare |
$7,519.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,895.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,647.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,271.76
|
| Rate for Payer: PACE Medicare |
$7,143.79
|
| Rate for Payer: PACE SWMI |
$7,519.78
|
| Rate for Payer: PHP Commercial |
$8,271.76
|
| Rate for Payer: PHP Medicare Advantage |
$7,519.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,999.28
|
| Rate for Payer: Priority Health Medicare |
$7,519.78
|
| Rate for Payer: Priority Health Narrow Network |
$8,799.43
|
| Rate for Payer: Railroad Medicare Medicare |
$7,519.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,519.78
|
| Rate for Payer: UHC Exchange |
$11,655.66
|
| Rate for Payer: UHCCP DNSP |
$7,519.78
|
| Rate for Payer: VA VA |
$7,519.78
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$13,907.02
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$8,523.66 |
| Max. Negotiated Rate |
$13,907.02 |
| Rate for Payer: Aetna Medicare |
$8,972.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,215.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,215.34
|
| Rate for Payer: BCBS MAPPO |
$8,972.27
|
| Rate for Payer: BCN Medicare Advantage |
$8,972.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,972.27
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,972.27
|
| Rate for Payer: Mclaren Medicare |
$8,972.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,420.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,318.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,869.50
|
| Rate for Payer: PACE Medicare |
$8,523.66
|
| Rate for Payer: PACE SWMI |
$8,972.27
|
| Rate for Payer: PHP Commercial |
$9,869.50
|
| Rate for Payer: PHP Medicare Advantage |
$8,972.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,770.40
|
| Rate for Payer: Priority Health Medicare |
$8,972.27
|
| Rate for Payer: Priority Health Narrow Network |
$11,016.32
|
| Rate for Payer: Railroad Medicare Medicare |
$8,972.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,972.27
|
| Rate for Payer: UHC Exchange |
$13,907.02
|
| Rate for Payer: UHCCP DNSP |
$8,972.27
|
| Rate for Payer: VA VA |
$8,972.27
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$25,153.00
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$14,191.58 |
| Max. Negotiated Rate |
$25,153.00 |
| Rate for Payer: Aetna Medicare |
$14,938.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,673.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,673.12
|
| Rate for Payer: BCBS MAPPO |
$14,938.50
|
| Rate for Payer: BCN Medicare Advantage |
$14,938.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,938.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,938.50
|
| Rate for Payer: Mclaren Medicare |
$14,938.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,685.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,179.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,432.35
|
| Rate for Payer: PACE Medicare |
$14,191.58
|
| Rate for Payer: PACE SWMI |
$14,938.50
|
| Rate for Payer: PHP Commercial |
$16,432.35
|
| Rate for Payer: PHP Medicare Advantage |
$14,938.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,153.00
|
| Rate for Payer: Priority Health Medicare |
$14,938.50
|
| Rate for Payer: Priority Health Narrow Network |
$20,122.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14,938.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,938.50
|
| Rate for Payer: UHC Exchange |
$23,154.67
|
| Rate for Payer: UHCCP DNSP |
$14,938.50
|
| Rate for Payer: VA VA |
$14,938.50
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$10,403.29
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$6,376.21 |
| Max. Negotiated Rate |
$10,403.29 |
| Rate for Payer: Aetna Medicare |
$6,711.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,389.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,389.75
|
| Rate for Payer: BCBS MAPPO |
$6,711.80
|
| Rate for Payer: BCN Medicare Advantage |
$6,711.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,711.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,711.80
|
| Rate for Payer: Mclaren Medicare |
$6,711.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,047.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,718.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,382.98
|
| Rate for Payer: PACE Medicare |
$6,376.21
|
| Rate for Payer: PACE SWMI |
$6,711.80
|
| Rate for Payer: PHP Commercial |
$7,382.98
|
| Rate for Payer: PHP Medicare Advantage |
$6,711.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,457.79
|
| Rate for Payer: Priority Health Medicare |
$6,711.80
|
| Rate for Payer: Priority Health Narrow Network |
$7,566.23
|
| Rate for Payer: Railroad Medicare Medicare |
$6,711.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,711.80
|
| Rate for Payer: UHC Exchange |
$10,403.29
|
| Rate for Payer: UHCCP DNSP |
$6,711.80
|
| Rate for Payer: VA VA |
$6,711.80
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$181.63
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.22 |
| Max. Negotiated Rate |
$181.63 |
| Rate for Payer: Aetna Commercial |
$163.47
|
| Rate for Payer: ASR ASR |
$176.18
|
| Rate for Payer: BCBS Trust/PPO |
$149.16
|
| Rate for Payer: BCN Commercial |
$149.16
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Commercial |
$170.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$176.18
|
| Rate for Payer: Healthscope Whirlpool |
$181.63
|
| Rate for Payer: Mclaren Commercial |
$163.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Nomi Health Commercial |
$148.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.84
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
OP
|
$181.63
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$181.63 |
| Rate for Payer: Aetna Commercial |
$163.47
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: ASR ASR |
$176.18
|
| Rate for Payer: BCBS Complete |
$72.65
|
| Rate for Payer: BCBS Trust/PPO |
$149.76
|
| Rate for Payer: BCN Commercial |
$149.76
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Commercial |
$170.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$176.18
|
| Rate for Payer: Healthscope Whirlpool |
$181.63
|
| Rate for Payer: Mclaren Commercial |
$163.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Nomi Health Commercial |
$148.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.15
|
| Rate for Payer: Priority Health Narrow Network |
$127.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.84
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$149,397.09
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$76,058.43 |
| Max. Negotiated Rate |
$149,397.09 |
| Rate for Payer: Aetna Medicare |
$80,061.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100,076.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100,076.88
|
| Rate for Payer: BCBS MAPPO |
$80,061.50
|
| Rate for Payer: BCN Medicare Advantage |
$80,061.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80,061.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$80,061.50
|
| Rate for Payer: Mclaren Medicare |
$80,061.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84,064.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92,070.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$88,067.65
|
| Rate for Payer: PACE Medicare |
$76,058.43
|
| Rate for Payer: PACE SWMI |
$80,061.50
|
| Rate for Payer: PHP Commercial |
$88,067.65
|
| Rate for Payer: PHP Medicare Advantage |
$80,061.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$149,397.09
|
| Rate for Payer: Priority Health Medicare |
$80,061.50
|
| Rate for Payer: Priority Health Narrow Network |
$119,517.67
|
| Rate for Payer: Railroad Medicare Medicare |
$80,061.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80,061.50
|
| Rate for Payer: UHC Exchange |
$124,095.32
|
| Rate for Payer: UHCCP DNSP |
$80,061.50
|
| Rate for Payer: VA VA |
$80,061.50
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$91,864.49
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$47,410.30 |
| Max. Negotiated Rate |
$91,864.49 |
| Rate for Payer: Aetna Medicare |
$49,905.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,381.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,381.97
|
| Rate for Payer: BCBS MAPPO |
$49,905.58
|
| Rate for Payer: BCN Medicare Advantage |
$49,905.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,905.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,905.58
|
| Rate for Payer: Mclaren Medicare |
$49,905.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,400.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,391.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$54,896.14
|
| Rate for Payer: PACE Medicare |
$47,410.30
|
| Rate for Payer: PACE SWMI |
$49,905.58
|
| Rate for Payer: PHP Commercial |
$54,896.14
|
| Rate for Payer: PHP Medicare Advantage |
$49,905.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91,864.49
|
| Rate for Payer: Priority Health Medicare |
$49,905.58
|
| Rate for Payer: Priority Health Narrow Network |
$73,491.59
|
| Rate for Payer: Railroad Medicare Medicare |
$49,905.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49,905.58
|
| Rate for Payer: UHC Exchange |
$77,353.65
|
| Rate for Payer: UHCCP DNSP |
$49,905.58
|
| Rate for Payer: VA VA |
$49,905.58
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$15,093.45
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$9,182.45 |
| Max. Negotiated Rate |
$15,093.45 |
| Rate for Payer: Aetna Medicare |
$9,665.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,082.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,082.17
|
| Rate for Payer: BCBS MAPPO |
$9,665.74
|
| Rate for Payer: BCN Medicare Advantage |
$9,665.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,665.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,665.74
|
| Rate for Payer: Mclaren Medicare |
$9,665.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,149.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,115.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,632.31
|
| Rate for Payer: PACE Medicare |
$9,182.45
|
| Rate for Payer: PACE SWMI |
$9,665.74
|
| Rate for Payer: PHP Commercial |
$10,632.31
|
| Rate for Payer: PHP Medicare Advantage |
$9,665.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,093.45
|
| Rate for Payer: Priority Health Medicare |
$9,665.74
|
| Rate for Payer: Priority Health Narrow Network |
$12,074.76
|
| Rate for Payer: Railroad Medicare Medicare |
$9,665.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,665.74
|
| Rate for Payer: UHC Exchange |
$14,981.90
|
| Rate for Payer: UHCCP DNSP |
$9,665.74
|
| Rate for Payer: VA VA |
$9,665.74
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$18,572.11
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$10,914.65 |
| Max. Negotiated Rate |
$18,572.11 |
| Rate for Payer: Aetna Medicare |
$11,489.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,361.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,361.39
|
| Rate for Payer: BCBS MAPPO |
$11,489.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,489.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,489.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,489.11
|
| Rate for Payer: Mclaren Medicare |
$11,489.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,063.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,212.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,638.02
|
| Rate for Payer: PACE Medicare |
$10,914.65
|
| Rate for Payer: PACE SWMI |
$11,489.11
|
| Rate for Payer: PHP Commercial |
$12,638.02
|
| Rate for Payer: PHP Medicare Advantage |
$11,489.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,572.11
|
| Rate for Payer: Priority Health Medicare |
$11,489.11
|
| Rate for Payer: Priority Health Narrow Network |
$14,857.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,489.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,489.11
|
| Rate for Payer: UHC Exchange |
$17,808.12
|
| Rate for Payer: UHCCP DNSP |
$11,489.11
|
| Rate for Payer: VA VA |
$11,489.11
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$11,907.91
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$7,298.39 |
| Max. Negotiated Rate |
$11,907.91 |
| Rate for Payer: Aetna Medicare |
$7,682.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,603.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,603.15
|
| Rate for Payer: BCBS MAPPO |
$7,682.52
|
| Rate for Payer: BCN Medicare Advantage |
$7,682.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,682.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,682.52
|
| Rate for Payer: Mclaren Medicare |
$7,682.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,066.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,834.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,450.77
|
| Rate for Payer: PACE Medicare |
$7,298.39
|
| Rate for Payer: PACE SWMI |
$7,682.52
|
| Rate for Payer: PHP Commercial |
$8,450.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,682.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,309.78
|
| Rate for Payer: Priority Health Medicare |
$7,682.52
|
| Rate for Payer: Priority Health Narrow Network |
$9,047.82
|
| Rate for Payer: Railroad Medicare Medicare |
$7,682.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,682.52
|
| Rate for Payer: UHC Exchange |
$11,907.91
|
| Rate for Payer: UHCCP DNSP |
$7,682.52
|
| Rate for Payer: VA VA |
$7,682.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,615.11
|
|
|
Service Code
|
NDC 46087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$597.59 |
| Max. Negotiated Rate |
$1,615.11 |
| Rate for Payer: Aetna Commercial |
$1,453.60
|
| Rate for Payer: Aetna Medicare |
$597.59
|
| Rate for Payer: ASR ASR |
$1,566.66
|
| Rate for Payer: BCBS Complete |
$646.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.66
|
| Rate for Payer: BCN Commercial |
$1,331.66
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Commercial |
$1,518.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,566.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,615.11
|
| Rate for Payer: Mclaren Commercial |
$1,453.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Nomi Health Commercial |
$1,324.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,415.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,132.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,421.30
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,615.11
|
|
|
Service Code
|
NDC 46087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,211.33 |
| Max. Negotiated Rate |
$1,615.11 |
| Rate for Payer: Aetna Commercial |
$1,453.60
|
| Rate for Payer: ASR ASR |
$1,566.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.33
|
| Rate for Payer: BCN Commercial |
$1,326.33
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Commercial |
$1,518.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,566.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,615.11
|
| Rate for Payer: Mclaren Commercial |
$1,453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Nomi Health Commercial |
$1,324.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,421.30
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 46110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$969.39 |
| Max. Negotiated Rate |
$2,619.97 |
| Rate for Payer: Aetna Commercial |
$2,357.97
|
| Rate for Payer: Aetna Medicare |
$969.39
|
| Rate for Payer: ASR ASR |
$2,541.37
|
| Rate for Payer: BCBS Complete |
$1,047.99
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.17
|
| Rate for Payer: BCN Commercial |
$2,160.17
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,462.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,541.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,619.97
|
| Rate for Payer: Mclaren Commercial |
$2,357.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,095.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,295.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,836.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,305.57
|
|
|
CONJUGATED ESTROGENS 0.625 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 46110281
|
| Hospital Charge Code |
9974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,964.98 |
| Max. Negotiated Rate |
$2,619.97 |
| Rate for Payer: Aetna Commercial |
$2,357.97
|
| Rate for Payer: ASR ASR |
$2,541.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,151.52
|
| Rate for Payer: BCN Commercial |
$2,151.52
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Commercial |
$2,462.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,541.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,619.97
|
| Rate for Payer: Mclaren Commercial |
$2,357.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Nomi Health Commercial |
$2,148.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,305.57
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$905.71 |
| Max. Negotiated Rate |
$1,207.62 |
| Rate for Payer: Aetna Commercial |
$1,086.85
|
| Rate for Payer: ASR ASR |
$1,171.39
|
| Rate for Payer: BCBS Trust/PPO |
$991.69
|
| Rate for Payer: BCN Commercial |
$991.69
|
| Rate for Payer: Cash Price |
$966.09
|
| Rate for Payer: Cofinity Commercial |
$1,135.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.09
|
| Rate for Payer: Healthscope Commercial |
$1,171.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.62
|
| Rate for Payer: Mclaren Commercial |
$1,086.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.47
|
| Rate for Payer: Nomi Health Commercial |
$990.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,062.70
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$1,207.62 |
| Rate for Payer: Aetna Commercial |
$1,086.85
|
| Rate for Payer: Aetna Medicare |
$391.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.65
|
| Rate for Payer: ASR ASR |
$1,171.39
|
| Rate for Payer: BCBS Complete |
$215.13
|
| Rate for Payer: BCBS MAPPO |
$391.72
|
| Rate for Payer: BCBS Trust/PPO |
$995.68
|
| Rate for Payer: BCN Commercial |
$995.68
|
| Rate for Payer: BCN Medicare Advantage |
$391.72
|
| Rate for Payer: Cash Price |
$966.09
|
| Rate for Payer: Cash Price |
$966.09
|
| Rate for Payer: Cofinity Commercial |
$1,135.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.72
|
| Rate for Payer: Healthscope Commercial |
$1,171.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,207.62
|
| Rate for Payer: Humana Choice PPO Medicare |
$391.72
|
| Rate for Payer: Mclaren Commercial |
$1,086.85
|
| Rate for Payer: Mclaren Medicaid |
$391.72
|
| Rate for Payer: Mclaren Medicare |
$391.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.31
|
| Rate for Payer: Meridian Medicaid |
$215.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$430.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.47
|
| Rate for Payer: Nomi Health Commercial |
$990.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.71
|
| Rate for Payer: PACE Medicare |
$372.13
|
| Rate for Payer: PACE SWMI |
$391.72
|
| Rate for Payer: PHP Commercial |
$430.89
|
| Rate for Payer: PHP Medicaid |
$209.96
|
| Rate for Payer: PHP Medicare Advantage |
$391.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$406.54
|
| Rate for Payer: Priority Health Medicare |
$391.72
|
| Rate for Payer: Priority Health Narrow Network |
$325.23
|
| Rate for Payer: Railroad Medicare Medicare |
$391.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,062.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$391.72
|
| Rate for Payer: UHC Exchange |
$607.17
|
| Rate for Payer: UHC Medicaid |
$204.87
|
| Rate for Payer: UHCCP DNSP |
$391.72
|
| Rate for Payer: UHCCP Medicaid |
$204.87
|
| Rate for Payer: VA VA |
$391.72
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$4,986.29
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$4,508.20 |
| Max. Negotiated Rate |
$4,986.29 |
| Rate for Payer: BCBS Complete |
$4,986.29
|
| Rate for Payer: Mclaren Medicaid |
$4,748.85
|
| Rate for Payer: Meridian Medicaid |
$4,986.29
|
| Rate for Payer: PHP Medicaid |
$4,508.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,748.85
|
| Rate for Payer: UHC Medicaid |
$4,748.85
|
| Rate for Payer: UHCCP Medicaid |
$4,748.85
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$15,261.32
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$13,798.06 |
| Max. Negotiated Rate |
$15,261.32 |
| Rate for Payer: BCBS Complete |
$15,261.32
|
| Rate for Payer: Mclaren Medicaid |
$14,534.59
|
| Rate for Payer: Meridian Medicaid |
$15,261.32
|
| Rate for Payer: PHP Medicaid |
$13,798.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,534.59
|
| Rate for Payer: UHC Medicaid |
$14,534.59
|
| Rate for Payer: UHCCP Medicaid |
$14,534.59
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$8,226.57
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$7,437.80 |
| Max. Negotiated Rate |
$8,226.57 |
| Rate for Payer: BCBS Complete |
$8,226.57
|
| Rate for Payer: Mclaren Medicaid |
$7,834.82
|
| Rate for Payer: Meridian Medicaid |
$8,226.57
|
| Rate for Payer: PHP Medicaid |
$7,437.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,834.82
|
| Rate for Payer: UHC Medicaid |
$7,834.82
|
| Rate for Payer: UHCCP Medicaid |
$7,834.82
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$5,955.21
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$5,384.23 |
| Max. Negotiated Rate |
$5,955.21 |
| Rate for Payer: BCBS Complete |
$5,955.21
|
| Rate for Payer: Mclaren Medicaid |
$5,671.63
|
| Rate for Payer: Meridian Medicaid |
$5,955.21
|
| Rate for Payer: PHP Medicaid |
$5,384.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,671.63
|
| Rate for Payer: UHC Medicaid |
$5,671.63
|
| Rate for Payer: UHCCP Medicaid |
$5,671.63
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$15,846.33
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$9,557.35 |
| Max. Negotiated Rate |
$15,846.33 |
| Rate for Payer: Aetna Medicare |
$10,060.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,575.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,575.46
|
| Rate for Payer: BCBS MAPPO |
$10,060.37
|
| Rate for Payer: BCN Medicare Advantage |
$10,060.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,060.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,060.37
|
| Rate for Payer: Mclaren Medicare |
$10,060.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,563.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,569.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,066.41
|
| Rate for Payer: PACE Medicare |
$9,557.35
|
| Rate for Payer: PACE SWMI |
$10,060.37
|
| Rate for Payer: PHP Commercial |
$11,066.41
|
| Rate for Payer: PHP Medicare Advantage |
$10,060.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,846.33
|
| Rate for Payer: Priority Health Medicare |
$10,060.37
|
| Rate for Payer: Priority Health Narrow Network |
$12,677.07
|
| Rate for Payer: Railroad Medicare Medicare |
$10,060.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,060.37
|
| Rate for Payer: UHC Exchange |
$15,593.57
|
| Rate for Payer: UHCCP DNSP |
$10,060.37
|
| Rate for Payer: VA VA |
$10,060.37
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$34,095.58
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$18,644.50 |
| Max. Negotiated Rate |
$34,095.58 |
| Rate for Payer: Aetna Medicare |
$19,625.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,532.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,532.24
|
| Rate for Payer: BCBS MAPPO |
$19,625.79
|
| Rate for Payer: BCN Medicare Advantage |
$19,625.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,625.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,625.79
|
| Rate for Payer: Mclaren Medicare |
$19,625.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,607.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,569.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,588.37
|
| Rate for Payer: PACE Medicare |
$18,644.50
|
| Rate for Payer: PACE SWMI |
$19,625.79
|
| Rate for Payer: PHP Commercial |
$21,588.37
|
| Rate for Payer: PHP Medicare Advantage |
$19,625.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34,095.58
|
| Rate for Payer: Priority Health Medicare |
$19,625.79
|
| Rate for Payer: Priority Health Narrow Network |
$27,276.46
|
| Rate for Payer: Railroad Medicare Medicare |
$19,625.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,625.79
|
| Rate for Payer: UHC Exchange |
$30,419.97
|
| Rate for Payer: UHCCP DNSP |
$19,625.79
|
| Rate for Payer: VA VA |
$19,625.79
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,053.02
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$7,387.33 |
| Max. Negotiated Rate |
$12,053.02 |
| Rate for Payer: Aetna Medicare |
$7,776.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,720.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,720.17
|
| Rate for Payer: BCBS MAPPO |
$7,776.14
|
| Rate for Payer: BCN Medicare Advantage |
$7,776.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,776.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,776.14
|
| Rate for Payer: Mclaren Medicare |
$7,776.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,164.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,942.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,553.75
|
| Rate for Payer: PACE Medicare |
$7,387.33
|
| Rate for Payer: PACE SWMI |
$7,776.14
|
| Rate for Payer: PHP Commercial |
$8,553.75
|
| Rate for Payer: PHP Medicare Advantage |
$7,776.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,488.38
|
| Rate for Payer: Priority Health Medicare |
$7,776.14
|
| Rate for Payer: Priority Health Narrow Network |
$9,190.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,776.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,776.14
|
| Rate for Payer: UHC Exchange |
$12,053.02
|
| Rate for Payer: UHCCP DNSP |
$7,776.14
|
| Rate for Payer: VA VA |
$7,776.14
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$4,856.59
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$4,390.94 |
| Max. Negotiated Rate |
$4,856.59 |
| Rate for Payer: BCBS Complete |
$4,856.59
|
| Rate for Payer: Mclaren Medicaid |
$4,625.33
|
| Rate for Payer: Meridian Medicaid |
$4,856.59
|
| Rate for Payer: PHP Medicaid |
$4,390.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,625.33
|
| Rate for Payer: UHC Medicaid |
$4,625.33
|
| Rate for Payer: UHCCP Medicaid |
$4,625.33
|
|
