|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
IP
|
$340.75
|
|
|
Service Code
|
NDC 77333-812-10
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.52 |
| Max. Negotiated Rate |
$340.75 |
| Rate for Payer: Aetna Commercial |
$306.68
|
| Rate for Payer: ASR ASR |
$330.53
|
| Rate for Payer: BCBS Trust/PPO |
$264.18
|
| Rate for Payer: BCN Commercial |
$264.18
|
| Rate for Payer: Cash Price |
$272.60
|
| Rate for Payer: Cofinity Commercial |
$320.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.60
|
| Rate for Payer: Healthscope Commercial |
$340.75
|
| Rate for Payer: Healthscope Whirlpool |
$330.53
|
| Rate for Payer: Mclaren Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$289.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.86
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
IP
|
$63.45
|
|
|
Service Code
|
NDC 0904-5068-60
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: BCBS Trust/PPO |
$49.19
|
| Rate for Payer: BCN Commercial |
$49.19
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
IP
|
$51.70
|
|
|
Service Code
|
NDC 0904-7206-60
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$51.70 |
| Rate for Payer: Aetna Commercial |
$46.53
|
| Rate for Payer: ASR ASR |
$50.15
|
| Rate for Payer: BCBS Trust/PPO |
$40.08
|
| Rate for Payer: BCN Commercial |
$40.08
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$48.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$51.70
|
| Rate for Payer: Healthscope Whirlpool |
$50.15
|
| Rate for Payer: Mclaren Commercial |
$46.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.50
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
IP
|
$10,802.51
|
|
|
Service Code
|
MS-DRG 194
|
| Min. Negotiated Rate |
$8,209.91 |
| Max. Negotiated Rate |
$10,802.51 |
| Rate for Payer: Aetna Medicare |
$8,642.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,802.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,802.51
|
| Rate for Payer: BCBS MAPPO |
$8,642.01
|
| Rate for Payer: BCN Medicare Advantage |
$8,642.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,642.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,642.01
|
| Rate for Payer: Mclaren Medicare |
$8,642.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,074.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,938.31
|
| Rate for Payer: PACE Medicare |
$8,209.91
|
| Rate for Payer: PACE SWMI |
$8,642.01
|
| Rate for Payer: PHP Commercial |
$9,506.21
|
| Rate for Payer: PHP Medicare Advantage |
$8,642.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,557.05
|
| Rate for Payer: Priority Health Medicare |
$8,642.01
|
| Rate for Payer: Priority Health Narrow Network |
$8,445.64
|
| Rate for Payer: Railroad Medicare Medicare |
$8,642.01
|
| Rate for Payer: UHC Medicare Advantage |
$8,901.27
|
| Rate for Payer: VA VA |
$8,642.01
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
IP
|
$17,033.54
|
|
|
Service Code
|
MS-DRG 193
|
| Min. Negotiated Rate |
$12,266.84 |
| Max. Negotiated Rate |
$17,033.54 |
| Rate for Payer: Aetna Medicare |
$12,912.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,140.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,140.58
|
| Rate for Payer: BCBS MAPPO |
$12,912.46
|
| Rate for Payer: BCN Medicare Advantage |
$12,912.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,912.46
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,912.46
|
| Rate for Payer: Mclaren Medicare |
$12,912.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,558.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,849.33
|
| Rate for Payer: PACE Medicare |
$12,266.84
|
| Rate for Payer: PACE SWMI |
$12,912.46
|
| Rate for Payer: PHP Commercial |
$14,203.71
|
| Rate for Payer: PHP Medicare Advantage |
$12,912.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,033.54
|
| Rate for Payer: Priority Health Medicare |
$12,912.46
|
| Rate for Payer: Priority Health Narrow Network |
$13,626.83
|
| Rate for Payer: Railroad Medicare Medicare |
$12,912.46
|
| Rate for Payer: UHC Medicare Advantage |
$13,299.83
|
| Rate for Payer: VA VA |
$12,912.46
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
IP
|
$8,721.89
|
|
|
Service Code
|
MS-DRG 195
|
| Min. Negotiated Rate |
$6,426.16 |
| Max. Negotiated Rate |
$8,721.89 |
| Rate for Payer: Aetna Medicare |
$6,977.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,721.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,721.89
|
| Rate for Payer: BCBS MAPPO |
$6,977.51
|
| Rate for Payer: BCN Medicare Advantage |
$6,977.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,977.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,977.51
|
| Rate for Payer: Mclaren Medicare |
$6,977.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,326.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,024.14
|
| Rate for Payer: PACE Medicare |
$6,628.63
|
| Rate for Payer: PACE SWMI |
$6,977.51
|
| Rate for Payer: PHP Commercial |
$7,675.26
|
| Rate for Payer: PHP Medicare Advantage |
$6,977.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,032.70
|
| Rate for Payer: Priority Health Medicare |
$6,977.51
|
| Rate for Payer: Priority Health Narrow Network |
$6,426.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6,977.51
|
| Rate for Payer: UHC Medicare Advantage |
$7,186.84
|
| Rate for Payer: VA VA |
$6,977.51
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
OP
|
$248.58
|
|
|
Service Code
|
CPT 12001
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$248.58 |
| Rate for Payer: Aetna Medicare |
$177.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.44
|
| Rate for Payer: BCBS Complete |
$102.21
|
| Rate for Payer: BCBS MAPPO |
$177.95
|
| Rate for Payer: BCN Medicare Advantage |
$177.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$177.95
|
| Rate for Payer: Mclaren Medicaid |
$97.34
|
| Rate for Payer: Mclaren Medicare |
$177.95
|
| Rate for Payer: Meridian Medicaid |
$102.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.64
|
| Rate for Payer: PACE Medicare |
$169.05
|
| Rate for Payer: PACE SWMI |
$177.95
|
| Rate for Payer: PHP Commercial |
$195.74
|
| Rate for Payer: PHP Medicaid |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$177.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.58
|
| Rate for Payer: Priority Health Medicare |
$177.95
|
| Rate for Payer: Priority Health Narrow Network |
$198.86
|
| Rate for Payer: Railroad Medicare Medicare |
$177.95
|
| Rate for Payer: UHC Medicare Advantage |
$183.29
|
| Rate for Payer: VA VA |
$177.95
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
IP
|
$67,560.23
|
|
|
Service Code
|
MS-DRG 008
|
| Min. Negotiated Rate |
$43,917.15 |
| Max. Negotiated Rate |
$67,560.23 |
| Rate for Payer: Aetna Medicare |
$46,228.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,785.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,785.72
|
| Rate for Payer: BCBS MAPPO |
$46,228.58
|
| Rate for Payer: BCN Medicare Advantage |
$46,228.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,228.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$46,228.58
|
| Rate for Payer: Mclaren Medicare |
$46,228.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48,540.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,162.87
|
| Rate for Payer: PACE Medicare |
$43,917.15
|
| Rate for Payer: PACE SWMI |
$46,228.58
|
| Rate for Payer: PHP Commercial |
$50,851.44
|
| Rate for Payer: PHP Medicare Advantage |
$46,228.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67,560.23
|
| Rate for Payer: Priority Health Medicare |
$46,228.58
|
| Rate for Payer: Priority Health Narrow Network |
$54,048.18
|
| Rate for Payer: Railroad Medicare Medicare |
$46,228.58
|
| Rate for Payer: UHC Medicare Advantage |
$47,615.44
|
| Rate for Payer: VA VA |
$46,228.58
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
IP
|
$102,636.54
|
|
|
Service Code
|
MS-DRG 019
|
| Min. Negotiated Rate |
$65,889.23 |
| Max. Negotiated Rate |
$102,636.54 |
| Rate for Payer: Aetna Medicare |
$69,357.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86,696.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86,696.35
|
| Rate for Payer: BCBS MAPPO |
$69,357.08
|
| Rate for Payer: BCN Medicare Advantage |
$69,357.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69,357.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$69,357.08
|
| Rate for Payer: Mclaren Medicare |
$69,357.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72,824.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79,760.64
|
| Rate for Payer: PACE Medicare |
$65,889.23
|
| Rate for Payer: PACE SWMI |
$69,357.08
|
| Rate for Payer: PHP Commercial |
$76,292.79
|
| Rate for Payer: PHP Medicare Advantage |
$69,357.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102,636.54
|
| Rate for Payer: Priority Health Medicare |
$69,357.08
|
| Rate for Payer: Priority Health Narrow Network |
$82,109.23
|
| Rate for Payer: Railroad Medicare Medicare |
$69,357.08
|
| Rate for Payer: UHC Medicare Advantage |
$71,437.79
|
| Rate for Payer: VA VA |
$69,357.08
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
IP
|
$249.10
|
|
|
Service Code
|
NDC 63739-571-10
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.37 |
| Max. Negotiated Rate |
$249.10 |
| Rate for Payer: Aetna Commercial |
$224.19
|
| Rate for Payer: ASR ASR |
$241.63
|
| Rate for Payer: BCBS Trust/PPO |
$193.13
|
| Rate for Payer: BCN Commercial |
$193.13
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Commercial |
$234.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$249.10
|
| Rate for Payer: Healthscope Whirlpool |
$241.63
|
| Rate for Payer: Mclaren Commercial |
$224.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.21
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
IP
|
$34,052.96
|
|
|
Service Code
|
MS-DRG 135
|
| Min. Negotiated Rate |
$22,927.93 |
| Max. Negotiated Rate |
$34,052.96 |
| Rate for Payer: Aetna Medicare |
$24,134.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,168.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,168.32
|
| Rate for Payer: BCBS MAPPO |
$24,134.66
|
| Rate for Payer: BCN Medicare Advantage |
$24,134.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,134.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,134.66
|
| Rate for Payer: Mclaren Medicare |
$24,134.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,341.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,754.86
|
| Rate for Payer: PACE Medicare |
$22,927.93
|
| Rate for Payer: PACE SWMI |
$24,134.66
|
| Rate for Payer: PHP Commercial |
$26,548.13
|
| Rate for Payer: PHP Medicare Advantage |
$24,134.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,052.96
|
| Rate for Payer: Priority Health Medicare |
$24,134.66
|
| Rate for Payer: Priority Health Narrow Network |
$27,242.37
|
| Rate for Payer: Railroad Medicare Medicare |
$24,134.66
|
| Rate for Payer: UHC Medicare Advantage |
$24,858.70
|
| Rate for Payer: VA VA |
$24,134.66
|
|
|
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$13,152.99
|
|
|
Service Code
|
MS-DRG 136
|
| Min. Negotiated Rate |
$9,646.43 |
| Max. Negotiated Rate |
$13,152.99 |
| Rate for Payer: Aetna Medicare |
$10,522.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,152.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,152.99
|
| Rate for Payer: BCBS MAPPO |
$10,522.39
|
| Rate for Payer: BCN Medicare Advantage |
$10,522.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,522.39
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,522.39
|
| Rate for Payer: Mclaren Medicare |
$10,522.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,048.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,100.75
|
| Rate for Payer: PACE Medicare |
$9,996.27
|
| Rate for Payer: PACE SWMI |
$10,522.39
|
| Rate for Payer: PHP Commercial |
$11,574.63
|
| Rate for Payer: PHP Medicare Advantage |
$10,522.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,058.04
|
| Rate for Payer: Priority Health Medicare |
$10,522.39
|
| Rate for Payer: Priority Health Narrow Network |
$9,646.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10,522.39
|
| Rate for Payer: UHC Medicare Advantage |
$10,838.06
|
| Rate for Payer: VA VA |
$10,522.39
|
|
|
SITAGLIPTIN PHOSPHATE 100 MG TABLET
|
Facility
IP
|
$1,971.47
|
|
|
Service Code
|
NDC 0006-0277-31
|
| Hospital Charge Code |
77617
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,380.03 |
| Max. Negotiated Rate |
$1,971.47 |
| Rate for Payer: Aetna Commercial |
$1,774.32
|
| Rate for Payer: ASR ASR |
$1,912.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,528.48
|
| Rate for Payer: BCN Commercial |
$1,528.48
|
| Rate for Payer: Cash Price |
$1,577.18
|
| Rate for Payer: Cofinity Commercial |
$1,853.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,577.18
|
| Rate for Payer: Healthscope Commercial |
$1,971.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,912.33
|
| Rate for Payer: Mclaren Commercial |
$1,774.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,675.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,734.89
|
|
|
SITAGLIPTIN PHOSPHATE 25 MG TABLET
|
Facility
IP
|
$5,914.75
|
|
|
Service Code
|
NDC 0006-0221-54
|
| Hospital Charge Code |
77615
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,140.32 |
| Max. Negotiated Rate |
$5,914.75 |
| Rate for Payer: Aetna Commercial |
$5,323.28
|
| Rate for Payer: ASR ASR |
$5,737.31
|
| Rate for Payer: BCBS Trust/PPO |
$4,585.71
|
| Rate for Payer: BCN Commercial |
$4,585.71
|
| Rate for Payer: Cash Price |
$4,731.80
|
| Rate for Payer: Cofinity Commercial |
$5,559.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,731.80
|
| Rate for Payer: Healthscope Commercial |
$5,914.75
|
| Rate for Payer: Healthscope Whirlpool |
$5,737.31
|
| Rate for Payer: Mclaren Commercial |
$5,323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,027.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,140.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,204.98
|
|
|
SKIN CARE CONSULT
|
Professional
|
$25.00
|
|
|
Service Code
|
HCPCS 00177
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
SKIN DEBRIDEMENT WITH CC
|
Facility
IP
|
$21,724.00
|
|
|
Service Code
|
MS-DRG 571
|
| Min. Negotiated Rate |
$15,204.98 |
| Max. Negotiated Rate |
$21,724.00 |
| Rate for Payer: Aetna Medicare |
$16,005.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,006.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,006.55
|
| Rate for Payer: BCBS MAPPO |
$16,005.24
|
| Rate for Payer: BCN Medicare Advantage |
$16,005.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,005.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,005.24
|
| Rate for Payer: Mclaren Medicare |
$16,005.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,805.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,406.03
|
| Rate for Payer: PACE Medicare |
$15,204.98
|
| Rate for Payer: PACE SWMI |
$16,005.24
|
| Rate for Payer: PHP Commercial |
$17,605.76
|
| Rate for Payer: PHP Medicare Advantage |
$16,005.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,724.00
|
| Rate for Payer: Priority Health Medicare |
$16,005.24
|
| Rate for Payer: Priority Health Narrow Network |
$17,379.20
|
| Rate for Payer: Railroad Medicare Medicare |
$16,005.24
|
| Rate for Payer: UHC Medicare Advantage |
$16,485.40
|
| Rate for Payer: VA VA |
$16,005.24
|
|
|
SKIN DEBRIDEMENT WITH MCC
|
Facility
IP
|
$37,521.05
|
|
|
Service Code
|
MS-DRG 570
|
| Min. Negotiated Rate |
$25,100.38 |
| Max. Negotiated Rate |
$37,521.05 |
| Rate for Payer: Aetna Medicare |
$26,421.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,026.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,026.81
|
| Rate for Payer: BCBS MAPPO |
$26,421.45
|
| Rate for Payer: BCN Medicare Advantage |
$26,421.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,421.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,421.45
|
| Rate for Payer: Mclaren Medicare |
$26,421.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,742.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,384.67
|
| Rate for Payer: PACE Medicare |
$25,100.38
|
| Rate for Payer: PACE SWMI |
$26,421.45
|
| Rate for Payer: PHP Commercial |
$29,063.60
|
| Rate for Payer: PHP Medicare Advantage |
$26,421.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,521.05
|
| Rate for Payer: Priority Health Medicare |
$26,421.45
|
| Rate for Payer: Priority Health Narrow Network |
$30,016.84
|
| Rate for Payer: Railroad Medicare Medicare |
$26,421.45
|
| Rate for Payer: UHC Medicare Advantage |
$27,214.09
|
| Rate for Payer: VA VA |
$26,421.45
|
|
|
SKIN DEBRIDEMENT WITHOUT CC/MCC
|
Facility
IP
|
$14,632.46
|
|
|
Service Code
|
MS-DRG 572
|
| Min. Negotiated Rate |
$10,762.78 |
| Max. Negotiated Rate |
$14,632.46 |
| Rate for Payer: Aetna Medicare |
$11,329.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,161.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,161.55
|
| Rate for Payer: BCBS MAPPO |
$11,329.24
|
| Rate for Payer: BCN Medicare Advantage |
$11,329.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,329.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,329.24
|
| Rate for Payer: Mclaren Medicare |
$11,329.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,895.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,028.63
|
| Rate for Payer: PACE Medicare |
$10,762.78
|
| Rate for Payer: PACE SWMI |
$11,329.24
|
| Rate for Payer: PHP Commercial |
$12,462.16
|
| Rate for Payer: PHP Medicare Advantage |
$11,329.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,632.46
|
| Rate for Payer: Priority Health Medicare |
$11,329.24
|
| Rate for Payer: Priority Health Narrow Network |
$11,705.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11,329.24
|
| Rate for Payer: UHC Medicare Advantage |
$11,669.12
|
| Rate for Payer: VA VA |
$11,329.24
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
IP
|
$34,014.44
|
|
|
Service Code
|
MS-DRG 577
|
| Min. Negotiated Rate |
$22,903.82 |
| Max. Negotiated Rate |
$34,014.44 |
| Rate for Payer: Aetna Medicare |
$24,109.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,136.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,136.60
|
| Rate for Payer: BCBS MAPPO |
$24,109.28
|
| Rate for Payer: BCN Medicare Advantage |
$24,109.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,109.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,109.28
|
| Rate for Payer: Mclaren Medicare |
$24,109.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,314.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,725.67
|
| Rate for Payer: PACE Medicare |
$22,903.82
|
| Rate for Payer: PACE SWMI |
$24,109.28
|
| Rate for Payer: PHP Commercial |
$26,520.21
|
| Rate for Payer: PHP Medicare Advantage |
$24,109.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,014.44
|
| Rate for Payer: Priority Health Medicare |
$24,109.28
|
| Rate for Payer: Priority Health Narrow Network |
$27,211.55
|
| Rate for Payer: Railroad Medicare Medicare |
$24,109.28
|
| Rate for Payer: UHC Medicare Advantage |
$24,832.56
|
| Rate for Payer: VA VA |
$24,109.28
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
IP
|
$72,971.00
|
|
|
Service Code
|
MS-DRG 576
|
| Min. Negotiated Rate |
$47,306.49 |
| Max. Negotiated Rate |
$72,971.00 |
| Rate for Payer: Aetna Medicare |
$49,796.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,245.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,245.39
|
| Rate for Payer: BCBS MAPPO |
$49,796.31
|
| Rate for Payer: BCN Medicare Advantage |
$49,796.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,796.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$49,796.31
|
| Rate for Payer: Mclaren Medicare |
$49,796.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,286.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,265.76
|
| Rate for Payer: PACE Medicare |
$47,306.49
|
| Rate for Payer: PACE SWMI |
$49,796.31
|
| Rate for Payer: PHP Commercial |
$54,775.94
|
| Rate for Payer: PHP Medicare Advantage |
$49,796.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72,971.00
|
| Rate for Payer: Priority Health Medicare |
$49,796.31
|
| Rate for Payer: Priority Health Narrow Network |
$58,376.80
|
| Rate for Payer: Railroad Medicare Medicare |
$49,796.31
|
| Rate for Payer: UHC Medicare Advantage |
$51,290.20
|
| Rate for Payer: VA VA |
$49,796.31
|
|
|
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
IP
|
$20,678.82
|
|
|
Service Code
|
MS-DRG 578
|
| Min. Negotiated Rate |
$14,550.26 |
| Max. Negotiated Rate |
$20,678.82 |
| Rate for Payer: Aetna Medicare |
$15,316.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,145.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,145.08
|
| Rate for Payer: BCBS MAPPO |
$15,316.06
|
| Rate for Payer: BCN Medicare Advantage |
$15,316.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,316.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,316.06
|
| Rate for Payer: Mclaren Medicare |
$15,316.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,081.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,613.47
|
| Rate for Payer: PACE Medicare |
$14,550.26
|
| Rate for Payer: PACE SWMI |
$15,316.06
|
| Rate for Payer: PHP Commercial |
$16,847.67
|
| Rate for Payer: PHP Medicare Advantage |
$15,316.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,678.82
|
| Rate for Payer: Priority Health Medicare |
$15,316.06
|
| Rate for Payer: Priority Health Narrow Network |
$16,543.06
|
| Rate for Payer: Railroad Medicare Medicare |
$15,316.06
|
| Rate for Payer: UHC Medicare Advantage |
$15,775.54
|
| Rate for Payer: VA VA |
$15,316.06
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC
|
Facility
IP
|
$43,730.47
|
|
|
Service Code
|
MS-DRG 574
|
| Min. Negotiated Rate |
$28,990.00 |
| Max. Negotiated Rate |
$43,730.47 |
| Rate for Payer: Aetna Medicare |
$30,515.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,144.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,144.74
|
| Rate for Payer: BCBS MAPPO |
$30,515.79
|
| Rate for Payer: BCN Medicare Advantage |
$30,515.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,515.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,515.79
|
| Rate for Payer: Mclaren Medicare |
$30,515.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,041.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,093.16
|
| Rate for Payer: PACE Medicare |
$28,990.00
|
| Rate for Payer: PACE SWMI |
$30,515.79
|
| Rate for Payer: PHP Commercial |
$33,567.37
|
| Rate for Payer: PHP Medicare Advantage |
$30,515.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,730.47
|
| Rate for Payer: Priority Health Medicare |
$30,515.79
|
| Rate for Payer: Priority Health Narrow Network |
$34,984.38
|
| Rate for Payer: Railroad Medicare Medicare |
$30,515.79
|
| Rate for Payer: UHC Medicare Advantage |
$31,431.26
|
| Rate for Payer: VA VA |
$30,515.79
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC
|
Facility
IP
|
$79,840.40
|
|
|
Service Code
|
MS-DRG 573
|
| Min. Negotiated Rate |
$51,609.55 |
| Max. Negotiated Rate |
$79,840.40 |
| Rate for Payer: Aetna Medicare |
$54,325.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,907.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,907.30
|
| Rate for Payer: BCBS MAPPO |
$54,325.84
|
| Rate for Payer: BCN Medicare Advantage |
$54,325.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54,325.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$54,325.84
|
| Rate for Payer: Mclaren Medicare |
$54,325.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57,042.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62,474.72
|
| Rate for Payer: PACE Medicare |
$51,609.55
|
| Rate for Payer: PACE SWMI |
$54,325.84
|
| Rate for Payer: PHP Commercial |
$59,758.42
|
| Rate for Payer: PHP Medicare Advantage |
$54,325.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79,840.40
|
| Rate for Payer: Priority Health Medicare |
$54,325.84
|
| Rate for Payer: Priority Health Narrow Network |
$63,872.32
|
| Rate for Payer: Railroad Medicare Medicare |
$54,325.84
|
| Rate for Payer: UHC Medicare Advantage |
$55,955.62
|
| Rate for Payer: VA VA |
$54,325.84
|
|
|
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC
|
Facility
IP
|
$26,270.64
|
|
|
Service Code
|
MS-DRG 575
|
| Min. Negotiated Rate |
$18,053.02 |
| Max. Negotiated Rate |
$26,270.64 |
| Rate for Payer: Aetna Medicare |
$19,003.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,753.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,753.98
|
| Rate for Payer: BCBS MAPPO |
$19,003.18
|
| Rate for Payer: BCN Medicare Advantage |
$19,003.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,003.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$19,003.18
|
| Rate for Payer: Mclaren Medicare |
$19,003.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,953.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,853.66
|
| Rate for Payer: PACE Medicare |
$18,053.02
|
| Rate for Payer: PACE SWMI |
$19,003.18
|
| Rate for Payer: PHP Commercial |
$20,903.50
|
| Rate for Payer: PHP Medicare Advantage |
$19,003.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,270.64
|
| Rate for Payer: Priority Health Medicare |
$19,003.18
|
| Rate for Payer: Priority Health Narrow Network |
$21,016.51
|
| Rate for Payer: Railroad Medicare Medicare |
$19,003.18
|
| Rate for Payer: UHC Medicare Advantage |
$19,573.28
|
| Rate for Payer: VA VA |
$19,003.18
|
|
|
SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$23,900.38
|
|
|
Service Code
|
MS-DRG 623
|
| Min. Negotiated Rate |
$16,568.28 |
| Max. Negotiated Rate |
$23,900.38 |
| Rate for Payer: Aetna Medicare |
$17,440.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,800.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,800.38
|
| Rate for Payer: BCBS MAPPO |
$17,440.30
|
| Rate for Payer: BCN Medicare Advantage |
$17,440.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,440.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,440.30
|
| Rate for Payer: Mclaren Medicare |
$17,440.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,312.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,056.34
|
| Rate for Payer: PACE Medicare |
$16,568.28
|
| Rate for Payer: PACE SWMI |
$17,440.30
|
| Rate for Payer: PHP Commercial |
$19,184.33
|
| Rate for Payer: PHP Medicare Advantage |
$17,440.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,900.38
|
| Rate for Payer: Priority Health Medicare |
$17,440.30
|
| Rate for Payer: Priority Health Narrow Network |
$19,120.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17,440.30
|
| Rate for Payer: UHC Medicare Advantage |
$17,963.51
|
| Rate for Payer: VA VA |
$17,440.30
|
|
