|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$21,781.78
|
|
|
Service Code
|
MS-DRG 177
|
| Min. Negotiated Rate |
$15,241.16 |
| Max. Negotiated Rate |
$21,781.78 |
| Rate for Payer: Aetna Medicare |
$16,043.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,054.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,054.16
|
| Rate for Payer: BCBS MAPPO |
$16,043.33
|
| Rate for Payer: BCN Medicare Advantage |
$16,043.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,043.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,043.33
|
| Rate for Payer: Mclaren Medicare |
$16,043.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,845.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,449.83
|
| Rate for Payer: PACE Medicare |
$15,241.16
|
| Rate for Payer: PACE SWMI |
$16,043.33
|
| Rate for Payer: PHP Commercial |
$17,647.66
|
| Rate for Payer: PHP Medicare Advantage |
$16,043.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,781.78
|
| Rate for Payer: Priority Health Medicare |
$16,043.33
|
| Rate for Payer: Priority Health Narrow Network |
$17,425.42
|
| Rate for Payer: Railroad Medicare Medicare |
$16,043.33
|
| Rate for Payer: UHC Medicare Advantage |
$16,524.63
|
| Rate for Payer: VA VA |
$16,043.33
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,179.18
|
|
|
Service Code
|
MS-DRG 179
|
| Min. Negotiated Rate |
$7,736.17 |
| Max. Negotiated Rate |
$10,179.18 |
| Rate for Payer: Aetna Medicare |
$8,143.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,179.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,179.18
|
| Rate for Payer: BCBS MAPPO |
$8,143.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,143.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,143.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,143.34
|
| Rate for Payer: Mclaren Medicare |
$8,143.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,550.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,364.84
|
| Rate for Payer: PACE Medicare |
$7,736.17
|
| Rate for Payer: PACE SWMI |
$8,143.34
|
| Rate for Payer: PHP Commercial |
$8,957.67
|
| Rate for Payer: PHP Medicare Advantage |
$8,143.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,800.77
|
| Rate for Payer: Priority Health Medicare |
$8,143.34
|
| Rate for Payer: Priority Health Narrow Network |
$7,840.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8,143.34
|
| Rate for Payer: UHC Medicare Advantage |
$8,387.64
|
| Rate for Payer: VA VA |
$8,143.34
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$14,138.12
|
|
|
Service Code
|
MS-DRG 181
|
| Min. Negotiated Rate |
$10,453.14 |
| Max. Negotiated Rate |
$14,138.12 |
| Rate for Payer: Aetna Medicare |
$11,003.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,754.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,754.12
|
| Rate for Payer: BCBS MAPPO |
$11,003.30
|
| Rate for Payer: BCN Medicare Advantage |
$11,003.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,003.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,003.30
|
| Rate for Payer: Mclaren Medicare |
$11,003.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,553.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,653.80
|
| Rate for Payer: PACE Medicare |
$10,453.14
|
| Rate for Payer: PACE SWMI |
$11,003.30
|
| Rate for Payer: PHP Commercial |
$12,103.63
|
| Rate for Payer: PHP Medicare Advantage |
$11,003.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,138.12
|
| Rate for Payer: Priority Health Medicare |
$11,003.30
|
| Rate for Payer: Priority Health Narrow Network |
$11,310.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11,003.30
|
| Rate for Payer: UHC Medicare Advantage |
$11,333.40
|
| Rate for Payer: VA VA |
$11,003.30
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$22,318.49
|
|
|
Service Code
|
MS-DRG 180
|
| Min. Negotiated Rate |
$15,577.35 |
| Max. Negotiated Rate |
$22,318.49 |
| Rate for Payer: Aetna Medicare |
$16,397.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,496.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,496.51
|
| Rate for Payer: BCBS MAPPO |
$16,397.21
|
| Rate for Payer: BCN Medicare Advantage |
$16,397.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,397.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,397.21
|
| Rate for Payer: Mclaren Medicare |
$16,397.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,217.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,856.79
|
| Rate for Payer: PACE Medicare |
$15,577.35
|
| Rate for Payer: PACE SWMI |
$16,397.21
|
| Rate for Payer: PHP Commercial |
$18,036.93
|
| Rate for Payer: PHP Medicare Advantage |
$16,397.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,318.49
|
| Rate for Payer: Priority Health Medicare |
$16,397.21
|
| Rate for Payer: Priority Health Narrow Network |
$17,854.79
|
| Rate for Payer: Railroad Medicare Medicare |
$16,397.21
|
| Rate for Payer: UHC Medicare Advantage |
$16,889.13
|
| Rate for Payer: VA VA |
$16,397.21
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,554.88
|
|
|
Service Code
|
MS-DRG 182
|
| Min. Negotiated Rate |
$7,796.45 |
| Max. Negotiated Rate |
$10,554.88 |
| Rate for Payer: Aetna Medicare |
$8,443.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,554.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,554.88
|
| Rate for Payer: BCBS MAPPO |
$8,443.90
|
| Rate for Payer: BCN Medicare Advantage |
$8,443.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,443.90
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,443.90
|
| Rate for Payer: Mclaren Medicare |
$8,443.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,866.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,710.48
|
| Rate for Payer: PACE Medicare |
$8,021.70
|
| Rate for Payer: PACE SWMI |
$8,443.90
|
| Rate for Payer: PHP Commercial |
$9,288.29
|
| Rate for Payer: PHP Medicare Advantage |
$8,443.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,745.56
|
| Rate for Payer: Priority Health Medicare |
$8,443.90
|
| Rate for Payer: Priority Health Narrow Network |
$7,796.45
|
| Rate for Payer: Railroad Medicare Medicare |
$8,443.90
|
| Rate for Payer: UHC Medicare Advantage |
$8,697.22
|
| Rate for Payer: VA VA |
$8,443.90
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$10,809.92
|
|
|
Service Code
|
MS-DRG 204
|
| Min. Negotiated Rate |
$8,215.54 |
| Max. Negotiated Rate |
$10,809.92 |
| Rate for Payer: Aetna Medicare |
$8,647.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,809.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,809.92
|
| Rate for Payer: BCBS MAPPO |
$8,647.94
|
| Rate for Payer: BCN Medicare Advantage |
$8,647.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,647.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,647.94
|
| Rate for Payer: Mclaren Medicare |
$8,647.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,080.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,945.13
|
| Rate for Payer: PACE Medicare |
$8,215.54
|
| Rate for Payer: PACE SWMI |
$8,647.94
|
| Rate for Payer: PHP Commercial |
$9,512.73
|
| Rate for Payer: PHP Medicare Advantage |
$8,647.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,566.04
|
| Rate for Payer: Priority Health Medicare |
$8,647.94
|
| Rate for Payer: Priority Health Narrow Network |
$8,452.83
|
| Rate for Payer: Railroad Medicare Medicare |
$8,647.94
|
| Rate for Payer: UHC Medicare Advantage |
$8,907.38
|
| Rate for Payer: VA VA |
$8,647.94
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$34,716.79
|
|
|
Service Code
|
MS-DRG 208
|
| Min. Negotiated Rate |
$23,343.77 |
| Max. Negotiated Rate |
$34,716.79 |
| Rate for Payer: Aetna Medicare |
$24,572.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,715.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,715.49
|
| Rate for Payer: BCBS MAPPO |
$24,572.39
|
| Rate for Payer: BCN Medicare Advantage |
$24,572.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,572.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,572.39
|
| Rate for Payer: Mclaren Medicare |
$24,572.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,801.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,258.25
|
| Rate for Payer: PACE Medicare |
$23,343.77
|
| Rate for Payer: PACE SWMI |
$24,572.39
|
| Rate for Payer: PHP Commercial |
$27,029.63
|
| Rate for Payer: PHP Medicare Advantage |
$24,572.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,716.79
|
| Rate for Payer: Priority Health Medicare |
$24,572.39
|
| Rate for Payer: Priority Health Narrow Network |
$27,773.43
|
| Rate for Payer: Railroad Medicare Medicare |
$24,572.39
|
| Rate for Payer: UHC Medicare Advantage |
$25,309.56
|
| Rate for Payer: VA VA |
$24,572.39
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$88,698.72
|
|
|
Service Code
|
MS-DRG 207
|
| Min. Negotiated Rate |
$57,158.46 |
| Max. Negotiated Rate |
$88,698.72 |
| Rate for Payer: Aetna Medicare |
$60,166.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75,208.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75,208.50
|
| Rate for Payer: BCBS MAPPO |
$60,166.80
|
| Rate for Payer: BCN Medicare Advantage |
$60,166.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,166.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$60,166.80
|
| Rate for Payer: Mclaren Medicare |
$60,166.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63,175.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69,191.82
|
| Rate for Payer: PACE Medicare |
$57,158.46
|
| Rate for Payer: PACE SWMI |
$60,166.80
|
| Rate for Payer: PHP Commercial |
$66,183.48
|
| Rate for Payer: PHP Medicare Advantage |
$60,166.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88,698.72
|
| Rate for Payer: Priority Health Medicare |
$60,166.80
|
| Rate for Payer: Priority Health Narrow Network |
$70,958.98
|
| Rate for Payer: Railroad Medicare Medicare |
$60,166.80
|
| Rate for Payer: UHC Medicare Advantage |
$61,971.80
|
| Rate for Payer: VA VA |
$60,166.80
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$12,765.53
|
|
|
Service Code
|
MS-DRG 815
|
| Min. Negotiated Rate |
$9,593.33 |
| Max. Negotiated Rate |
$12,765.53 |
| Rate for Payer: Aetna Medicare |
$10,098.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,622.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,622.80
|
| Rate for Payer: BCBS MAPPO |
$10,098.24
|
| Rate for Payer: BCN Medicare Advantage |
$10,098.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,098.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,098.24
|
| Rate for Payer: Mclaren Medicare |
$10,098.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,603.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,612.98
|
| Rate for Payer: PACE Medicare |
$9,593.33
|
| Rate for Payer: PACE SWMI |
$10,098.24
|
| Rate for Payer: PHP Commercial |
$11,108.06
|
| Rate for Payer: PHP Medicare Advantage |
$10,098.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,765.53
|
| Rate for Payer: Priority Health Medicare |
$10,098.24
|
| Rate for Payer: Priority Health Narrow Network |
$10,212.42
|
| Rate for Payer: Railroad Medicare Medicare |
$10,098.24
|
| Rate for Payer: UHC Medicare Advantage |
$10,401.19
|
| Rate for Payer: VA VA |
$10,098.24
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$27,324.80
|
|
|
Service Code
|
MS-DRG 814
|
| Min. Negotiated Rate |
$18,713.37 |
| Max. Negotiated Rate |
$27,324.80 |
| Rate for Payer: Aetna Medicare |
$19,698.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,622.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,622.85
|
| Rate for Payer: BCBS MAPPO |
$19,698.28
|
| Rate for Payer: BCN Medicare Advantage |
$19,698.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,698.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,698.28
|
| Rate for Payer: Mclaren Medicare |
$19,698.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,683.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,653.02
|
| Rate for Payer: PACE Medicare |
$18,713.37
|
| Rate for Payer: PACE SWMI |
$19,698.28
|
| Rate for Payer: PHP Commercial |
$21,668.11
|
| Rate for Payer: PHP Medicare Advantage |
$19,698.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,324.80
|
| Rate for Payer: Priority Health Medicare |
$19,698.28
|
| Rate for Payer: Priority Health Narrow Network |
$21,859.84
|
| Rate for Payer: Railroad Medicare Medicare |
$19,698.28
|
| Rate for Payer: UHC Medicare Advantage |
$20,289.23
|
| Rate for Payer: VA VA |
$19,698.28
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,617.20
|
|
|
Service Code
|
MS-DRG 816
|
| Min. Negotiated Rate |
$7,295.18 |
| Max. Negotiated Rate |
$9,617.20 |
| Rate for Payer: Aetna Medicare |
$7,693.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,617.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,617.20
|
| Rate for Payer: BCBS MAPPO |
$7,693.76
|
| Rate for Payer: BCN Medicare Advantage |
$7,693.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,693.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,693.76
|
| Rate for Payer: Mclaren Medicare |
$7,693.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,078.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,847.82
|
| Rate for Payer: PACE Medicare |
$7,309.07
|
| Rate for Payer: PACE SWMI |
$7,693.76
|
| Rate for Payer: PHP Commercial |
$8,463.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,693.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,118.97
|
| Rate for Payer: Priority Health Medicare |
$7,693.76
|
| Rate for Payer: Priority Health Narrow Network |
$7,295.18
|
| Rate for Payer: Railroad Medicare Medicare |
$7,693.76
|
| Rate for Payer: UHC Medicare Advantage |
$7,924.57
|
| Rate for Payer: VA VA |
$7,693.76
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$44,764.09
|
|
|
Service Code
|
MS-DRG 467
|
| Min. Negotiated Rate |
$29,637.47 |
| Max. Negotiated Rate |
$44,764.09 |
| Rate for Payer: Aetna Medicare |
$31,197.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,996.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,996.68
|
| Rate for Payer: BCBS MAPPO |
$31,197.34
|
| Rate for Payer: BCN Medicare Advantage |
$31,197.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,197.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,197.34
|
| Rate for Payer: Mclaren Medicare |
$31,197.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,757.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,876.94
|
| Rate for Payer: PACE Medicare |
$29,637.47
|
| Rate for Payer: PACE SWMI |
$31,197.34
|
| Rate for Payer: PHP Commercial |
$34,317.07
|
| Rate for Payer: PHP Medicare Advantage |
$31,197.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,764.09
|
| Rate for Payer: Priority Health Medicare |
$31,197.34
|
| Rate for Payer: Priority Health Narrow Network |
$35,811.27
|
| Rate for Payer: Railroad Medicare Medicare |
$31,197.34
|
| Rate for Payer: UHC Medicare Advantage |
$32,133.26
|
| Rate for Payer: VA VA |
$31,197.34
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$66,595.94
|
|
|
Service Code
|
MS-DRG 466
|
| Min. Negotiated Rate |
$43,313.11 |
| Max. Negotiated Rate |
$66,595.94 |
| Rate for Payer: Aetna Medicare |
$45,592.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,990.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,990.94
|
| Rate for Payer: BCBS MAPPO |
$45,592.75
|
| Rate for Payer: BCN Medicare Advantage |
$45,592.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,592.75
|
| Rate for Payer: Humana Choice PPO Medicare |
$45,592.75
|
| Rate for Payer: Mclaren Medicare |
$45,592.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$47,872.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,431.66
|
| Rate for Payer: PACE Medicare |
$43,313.11
|
| Rate for Payer: PACE SWMI |
$45,592.75
|
| Rate for Payer: PHP Commercial |
$50,152.02
|
| Rate for Payer: PHP Medicare Advantage |
$45,592.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,595.94
|
| Rate for Payer: Priority Health Medicare |
$45,592.75
|
| Rate for Payer: Priority Health Narrow Network |
$53,276.75
|
| Rate for Payer: Railroad Medicare Medicare |
$45,592.75
|
| Rate for Payer: UHC Medicare Advantage |
$46,960.53
|
| Rate for Payer: VA VA |
$45,592.75
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$34,277.66
|
|
|
Service Code
|
MS-DRG 468
|
| Min. Negotiated Rate |
$23,068.69 |
| Max. Negotiated Rate |
$34,277.66 |
| Rate for Payer: Aetna Medicare |
$24,282.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,353.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,353.54
|
| Rate for Payer: BCBS MAPPO |
$24,282.83
|
| Rate for Payer: BCN Medicare Advantage |
$24,282.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,282.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,282.83
|
| Rate for Payer: Mclaren Medicare |
$24,282.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,496.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,925.25
|
| Rate for Payer: PACE Medicare |
$23,068.69
|
| Rate for Payer: PACE SWMI |
$24,282.83
|
| Rate for Payer: PHP Commercial |
$26,711.11
|
| Rate for Payer: PHP Medicare Advantage |
$24,282.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,277.66
|
| Rate for Payer: Priority Health Medicare |
$24,282.83
|
| Rate for Payer: Priority Health Narrow Network |
$27,422.13
|
| Rate for Payer: Railroad Medicare Medicare |
$24,282.83
|
| Rate for Payer: UHC Medicare Advantage |
$25,011.31
|
| Rate for Payer: VA VA |
$24,282.83
|
|
|
RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$260.98
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
11283
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.69 |
| Max. Negotiated Rate |
$260.98 |
| Rate for Payer: Aetna Commercial |
$234.88
|
| Rate for Payer: Aetna Commercial |
$234.86
|
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: ASR ASR |
$253.15
|
| Rate for Payer: ASR ASR |
$241.53
|
| Rate for Payer: ASR ASR |
$253.13
|
| Rate for Payer: BCBS Trust/PPO |
$202.32
|
| Rate for Payer: BCBS Trust/PPO |
$193.05
|
| Rate for Payer: BCBS Trust/PPO |
$202.34
|
| Rate for Payer: BCN Commercial |
$202.34
|
| Rate for Payer: BCN Commercial |
$193.05
|
| Rate for Payer: BCN Commercial |
$202.32
|
| Rate for Payer: Cash Price |
$208.77
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$208.78
|
| Rate for Payer: Cofinity Commercial |
$245.32
|
| Rate for Payer: Cofinity Commercial |
$234.06
|
| Rate for Payer: Cofinity Commercial |
$245.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.78
|
| Rate for Payer: Healthscope Commercial |
$249.00
|
| Rate for Payer: Healthscope Commercial |
$260.96
|
| Rate for Payer: Healthscope Commercial |
$260.98
|
| Rate for Payer: Healthscope Whirlpool |
$253.13
|
| Rate for Payer: Healthscope Whirlpool |
$241.53
|
| Rate for Payer: Healthscope Whirlpool |
$253.15
|
| Rate for Payer: Mclaren Commercial |
$234.88
|
| Rate for Payer: Mclaren Commercial |
$234.86
|
| Rate for Payer: Mclaren Commercial |
$224.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$221.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.64
|
|
|
RIFAXIMIN 550 MG TABLET
|
Facility
|
IP
|
$10,872.89
|
|
|
Service Code
|
NDC 65649-303-02
|
| Hospital Charge Code |
104604
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,611.02 |
| Max. Negotiated Rate |
$10,872.89 |
| Rate for Payer: Aetna Commercial |
$9,785.60
|
| Rate for Payer: ASR ASR |
$10,546.70
|
| Rate for Payer: BCBS Trust/PPO |
$8,429.75
|
| Rate for Payer: BCN Commercial |
$8,429.75
|
| Rate for Payer: Cash Price |
$8,698.32
|
| Rate for Payer: Cofinity Commercial |
$10,220.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8,698.31
|
| Rate for Payer: Healthscope Commercial |
$10,872.89
|
| Rate for Payer: Healthscope Whirlpool |
$10,546.70
|
| Rate for Payer: Mclaren Commercial |
$9,785.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9,241.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,611.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9,568.14
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
NDC 0904-6359-61
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.88 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna Commercial |
$304.56
|
| Rate for Payer: ASR ASR |
$328.25
|
| Rate for Payer: BCBS Trust/PPO |
$262.36
|
| Rate for Payer: BCN Commercial |
$262.36
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$318.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$270.72
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Healthscope Whirlpool |
$328.25
|
| Rate for Payer: Mclaren Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.79
|
|
|
RISPERIDONE 1 MG TABLET
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
NDC 68382-114-14
|
| Hospital Charge Code |
18313
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.65 |
| Max. Negotiated Rate |
$38.07 |
| Rate for Payer: Aetna Commercial |
$34.26
|
| Rate for Payer: ASR ASR |
$36.93
|
| Rate for Payer: BCBS Trust/PPO |
$29.52
|
| Rate for Payer: BCN Commercial |
$29.52
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$35.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$38.07
|
| Rate for Payer: Healthscope Whirlpool |
$36.93
|
| Rate for Payer: Mclaren Commercial |
$34.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.50
|
|
|
RISPERIDONE MICROSPHERES ER 25 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE
|
Facility
|
IP
|
$1,792.35
|
|
|
Service Code
|
HCPCS J2794
|
| Hospital Charge Code |
37237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,254.64 |
| Max. Negotiated Rate |
$1,792.35 |
| Rate for Payer: Aetna Commercial |
$1,613.12
|
| Rate for Payer: ASR ASR |
$1,738.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,389.61
|
| Rate for Payer: BCN Commercial |
$1,389.61
|
| Rate for Payer: Cash Price |
$1,433.88
|
| Rate for Payer: Cofinity Commercial |
$1,684.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.88
|
| Rate for Payer: Healthscope Commercial |
$1,792.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,738.58
|
| Rate for Payer: Mclaren Commercial |
$1,613.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,523.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,254.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,577.27
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,498.60
|
|
|
Service Code
|
HCPCS Q5115
|
| Hospital Charge Code |
192042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,749.02 |
| Max. Negotiated Rate |
$2,498.60 |
| Rate for Payer: Aetna Commercial |
$2,248.74
|
| Rate for Payer: ASR ASR |
$2,423.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,937.16
|
| Rate for Payer: BCN Commercial |
$1,937.16
|
| Rate for Payer: Cash Price |
$1,998.88
|
| Rate for Payer: Cofinity Commercial |
$2,348.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,998.88
|
| Rate for Payer: Healthscope Commercial |
$2,498.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,423.64
|
| Rate for Payer: Mclaren Commercial |
$2,248.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,123.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,749.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,198.77
|
|
|
RIVAROXABAN 10 MG TABLET
|
Facility
|
IP
|
$1,399.93
|
|
|
Service Code
|
NDC 50458-580-30
|
| Hospital Charge Code |
153024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$979.95 |
| Max. Negotiated Rate |
$1,399.93 |
| Rate for Payer: Aetna Commercial |
$1,259.94
|
| Rate for Payer: ASR ASR |
$1,357.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.37
|
| Rate for Payer: BCN Commercial |
$1,085.37
|
| Rate for Payer: Cash Price |
$1,119.95
|
| Rate for Payer: Cofinity Commercial |
$1,315.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.94
|
| Rate for Payer: Healthscope Commercial |
$1,399.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.93
|
| Rate for Payer: Mclaren Commercial |
$1,259.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,189.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,231.94
|
|
|
RIVAROXABAN 15 MG TABLET
|
Facility
|
IP
|
$1,399.93
|
|
|
Service Code
|
NDC 50458-578-30
|
| Hospital Charge Code |
155830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$979.95 |
| Max. Negotiated Rate |
$1,399.93 |
| Rate for Payer: Aetna Commercial |
$1,259.94
|
| Rate for Payer: ASR ASR |
$1,357.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.37
|
| Rate for Payer: BCN Commercial |
$1,085.37
|
| Rate for Payer: Cash Price |
$1,119.95
|
| Rate for Payer: Cofinity Commercial |
$1,315.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.94
|
| Rate for Payer: Healthscope Commercial |
$1,399.93
|
| Rate for Payer: Healthscope Whirlpool |
$1,357.93
|
| Rate for Payer: Mclaren Commercial |
$1,259.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,189.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$979.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,231.94
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$28.97
|
|
|
Service Code
|
NDC 67457-228-10
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.28 |
| Max. Negotiated Rate |
$28.97 |
| Rate for Payer: Aetna Commercial |
$26.07
|
| Rate for Payer: ASR ASR |
$28.10
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCN Commercial |
$22.46
|
| Rate for Payer: Cash Price |
$23.18
|
| Rate for Payer: Cofinity Commercial |
$27.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.18
|
| Rate for Payer: Healthscope Commercial |
$28.97
|
| Rate for Payer: Healthscope Whirlpool |
$28.10
|
| Rate for Payer: Mclaren Commercial |
$26.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.49
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
NDC 0409-9558-49
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$23.49 |
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: ASR ASR |
$22.79
|
| Rate for Payer: BCBS Trust/PPO |
$18.21
|
| Rate for Payer: BCN Commercial |
$18.21
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$22.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$23.49
|
| Rate for Payer: Healthscope Whirlpool |
$22.79
|
| Rate for Payer: Mclaren Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.67
|
|
|
ROCURONIUM 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.09
|
|
|
Service Code
|
NDC 39822-4200-1
|
| Hospital Charge Code |
12734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: ASR ASR |
$23.37
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.27
|
| Rate for Payer: Healthscope Commercial |
$24.09
|
| Rate for Payer: Healthscope Whirlpool |
$23.37
|
| Rate for Payer: Mclaren Commercial |
$21.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.20
|
|
