|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 0487-2784-01
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.88
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
RACEPINEPHRINE 2.25 % SOLUTION FOR NEBULIZATION
|
Facility
|
IP
|
$6.68
|
|
|
Service Code
|
NDC 0487-5901-99
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$6.68 |
| Rate for Payer: Aetna Commercial |
$6.01
|
| Rate for Payer: ASR ASR |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$5.18
|
| Rate for Payer: BCN Commercial |
$5.18
|
| Rate for Payer: Cash Price |
$5.35
|
| Rate for Payer: Cofinity Commercial |
$6.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.34
|
| Rate for Payer: Healthscope Commercial |
$6.68
|
| Rate for Payer: Healthscope Whirlpool |
$6.48
|
| Rate for Payer: Mclaren Commercial |
$6.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.88
|
|
|
RADIOTHERAPY
|
Facility
|
IP
|
$34,557.58
|
|
|
Service Code
|
MS-DRG 849
|
| Min. Negotiated Rate |
$23,244.03 |
| Max. Negotiated Rate |
$34,557.58 |
| Rate for Payer: Aetna Medicare |
$24,467.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,584.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,584.25
|
| Rate for Payer: BCBS MAPPO |
$24,467.40
|
| Rate for Payer: BCN Medicare Advantage |
$24,467.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,467.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,467.40
|
| Rate for Payer: Mclaren Medicare |
$24,467.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,690.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,137.51
|
| Rate for Payer: PACE Medicare |
$23,244.03
|
| Rate for Payer: PACE SWMI |
$24,467.40
|
| Rate for Payer: PHP Commercial |
$26,914.14
|
| Rate for Payer: PHP Medicare Advantage |
$24,467.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,557.58
|
| Rate for Payer: Priority Health Medicare |
$24,467.40
|
| Rate for Payer: Priority Health Narrow Network |
$27,646.06
|
| Rate for Payer: Railroad Medicare Medicare |
$24,467.40
|
| Rate for Payer: UHC Medicare Advantage |
$25,201.42
|
| Rate for Payer: VA VA |
$24,467.40
|
|
|
RALTEGRAVIR 400 MG TABLET
|
Facility
|
IP
|
$7,203.46
|
|
|
Service Code
|
NDC 0006-0227-61
|
| Hospital Charge Code |
88608
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,042.42 |
| Max. Negotiated Rate |
$7,203.46 |
| Rate for Payer: Aetna Commercial |
$6,483.11
|
| Rate for Payer: ASR ASR |
$6,987.36
|
| Rate for Payer: BCBS Trust/PPO |
$5,584.84
|
| Rate for Payer: BCN Commercial |
$5,584.84
|
| Rate for Payer: Cash Price |
$5,762.76
|
| Rate for Payer: Cofinity Commercial |
$6,771.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,762.77
|
| Rate for Payer: Healthscope Commercial |
$7,203.46
|
| Rate for Payer: Healthscope Whirlpool |
$6,987.36
|
| Rate for Payer: Mclaren Commercial |
$6,483.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,122.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,042.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,339.04
|
|
|
RAMIPRIL 1.25 MG CAPSULE
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 65862-474-01
|
| Hospital Charge Code |
11258
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.73 |
| Max. Negotiated Rate |
$173.90 |
| Rate for Payer: Aetna Commercial |
$156.51
|
| Rate for Payer: ASR ASR |
$168.68
|
| Rate for Payer: BCBS Trust/PPO |
$134.82
|
| Rate for Payer: BCN Commercial |
$134.82
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$163.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$173.90
|
| Rate for Payer: Healthscope Whirlpool |
$168.68
|
| Rate for Payer: Mclaren Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.03
|
|
|
RAMIPRIL 2.5 MG CAPSULE
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 65862-475-01
|
| Hospital Charge Code |
11260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.93 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: ASR ASR |
$77.50
|
| Rate for Payer: BCBS Trust/PPO |
$61.95
|
| Rate for Payer: BCN Commercial |
$61.95
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$75.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$79.90
|
| Rate for Payer: Healthscope Whirlpool |
$77.50
|
| Rate for Payer: Mclaren Commercial |
$71.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.31
|
|
|
RAMIPRIL 5 MG CAPSULE
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 65862-476-01
|
| Hospital Charge Code |
11261
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$95.18
|
| Rate for Payer: ASR ASR |
$102.58
|
| Rate for Payer: BCBS Trust/PPO |
$81.99
|
| Rate for Payer: BCN Commercial |
$81.99
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$99.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$105.75
|
| Rate for Payer: Healthscope Whirlpool |
$102.58
|
| Rate for Payer: Mclaren Commercial |
$95.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.06
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$5.78
|
|
|
Service Code
|
NDC 60687-549-11
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$5.78 |
| Rate for Payer: Aetna Commercial |
$5.20
|
| Rate for Payer: ASR ASR |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$4.48
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Cofinity Commercial |
$5.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$5.78
|
| Rate for Payer: Healthscope Whirlpool |
$5.61
|
| Rate for Payer: Mclaren Commercial |
$5.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.09
|
|
|
RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR
|
Facility
|
IP
|
$173.38
|
|
|
Service Code
|
NDC 60687-549-21
|
| Hospital Charge Code |
70434
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.37 |
| Max. Negotiated Rate |
$173.38 |
| Rate for Payer: Aetna Commercial |
$156.04
|
| Rate for Payer: ASR ASR |
$168.18
|
| Rate for Payer: BCBS Trust/PPO |
$134.42
|
| Rate for Payer: BCN Commercial |
$134.42
|
| Rate for Payer: Cash Price |
$138.70
|
| Rate for Payer: Cofinity Commercial |
$162.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.70
|
| Rate for Payer: Healthscope Commercial |
$173.38
|
| Rate for Payer: Healthscope Whirlpool |
$168.18
|
| Rate for Payer: Mclaren Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.57
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,438.46
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,406.92 |
| Max. Negotiated Rate |
$3,438.46 |
| Rate for Payer: Aetna Commercial |
$3,094.61
|
| Rate for Payer: ASR ASR |
$3,335.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,665.84
|
| Rate for Payer: BCN Commercial |
$2,665.84
|
| Rate for Payer: Cash Price |
$2,750.76
|
| Rate for Payer: Cofinity Commercial |
$3,232.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,750.77
|
| Rate for Payer: Healthscope Commercial |
$3,438.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,335.31
|
| Rate for Payer: Mclaren Commercial |
$3,094.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,922.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,406.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,025.84
|
|
|
RASBURICASE 7.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$13,968.68
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
76868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,778.08 |
| Max. Negotiated Rate |
$13,968.68 |
| Rate for Payer: Aetna Commercial |
$12,571.81
|
| Rate for Payer: ASR ASR |
$13,549.62
|
| Rate for Payer: BCBS Trust/PPO |
$10,829.92
|
| Rate for Payer: BCN Commercial |
$10,829.92
|
| Rate for Payer: Cash Price |
$11,174.95
|
| Rate for Payer: Cofinity Commercial |
$13,130.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,174.94
|
| Rate for Payer: Healthscope Commercial |
$13,968.68
|
| Rate for Payer: Healthscope Whirlpool |
$13,549.62
|
| Rate for Payer: Mclaren Commercial |
$12,571.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11,873.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,778.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12,292.44
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$26,700.78
|
|
|
Service Code
|
MS-DRG 333
|
| Min. Negotiated Rate |
$18,322.46 |
| Max. Negotiated Rate |
$26,700.78 |
| Rate for Payer: Aetna Medicare |
$19,286.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,108.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,108.50
|
| Rate for Payer: BCBS MAPPO |
$19,286.80
|
| Rate for Payer: BCN Medicare Advantage |
$19,286.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,286.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,286.80
|
| Rate for Payer: Mclaren Medicare |
$19,286.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,251.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,179.82
|
| Rate for Payer: PACE Medicare |
$18,322.46
|
| Rate for Payer: PACE SWMI |
$19,286.80
|
| Rate for Payer: PHP Commercial |
$21,215.48
|
| Rate for Payer: PHP Medicare Advantage |
$19,286.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,700.78
|
| Rate for Payer: Priority Health Medicare |
$19,286.80
|
| Rate for Payer: Priority Health Narrow Network |
$21,360.62
|
| Rate for Payer: Railroad Medicare Medicare |
$19,286.80
|
| Rate for Payer: UHC Medicare Advantage |
$19,865.40
|
| Rate for Payer: VA VA |
$19,286.80
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$46,578.38
|
|
|
Service Code
|
MS-DRG 332
|
| Min. Negotiated Rate |
$30,988.71 |
| Max. Negotiated Rate |
$46,578.38 |
| Rate for Payer: Aetna Medicare |
$32,619.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,774.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,774.61
|
| Rate for Payer: BCBS MAPPO |
$32,619.69
|
| Rate for Payer: BCN Medicare Advantage |
$32,619.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,619.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,619.69
|
| Rate for Payer: Mclaren Medicare |
$32,619.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,250.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,512.64
|
| Rate for Payer: PACE Medicare |
$30,988.71
|
| Rate for Payer: PACE SWMI |
$32,619.69
|
| Rate for Payer: PHP Commercial |
$35,881.66
|
| Rate for Payer: PHP Medicare Advantage |
$32,619.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,578.38
|
| Rate for Payer: Priority Health Medicare |
$32,619.69
|
| Rate for Payer: Priority Health Narrow Network |
$37,262.70
|
| Rate for Payer: Railroad Medicare Medicare |
$32,619.69
|
| Rate for Payer: UHC Medicare Advantage |
$33,598.28
|
| Rate for Payer: VA VA |
$32,619.69
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,609.48
|
|
|
Service Code
|
MS-DRG 334
|
| Min. Negotiated Rate |
$14,506.83 |
| Max. Negotiated Rate |
$20,609.48 |
| Rate for Payer: Aetna Medicare |
$15,270.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,087.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,087.94
|
| Rate for Payer: BCBS MAPPO |
$15,270.35
|
| Rate for Payer: BCN Medicare Advantage |
$15,270.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,270.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,270.35
|
| Rate for Payer: Mclaren Medicare |
$15,270.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,033.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,560.90
|
| Rate for Payer: PACE Medicare |
$14,506.83
|
| Rate for Payer: PACE SWMI |
$15,270.35
|
| Rate for Payer: PHP Commercial |
$16,797.38
|
| Rate for Payer: PHP Medicare Advantage |
$15,270.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,609.48
|
| Rate for Payer: Priority Health Medicare |
$15,270.35
|
| Rate for Payer: Priority Health Narrow Network |
$16,487.58
|
| Rate for Payer: Railroad Medicare Medicare |
$15,270.35
|
| Rate for Payer: UHC Medicare Advantage |
$15,728.46
|
| Rate for Payer: VA VA |
$15,270.35
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$18,022.22
|
|
|
Service Code
|
MS-DRG 811
|
| Min. Negotiated Rate |
$12,886.16 |
| Max. Negotiated Rate |
$18,022.22 |
| Rate for Payer: Aetna Medicare |
$13,564.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,955.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,955.48
|
| Rate for Payer: BCBS MAPPO |
$13,564.38
|
| Rate for Payer: BCN Medicare Advantage |
$13,564.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,564.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,564.38
|
| Rate for Payer: Mclaren Medicare |
$13,564.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,242.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,599.04
|
| Rate for Payer: PACE Medicare |
$12,886.16
|
| Rate for Payer: PACE SWMI |
$13,564.38
|
| Rate for Payer: PHP Commercial |
$14,920.82
|
| Rate for Payer: PHP Medicare Advantage |
$13,564.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,022.22
|
| Rate for Payer: Priority Health Medicare |
$13,564.38
|
| Rate for Payer: Priority Health Narrow Network |
$14,417.78
|
| Rate for Payer: Railroad Medicare Medicare |
$13,564.38
|
| Rate for Payer: UHC Medicare Advantage |
$13,971.31
|
| Rate for Payer: VA VA |
$13,564.38
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$11,633.26
|
|
|
Service Code
|
MS-DRG 812
|
| Min. Negotiated Rate |
$8,841.28 |
| Max. Negotiated Rate |
$11,633.26 |
| Rate for Payer: Aetna Medicare |
$9,306.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,633.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,633.26
|
| Rate for Payer: BCBS MAPPO |
$9,306.61
|
| Rate for Payer: BCN Medicare Advantage |
$9,306.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,306.61
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,306.61
|
| Rate for Payer: Mclaren Medicare |
$9,306.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,771.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,702.60
|
| Rate for Payer: PACE Medicare |
$8,841.28
|
| Rate for Payer: PACE SWMI |
$9,306.61
|
| Rate for Payer: PHP Commercial |
$10,237.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,306.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,564.99
|
| Rate for Payer: Priority Health Medicare |
$9,306.61
|
| Rate for Payer: Priority Health Narrow Network |
$9,251.99
|
| Rate for Payer: Railroad Medicare Medicare |
$9,306.61
|
| Rate for Payer: UHC Medicare Advantage |
$9,585.81
|
| Rate for Payer: VA VA |
$9,306.61
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.36
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.85 |
| Max. Negotiated Rate |
$48.36 |
| Rate for Payer: Aetna Commercial |
$43.52
|
| Rate for Payer: Aetna Commercial |
$27.72
|
| Rate for Payer: Aetna Commercial |
$681.77
|
| Rate for Payer: ASR ASR |
$734.79
|
| Rate for Payer: ASR ASR |
$29.88
|
| Rate for Payer: ASR ASR |
$46.91
|
| Rate for Payer: BCBS Trust/PPO |
$587.31
|
| Rate for Payer: BCBS Trust/PPO |
$23.88
|
| Rate for Payer: BCBS Trust/PPO |
$37.49
|
| Rate for Payer: BCN Commercial |
$587.31
|
| Rate for Payer: BCN Commercial |
$23.88
|
| Rate for Payer: BCN Commercial |
$37.49
|
| Rate for Payer: Cash Price |
$24.64
|
| Rate for Payer: Cash Price |
$606.02
|
| Rate for Payer: Cash Price |
$38.69
|
| Rate for Payer: Cofinity Commercial |
$712.07
|
| Rate for Payer: Cofinity Commercial |
$45.46
|
| Rate for Payer: Cofinity Commercial |
$28.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.69
|
| Rate for Payer: Healthscope Commercial |
$30.80
|
| Rate for Payer: Healthscope Commercial |
$48.36
|
| Rate for Payer: Healthscope Commercial |
$757.52
|
| Rate for Payer: Healthscope Whirlpool |
$29.88
|
| Rate for Payer: Healthscope Whirlpool |
$46.91
|
| Rate for Payer: Healthscope Whirlpool |
$734.79
|
| Rate for Payer: Mclaren Commercial |
$27.72
|
| Rate for Payer: Mclaren Commercial |
$681.77
|
| Rate for Payer: Mclaren Commercial |
$43.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$643.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$42.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.62
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$19,381.98
|
|
|
Service Code
|
MS-DRG 945
|
| Min. Negotiated Rate |
$13,737.90 |
| Max. Negotiated Rate |
$19,381.98 |
| Rate for Payer: Aetna Medicare |
$14,460.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,076.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,076.19
|
| Rate for Payer: BCBS MAPPO |
$14,460.95
|
| Rate for Payer: BCN Medicare Advantage |
$14,460.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,460.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,460.95
|
| Rate for Payer: Mclaren Medicare |
$14,460.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,184.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,630.09
|
| Rate for Payer: PACE Medicare |
$13,737.90
|
| Rate for Payer: PACE SWMI |
$14,460.95
|
| Rate for Payer: PHP Commercial |
$15,907.04
|
| Rate for Payer: PHP Medicare Advantage |
$14,460.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,381.98
|
| Rate for Payer: Priority Health Medicare |
$14,460.95
|
| Rate for Payer: Priority Health Narrow Network |
$15,505.58
|
| Rate for Payer: Railroad Medicare Medicare |
$14,460.95
|
| Rate for Payer: UHC Medicare Advantage |
$14,894.78
|
| Rate for Payer: VA VA |
$14,460.95
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$13,003.07
|
|
|
Service Code
|
MS-DRG 946
|
| Min. Negotiated Rate |
$9,742.11 |
| Max. Negotiated Rate |
$13,003.07 |
| Rate for Payer: Aetna Medicare |
$10,254.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,818.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,818.56
|
| Rate for Payer: BCBS MAPPO |
$10,254.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,254.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,254.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,254.85
|
| Rate for Payer: Mclaren Medicare |
$10,254.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,767.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,793.08
|
| Rate for Payer: PACE Medicare |
$9,742.11
|
| Rate for Payer: PACE SWMI |
$10,254.85
|
| Rate for Payer: PHP Commercial |
$11,280.34
|
| Rate for Payer: PHP Medicare Advantage |
$10,254.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,003.07
|
| Rate for Payer: Priority Health Medicare |
$10,254.85
|
| Rate for Payer: Priority Health Narrow Network |
$10,402.46
|
| Rate for Payer: Railroad Medicare Medicare |
$10,254.85
|
| Rate for Payer: UHC Medicare Advantage |
$10,562.50
|
| Rate for Payer: VA VA |
$10,254.85
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$1,828.74
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,280.12 |
| Max. Negotiated Rate |
$1,828.74 |
| Rate for Payer: Aetna Commercial |
$1,645.87
|
| Rate for Payer: ASR ASR |
$1,773.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,417.82
|
| Rate for Payer: BCN Commercial |
$1,417.82
|
| Rate for Payer: Cash Price |
$1,462.99
|
| Rate for Payer: Cofinity Commercial |
$1,719.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,462.99
|
| Rate for Payer: Healthscope Commercial |
$1,828.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,773.88
|
| Rate for Payer: Mclaren Commercial |
$1,645.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,554.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,280.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,609.29
|
|
|
REMDESIVIR 200 MG/250 ML INFUSION (IV PREMIX)
|
Facility
|
IP
|
$3,520.00
|
|
|
Service Code
|
NDC 9900-0018-21
|
| Hospital Charge Code |
300873
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,464.00 |
| Max. Negotiated Rate |
$3,520.00 |
| Rate for Payer: Aetna Commercial |
$3,168.00
|
| Rate for Payer: ASR ASR |
$3,414.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,729.06
|
| Rate for Payer: BCN Commercial |
$2,729.06
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cofinity Commercial |
$3,308.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,816.00
|
| Rate for Payer: Healthscope Commercial |
$3,520.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,414.40
|
| Rate for Payer: Mclaren Commercial |
$3,168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,992.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,464.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,097.60
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$11,634.32
|
|
|
Service Code
|
MS-DRG 683
|
| Min. Negotiated Rate |
$8,842.09 |
| Max. Negotiated Rate |
$11,634.32 |
| Rate for Payer: Aetna Medicare |
$9,307.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,634.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,634.32
|
| Rate for Payer: BCBS MAPPO |
$9,307.46
|
| Rate for Payer: BCN Medicare Advantage |
$9,307.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,307.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,307.46
|
| Rate for Payer: Mclaren Medicare |
$9,307.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,772.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,703.58
|
| Rate for Payer: PACE Medicare |
$8,842.09
|
| Rate for Payer: PACE SWMI |
$9,307.46
|
| Rate for Payer: PHP Commercial |
$10,238.21
|
| Rate for Payer: PHP Medicare Advantage |
$9,307.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,566.27
|
| Rate for Payer: Priority Health Medicare |
$9,307.46
|
| Rate for Payer: Priority Health Narrow Network |
$9,253.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,307.46
|
| Rate for Payer: UHC Medicare Advantage |
$9,586.68
|
| Rate for Payer: VA VA |
$9,307.46
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$19,270.27
|
|
|
Service Code
|
MS-DRG 682
|
| Min. Negotiated Rate |
$13,667.94 |
| Max. Negotiated Rate |
$19,270.27 |
| Rate for Payer: Aetna Medicare |
$14,387.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,984.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,984.14
|
| Rate for Payer: BCBS MAPPO |
$14,387.31
|
| Rate for Payer: BCN Medicare Advantage |
$14,387.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,387.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,387.31
|
| Rate for Payer: Mclaren Medicare |
$14,387.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,106.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,545.41
|
| Rate for Payer: PACE Medicare |
$13,667.94
|
| Rate for Payer: PACE SWMI |
$14,387.31
|
| Rate for Payer: PHP Commercial |
$15,826.04
|
| Rate for Payer: PHP Medicare Advantage |
$14,387.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,270.27
|
| Rate for Payer: Priority Health Medicare |
$14,387.31
|
| Rate for Payer: Priority Health Narrow Network |
$15,416.22
|
| Rate for Payer: Railroad Medicare Medicare |
$14,387.31
|
| Rate for Payer: UHC Medicare Advantage |
$14,818.93
|
| Rate for Payer: VA VA |
$14,387.31
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$8,540.92
|
|
|
Service Code
|
MS-DRG 684
|
| Min. Negotiated Rate |
$6,250.51 |
| Max. Negotiated Rate |
$8,540.92 |
| Rate for Payer: Aetna Medicare |
$6,832.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,540.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,540.92
|
| Rate for Payer: BCBS MAPPO |
$6,832.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,832.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,832.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,832.74
|
| Rate for Payer: Mclaren Medicare |
$6,832.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,174.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,857.65
|
| Rate for Payer: PACE Medicare |
$6,491.10
|
| Rate for Payer: PACE SWMI |
$6,832.74
|
| Rate for Payer: PHP Commercial |
$7,516.01
|
| Rate for Payer: PHP Medicare Advantage |
$6,832.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,813.14
|
| Rate for Payer: Priority Health Medicare |
$6,832.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,250.51
|
| Rate for Payer: Railroad Medicare Medicare |
$6,832.74
|
| Rate for Payer: UHC Medicare Advantage |
$7,037.72
|
| Rate for Payer: VA VA |
$6,832.74
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$12,669.23
|
|
|
Service Code
|
MS-DRG 178
|
| Min. Negotiated Rate |
$9,533.00 |
| Max. Negotiated Rate |
$12,669.23 |
| Rate for Payer: Aetna Medicare |
$10,034.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,543.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,543.42
|
| Rate for Payer: BCBS MAPPO |
$10,034.74
|
| Rate for Payer: BCN Medicare Advantage |
$10,034.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,034.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,034.74
|
| Rate for Payer: Mclaren Medicare |
$10,034.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,536.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,539.95
|
| Rate for Payer: PACE Medicare |
$9,533.00
|
| Rate for Payer: PACE SWMI |
$10,034.74
|
| Rate for Payer: PHP Commercial |
$11,038.21
|
| Rate for Payer: PHP Medicare Advantage |
$10,034.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,669.23
|
| Rate for Payer: Priority Health Medicare |
$10,034.74
|
| Rate for Payer: Priority Health Narrow Network |
$10,135.38
|
| Rate for Payer: Railroad Medicare Medicare |
$10,034.74
|
| Rate for Payer: UHC Medicare Advantage |
$10,335.78
|
| Rate for Payer: VA VA |
$10,034.74
|
|
