|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
IP
|
$61,719.31
|
|
|
Service Code
|
MS-DRG 239
|
| Min. Negotiated Rate |
$40,258.37 |
| Max. Negotiated Rate |
$61,719.31 |
| Rate for Payer: Aetna Medicare |
$42,377.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,971.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,971.54
|
| Rate for Payer: BCBS MAPPO |
$42,377.23
|
| Rate for Payer: BCN Medicare Advantage |
$42,377.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,377.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,377.23
|
| Rate for Payer: Mclaren Medicare |
$42,377.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,496.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,733.81
|
| Rate for Payer: PACE Medicare |
$40,258.37
|
| Rate for Payer: PACE SWMI |
$42,377.23
|
| Rate for Payer: PHP Commercial |
$46,614.95
|
| Rate for Payer: PHP Medicare Advantage |
$42,377.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,719.31
|
| Rate for Payer: Priority Health Medicare |
$42,377.23
|
| Rate for Payer: Priority Health Narrow Network |
$49,375.45
|
| Rate for Payer: Railroad Medicare Medicare |
$42,377.23
|
| Rate for Payer: UHC Medicare Advantage |
$43,648.55
|
| Rate for Payer: VA VA |
$42,377.23
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
IP
|
$17,845.03
|
|
|
Service Code
|
MS-DRG 241
|
| Min. Negotiated Rate |
$12,808.94 |
| Max. Negotiated Rate |
$17,845.03 |
| Rate for Payer: Aetna Medicare |
$13,483.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,853.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,853.88
|
| Rate for Payer: BCBS MAPPO |
$13,483.10
|
| Rate for Payer: BCN Medicare Advantage |
$13,483.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,483.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,483.10
|
| Rate for Payer: Mclaren Medicare |
$13,483.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,157.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,505.56
|
| Rate for Payer: PACE Medicare |
$12,808.94
|
| Rate for Payer: PACE SWMI |
$13,483.10
|
| Rate for Payer: PHP Commercial |
$14,831.41
|
| Rate for Payer: PHP Medicare Advantage |
$13,483.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,845.03
|
| Rate for Payer: Priority Health Medicare |
$13,483.10
|
| Rate for Payer: Priority Health Narrow Network |
$14,276.02
|
| Rate for Payer: Railroad Medicare Medicare |
$13,483.10
|
| Rate for Payer: UHC Medicare Advantage |
$13,887.59
|
| Rate for Payer: VA VA |
$13,483.10
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$27,537.95
|
|
|
Service Code
|
MS-DRG 475
|
| Min. Negotiated Rate |
$18,846.89 |
| Max. Negotiated Rate |
$27,537.95 |
| Rate for Payer: Aetna Medicare |
$19,838.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,798.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,798.54
|
| Rate for Payer: BCBS MAPPO |
$19,838.83
|
| Rate for Payer: BCN Medicare Advantage |
$19,838.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,838.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,838.83
|
| Rate for Payer: Mclaren Medicare |
$19,838.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,830.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,814.65
|
| Rate for Payer: PACE Medicare |
$18,846.89
|
| Rate for Payer: PACE SWMI |
$19,838.83
|
| Rate for Payer: PHP Commercial |
$21,822.71
|
| Rate for Payer: PHP Medicare Advantage |
$19,838.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,537.95
|
| Rate for Payer: Priority Health Medicare |
$19,838.83
|
| Rate for Payer: Priority Health Narrow Network |
$22,030.36
|
| Rate for Payer: Railroad Medicare Medicare |
$19,838.83
|
| Rate for Payer: UHC Medicare Advantage |
$20,433.99
|
| Rate for Payer: VA VA |
$19,838.83
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$55,247.95
|
|
|
Service Code
|
MS-DRG 474
|
| Min. Negotiated Rate |
$36,204.63 |
| Max. Negotiated Rate |
$55,247.95 |
| Rate for Payer: Aetna Medicare |
$38,110.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,637.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,637.68
|
| Rate for Payer: BCBS MAPPO |
$38,110.14
|
| Rate for Payer: BCN Medicare Advantage |
$38,110.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,110.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$38,110.14
|
| Rate for Payer: Mclaren Medicare |
$38,110.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40,015.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,826.66
|
| Rate for Payer: PACE Medicare |
$36,204.63
|
| Rate for Payer: PACE SWMI |
$38,110.14
|
| Rate for Payer: PHP Commercial |
$41,921.15
|
| Rate for Payer: PHP Medicare Advantage |
$38,110.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,247.95
|
| Rate for Payer: Priority Health Medicare |
$38,110.14
|
| Rate for Payer: Priority Health Narrow Network |
$44,198.36
|
| Rate for Payer: Railroad Medicare Medicare |
$38,110.14
|
| Rate for Payer: UHC Medicare Advantage |
$39,253.44
|
| Rate for Payer: VA VA |
$38,110.14
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$15,111.40
|
|
|
Service Code
|
MS-DRG 476
|
| Min. Negotiated Rate |
$11,062.79 |
| Max. Negotiated Rate |
$15,111.40 |
| Rate for Payer: Aetna Medicare |
$11,645.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,556.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,556.30
|
| Rate for Payer: BCBS MAPPO |
$11,645.04
|
| Rate for Payer: BCN Medicare Advantage |
$11,645.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,645.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,645.04
|
| Rate for Payer: Mclaren Medicare |
$11,645.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,227.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,391.80
|
| Rate for Payer: PACE Medicare |
$11,062.79
|
| Rate for Payer: PACE SWMI |
$11,645.04
|
| Rate for Payer: PHP Commercial |
$12,809.54
|
| Rate for Payer: PHP Medicare Advantage |
$11,645.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,111.40
|
| Rate for Payer: Priority Health Medicare |
$11,645.04
|
| Rate for Payer: Priority Health Narrow Network |
$12,089.12
|
| Rate for Payer: Railroad Medicare Medicare |
$11,645.04
|
| Rate for Payer: UHC Medicare Advantage |
$11,994.39
|
| Rate for Payer: VA VA |
$11,645.04
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$25,480.98
|
|
|
Service Code
|
MS-DRG 617
|
| Min. Negotiated Rate |
$17,558.38 |
| Max. Negotiated Rate |
$25,480.98 |
| Rate for Payer: Aetna Medicare |
$18,482.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,103.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,103.12
|
| Rate for Payer: BCBS MAPPO |
$18,482.50
|
| Rate for Payer: BCN Medicare Advantage |
$18,482.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,482.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,482.50
|
| Rate for Payer: Mclaren Medicare |
$18,482.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,406.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,254.88
|
| Rate for Payer: PACE Medicare |
$17,558.38
|
| Rate for Payer: PACE SWMI |
$18,482.50
|
| Rate for Payer: PHP Commercial |
$20,330.75
|
| Rate for Payer: PHP Medicare Advantage |
$18,482.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,480.98
|
| Rate for Payer: Priority Health Medicare |
$18,482.50
|
| Rate for Payer: Priority Health Narrow Network |
$20,384.78
|
| Rate for Payer: Railroad Medicare Medicare |
$18,482.50
|
| Rate for Payer: UHC Medicare Advantage |
$19,036.98
|
| Rate for Payer: VA VA |
$18,482.50
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
IP
|
$50,816.87
|
|
|
Service Code
|
MS-DRG 616
|
| Min. Negotiated Rate |
$33,428.98 |
| Max. Negotiated Rate |
$50,816.87 |
| Rate for Payer: Aetna Medicare |
$35,188.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,985.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,985.50
|
| Rate for Payer: BCBS MAPPO |
$35,188.40
|
| Rate for Payer: BCN Medicare Advantage |
$35,188.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,188.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$35,188.40
|
| Rate for Payer: Mclaren Medicare |
$35,188.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,947.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,466.66
|
| Rate for Payer: PACE Medicare |
$33,428.98
|
| Rate for Payer: PACE SWMI |
$35,188.40
|
| Rate for Payer: PHP Commercial |
$38,707.24
|
| Rate for Payer: PHP Medicare Advantage |
$35,188.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,816.87
|
| Rate for Payer: Priority Health Medicare |
$35,188.40
|
| Rate for Payer: Priority Health Narrow Network |
$40,653.50
|
| Rate for Payer: Railroad Medicare Medicare |
$35,188.40
|
| Rate for Payer: UHC Medicare Advantage |
$36,244.05
|
| Rate for Payer: VA VA |
$35,188.40
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$14,913.66
|
|
|
Service Code
|
MS-DRG 618
|
| Min. Negotiated Rate |
$10,938.93 |
| Max. Negotiated Rate |
$14,913.66 |
| Rate for Payer: Aetna Medicare |
$11,514.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,393.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,393.32
|
| Rate for Payer: BCBS MAPPO |
$11,514.66
|
| Rate for Payer: BCN Medicare Advantage |
$11,514.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,514.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,514.66
|
| Rate for Payer: Mclaren Medicare |
$11,514.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,090.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,241.86
|
| Rate for Payer: PACE Medicare |
$10,938.93
|
| Rate for Payer: PACE SWMI |
$11,514.66
|
| Rate for Payer: PHP Commercial |
$12,666.13
|
| Rate for Payer: PHP Medicare Advantage |
$11,514.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,913.66
|
| Rate for Payer: Priority Health Medicare |
$11,514.66
|
| Rate for Payer: Priority Health Narrow Network |
$11,930.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11,514.66
|
| Rate for Payer: UHC Medicare Advantage |
$11,860.10
|
| Rate for Payer: VA VA |
$11,514.66
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
IP
|
$16,709.98
|
|
|
Service Code
|
MS-DRG 348
|
| Min. Negotiated Rate |
$12,064.15 |
| Max. Negotiated Rate |
$16,709.98 |
| Rate for Payer: Aetna Medicare |
$12,699.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,873.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,873.89
|
| Rate for Payer: BCBS MAPPO |
$12,699.11
|
| Rate for Payer: BCN Medicare Advantage |
$12,699.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,699.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,699.11
|
| Rate for Payer: Mclaren Medicare |
$12,699.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,334.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,603.98
|
| Rate for Payer: PACE Medicare |
$12,064.15
|
| Rate for Payer: PACE SWMI |
$12,699.11
|
| Rate for Payer: PHP Commercial |
$13,969.02
|
| Rate for Payer: PHP Medicare Advantage |
$12,699.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,709.98
|
| Rate for Payer: Priority Health Medicare |
$12,699.11
|
| Rate for Payer: Priority Health Narrow Network |
$13,367.98
|
| Rate for Payer: Railroad Medicare Medicare |
$12,699.11
|
| Rate for Payer: UHC Medicare Advantage |
$13,080.08
|
| Rate for Payer: VA VA |
$12,699.11
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
IP
|
$32,730.44
|
|
|
Service Code
|
MS-DRG 347
|
| Min. Negotiated Rate |
$22,099.50 |
| Max. Negotiated Rate |
$32,730.44 |
| Rate for Payer: Aetna Medicare |
$23,262.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,078.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,078.29
|
| Rate for Payer: BCBS MAPPO |
$23,262.63
|
| Rate for Payer: BCN Medicare Advantage |
$23,262.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,262.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,262.63
|
| Rate for Payer: Mclaren Medicare |
$23,262.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,425.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,752.02
|
| Rate for Payer: PACE Medicare |
$22,099.50
|
| Rate for Payer: PACE SWMI |
$23,262.63
|
| Rate for Payer: PHP Commercial |
$25,588.89
|
| Rate for Payer: PHP Medicare Advantage |
$23,262.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,730.44
|
| Rate for Payer: Priority Health Medicare |
$23,262.63
|
| Rate for Payer: Priority Health Narrow Network |
$26,184.35
|
| Rate for Payer: Railroad Medicare Medicare |
$23,262.63
|
| Rate for Payer: UHC Medicare Advantage |
$23,960.51
|
| Rate for Payer: VA VA |
$23,262.63
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$12,529.27
|
|
|
Service Code
|
MS-DRG 349
|
| Min. Negotiated Rate |
$9,445.32 |
| Max. Negotiated Rate |
$12,529.27 |
| Rate for Payer: Aetna Medicare |
$9,942.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,428.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,428.05
|
| Rate for Payer: BCBS MAPPO |
$9,942.44
|
| Rate for Payer: BCN Medicare Advantage |
$9,942.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,942.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,942.44
|
| Rate for Payer: Mclaren Medicare |
$9,942.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,439.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,433.81
|
| Rate for Payer: PACE Medicare |
$9,445.32
|
| Rate for Payer: PACE SWMI |
$9,942.44
|
| Rate for Payer: PHP Commercial |
$10,936.68
|
| Rate for Payer: PHP Medicare Advantage |
$9,942.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,529.27
|
| Rate for Payer: Priority Health Medicare |
$9,942.44
|
| Rate for Payer: Priority Health Narrow Network |
$10,023.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9,942.44
|
| Rate for Payer: UHC Medicare Advantage |
$10,240.71
|
| Rate for Payer: VA VA |
$9,942.44
|
|
|
ANGINA PECTORIS
|
Facility
IP
|
$9,489.16
|
|
|
Service Code
|
MS-DRG 311
|
| Min. Negotiated Rate |
$7,170.88 |
| Max. Negotiated Rate |
$9,489.16 |
| Rate for Payer: Aetna Medicare |
$7,591.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,489.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,489.16
|
| Rate for Payer: BCBS MAPPO |
$7,591.33
|
| Rate for Payer: BCN Medicare Advantage |
$7,591.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,591.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,591.33
|
| Rate for Payer: Mclaren Medicare |
$7,591.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,970.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,730.03
|
| Rate for Payer: PACE Medicare |
$7,211.76
|
| Rate for Payer: PACE SWMI |
$7,591.33
|
| Rate for Payer: PHP Commercial |
$8,350.46
|
| Rate for Payer: PHP Medicare Advantage |
$7,591.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,963.60
|
| Rate for Payer: Priority Health Medicare |
$7,591.33
|
| Rate for Payer: Priority Health Narrow Network |
$7,170.88
|
| Rate for Payer: Railroad Medicare Medicare |
$7,591.33
|
| Rate for Payer: UHC Medicare Advantage |
$7,819.07
|
| Rate for Payer: VA VA |
$7,591.33
|
|
|
ANIDULAFUNGIN 100 MG INTRAVENOUS SOLUTION
|
Facility
IP
|
$286.66
|
|
|
Service Code
|
HCPCS J0348
|
| Hospital Charge Code |
88093
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.66 |
| Max. Negotiated Rate |
$286.66 |
| Rate for Payer: Aetna Commercial |
$257.99
|
| Rate for Payer: ASR ASR |
$278.06
|
| Rate for Payer: BCBS Trust/PPO |
$222.25
|
| Rate for Payer: BCN Commercial |
$222.25
|
| Rate for Payer: Cash Price |
$229.33
|
| Rate for Payer: Cofinity Commercial |
$269.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.33
|
| Rate for Payer: Healthscope Commercial |
$286.66
|
| Rate for Payer: Healthscope Whirlpool |
$278.06
|
| Rate for Payer: Mclaren Commercial |
$257.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.26
|
|
|
ANTIHEMOPHILIC FACTOR VIII, FULL LENGTH 2,000 (+/-) UNIT IV SOLUTION
|
Facility
IP
|
$3.46
|
|
|
Service Code
|
HCPCS J7192
|
| Hospital Charge Code |
78225
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna Commercial |
$3.11
|
| Rate for Payer: ASR ASR |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.68
|
| Rate for Payer: BCN Commercial |
$2.68
|
| Rate for Payer: Cash Price |
$2.76
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Healthscope Whirlpool |
$3.36
|
| Rate for Payer: Mclaren Commercial |
$3.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.04
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
IP
|
$88,014.35
|
|
|
Service Code
|
MS-DRG 268
|
| Min. Negotiated Rate |
$56,729.76 |
| Max. Negotiated Rate |
$88,014.35 |
| Rate for Payer: Aetna Medicare |
$59,715.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74,644.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74,644.42
|
| Rate for Payer: BCBS MAPPO |
$59,715.54
|
| Rate for Payer: BCN Medicare Advantage |
$59,715.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59,715.54
|
| Rate for Payer: Humana Choice PPO Medicare |
$59,715.54
|
| Rate for Payer: Mclaren Medicare |
$59,715.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62,701.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68,672.87
|
| Rate for Payer: PACE Medicare |
$56,729.76
|
| Rate for Payer: PACE SWMI |
$59,715.54
|
| Rate for Payer: PHP Commercial |
$65,687.09
|
| Rate for Payer: PHP Medicare Advantage |
$59,715.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,014.35
|
| Rate for Payer: Priority Health Medicare |
$59,715.54
|
| Rate for Payer: Priority Health Narrow Network |
$70,411.48
|
| Rate for Payer: Railroad Medicare Medicare |
$59,715.54
|
| Rate for Payer: UHC Medicare Advantage |
$61,507.01
|
| Rate for Payer: VA VA |
$59,715.54
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
IP
|
$53,396.42
|
|
|
Service Code
|
MS-DRG 269
|
| Min. Negotiated Rate |
$35,044.83 |
| Max. Negotiated Rate |
$53,396.42 |
| Rate for Payer: Aetna Medicare |
$36,889.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46,111.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46,111.61
|
| Rate for Payer: BCBS MAPPO |
$36,889.29
|
| Rate for Payer: BCN Medicare Advantage |
$36,889.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,889.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$36,889.29
|
| Rate for Payer: Mclaren Medicare |
$36,889.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38,733.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,422.68
|
| Rate for Payer: PACE Medicare |
$35,044.83
|
| Rate for Payer: PACE SWMI |
$36,889.29
|
| Rate for Payer: PHP Commercial |
$40,578.22
|
| Rate for Payer: PHP Medicare Advantage |
$36,889.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53,396.42
|
| Rate for Payer: Priority Health Medicare |
$36,889.29
|
| Rate for Payer: Priority Health Narrow Network |
$42,717.14
|
| Rate for Payer: Railroad Medicare Medicare |
$36,889.29
|
| Rate for Payer: UHC Medicare Advantage |
$37,995.97
|
| Rate for Payer: VA VA |
$36,889.29
|
|
|
APIXABAN 5 MG TABLET
|
Facility
IP
|
$1,534.02
|
|
|
Service Code
|
NDC 0003-0894-21
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,073.81 |
| Max. Negotiated Rate |
$1,534.02 |
| Rate for Payer: Aetna Commercial |
$1,380.62
|
| Rate for Payer: ASR ASR |
$1,488.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.33
|
| Rate for Payer: BCN Commercial |
$1,189.33
|
| Rate for Payer: Cash Price |
$1,227.22
|
| Rate for Payer: Cofinity Commercial |
$1,441.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,227.22
|
| Rate for Payer: Healthscope Commercial |
$1,534.02
|
| Rate for Payer: Healthscope Whirlpool |
$1,488.00
|
| Rate for Payer: Mclaren Commercial |
$1,380.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,349.94
|
|
|
APIXABAN 5 MG TABLET
|
Facility
IP
|
$2,557.07
|
|
|
Service Code
|
NDC 0003-0894-31
|
| Hospital Charge Code |
164098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,789.95 |
| Max. Negotiated Rate |
$2,557.07 |
| Rate for Payer: Aetna Commercial |
$2,301.36
|
| Rate for Payer: ASR ASR |
$2,480.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,982.50
|
| Rate for Payer: BCN Commercial |
$1,982.50
|
| Rate for Payer: Cash Price |
$2,045.66
|
| Rate for Payer: Cofinity Commercial |
$2,403.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,045.66
|
| Rate for Payer: Healthscope Commercial |
$2,557.07
|
| Rate for Payer: Healthscope Whirlpool |
$2,480.36
|
| Rate for Payer: Mclaren Commercial |
$2,301.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,173.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,789.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,250.22
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
IP
|
$19,430.77
|
|
|
Service Code
|
MS-DRG 398
|
| Min. Negotiated Rate |
$13,768.47 |
| Max. Negotiated Rate |
$19,430.77 |
| Rate for Payer: Aetna Medicare |
$14,493.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,116.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,116.41
|
| Rate for Payer: BCBS MAPPO |
$14,493.13
|
| Rate for Payer: BCN Medicare Advantage |
$14,493.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,493.13
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,493.13
|
| Rate for Payer: Mclaren Medicare |
$14,493.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,217.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,667.10
|
| Rate for Payer: PACE Medicare |
$13,768.47
|
| Rate for Payer: PACE SWMI |
$14,493.13
|
| Rate for Payer: PHP Commercial |
$15,942.44
|
| Rate for Payer: PHP Medicare Advantage |
$14,493.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,430.77
|
| Rate for Payer: Priority Health Medicare |
$14,493.13
|
| Rate for Payer: Priority Health Narrow Network |
$15,544.62
|
| Rate for Payer: Railroad Medicare Medicare |
$14,493.13
|
| Rate for Payer: UHC Medicare Advantage |
$14,927.92
|
| Rate for Payer: VA VA |
$14,493.13
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
IP
|
$28,846.34
|
|
|
Service Code
|
MS-DRG 397
|
| Min. Negotiated Rate |
$19,666.47 |
| Max. Negotiated Rate |
$28,846.34 |
| Rate for Payer: Aetna Medicare |
$20,701.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,876.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,876.94
|
| Rate for Payer: BCBS MAPPO |
$20,701.55
|
| Rate for Payer: BCN Medicare Advantage |
$20,701.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,701.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$20,701.55
|
| Rate for Payer: Mclaren Medicare |
$20,701.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,736.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,806.78
|
| Rate for Payer: PACE Medicare |
$19,666.47
|
| Rate for Payer: PACE SWMI |
$20,701.55
|
| Rate for Payer: PHP Commercial |
$22,771.70
|
| Rate for Payer: PHP Medicare Advantage |
$20,701.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,846.34
|
| Rate for Payer: Priority Health Medicare |
$20,701.55
|
| Rate for Payer: Priority Health Narrow Network |
$23,077.07
|
| Rate for Payer: Railroad Medicare Medicare |
$20,701.55
|
| Rate for Payer: UHC Medicare Advantage |
$21,322.60
|
| Rate for Payer: VA VA |
$20,701.55
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$14,292.20
|
|
|
Service Code
|
MS-DRG 399
|
| Min. Negotiated Rate |
$10,549.65 |
| Max. Negotiated Rate |
$14,292.20 |
| Rate for Payer: Aetna Medicare |
$11,104.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,881.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,881.11
|
| Rate for Payer: BCBS MAPPO |
$11,104.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,104.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,104.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,104.89
|
| Rate for Payer: Mclaren Medicare |
$11,104.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,660.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,770.62
|
| Rate for Payer: PACE Medicare |
$10,549.65
|
| Rate for Payer: PACE SWMI |
$11,104.89
|
| Rate for Payer: PHP Commercial |
$12,215.38
|
| Rate for Payer: PHP Medicare Advantage |
$11,104.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,292.20
|
| Rate for Payer: Priority Health Medicare |
$11,104.89
|
| Rate for Payer: Priority Health Narrow Network |
$11,433.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11,104.89
|
| Rate for Payer: UHC Medicare Advantage |
$11,438.04
|
| Rate for Payer: VA VA |
$11,104.89
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
OP
|
$2,026.22
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,026.22 |
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
ARIPIPRAZOLE 15 MG TABLET
|
Facility
IP
|
$70.97
|
|
|
Service Code
|
NDC 65162-899-03
|
| Hospital Charge Code |
34370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$70.97 |
| Rate for Payer: Aetna Commercial |
$63.87
|
| Rate for Payer: ASR ASR |
$68.84
|
| Rate for Payer: BCBS Trust/PPO |
$55.02
|
| Rate for Payer: BCN Commercial |
$55.02
|
| Rate for Payer: Cash Price |
$56.77
|
| Rate for Payer: Cofinity Commercial |
$66.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.78
|
| Rate for Payer: Healthscope Commercial |
$70.97
|
| Rate for Payer: Healthscope Whirlpool |
$68.84
|
| Rate for Payer: Mclaren Commercial |
$63.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.45
|
|
|
ARIPIPRAZOLE 20 MG TABLET
|
Facility
IP
|
$69.25
|
|
|
Service Code
|
NDC 65162-901-03
|
| Hospital Charge Code |
34371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna Commercial |
$62.32
|
| Rate for Payer: ASR ASR |
$67.17
|
| Rate for Payer: BCBS Trust/PPO |
$53.69
|
| Rate for Payer: BCN Commercial |
$53.69
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cofinity Commercial |
$65.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.40
|
| Rate for Payer: Healthscope Commercial |
$69.25
|
| Rate for Payer: Healthscope Whirlpool |
$67.17
|
| Rate for Payer: Mclaren Commercial |
$62.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.94
|
|
|
ARIPIPRAZOLE 5 MG TABLET
|
Facility
IP
|
$81.22
|
|
|
Service Code
|
NDC 65162-897-03
|
| Hospital Charge Code |
36438
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.85 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: ASR ASR |
$78.78
|
| Rate for Payer: BCBS Trust/PPO |
$62.97
|
| Rate for Payer: BCN Commercial |
$62.97
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$76.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$81.22
|
| Rate for Payer: Healthscope Whirlpool |
$78.78
|
| Rate for Payer: Mclaren Commercial |
$73.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.47
|
|
