|
SPINAL FUSION EXCEPT CERVICAL WITH MCC
|
Facility
IP
|
$85,158.73
|
|
|
Service Code
|
MS-DRG 459
|
| Min. Negotiated Rate |
$54,941.00 |
| Max. Negotiated Rate |
$85,158.73 |
| Rate for Payer: Aetna Medicare |
$57,832.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72,290.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72,290.79
|
| Rate for Payer: BCBS MAPPO |
$57,832.63
|
| Rate for Payer: BCN Medicare Advantage |
$57,832.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57,832.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$57,832.63
|
| Rate for Payer: Mclaren Medicare |
$57,832.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60,724.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66,507.52
|
| Rate for Payer: PACE Medicare |
$54,941.00
|
| Rate for Payer: PACE SWMI |
$57,832.63
|
| Rate for Payer: PHP Commercial |
$63,615.89
|
| Rate for Payer: PHP Medicare Advantage |
$57,832.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85,158.73
|
| Rate for Payer: Priority Health Medicare |
$57,832.63
|
| Rate for Payer: Priority Health Narrow Network |
$68,126.98
|
| Rate for Payer: Railroad Medicare Medicare |
$57,832.63
|
| Rate for Payer: UHC Medicare Advantage |
$59,567.61
|
| Rate for Payer: VA VA |
$57,832.63
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
IP
|
$46,967.44
|
|
|
Service Code
|
MS-DRG 460
|
| Min. Negotiated Rate |
$31,017.67 |
| Max. Negotiated Rate |
$46,967.44 |
| Rate for Payer: Aetna Medicare |
$32,650.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,812.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,812.72
|
| Rate for Payer: BCBS MAPPO |
$32,650.18
|
| Rate for Payer: BCN Medicare Advantage |
$32,650.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,650.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,650.18
|
| Rate for Payer: Mclaren Medicare |
$32,650.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$34,282.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,547.71
|
| Rate for Payer: PACE Medicare |
$31,017.67
|
| Rate for Payer: PACE SWMI |
$32,650.18
|
| Rate for Payer: PHP Commercial |
$35,915.20
|
| Rate for Payer: PHP Medicare Advantage |
$32,650.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,967.44
|
| Rate for Payer: Priority Health Medicare |
$32,650.18
|
| Rate for Payer: Priority Health Narrow Network |
$37,573.95
|
| Rate for Payer: Railroad Medicare Medicare |
$32,650.18
|
| Rate for Payer: UHC Medicare Advantage |
$33,629.69
|
| Rate for Payer: VA VA |
$32,650.18
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
IP
|
$78,006.85
|
|
|
Service Code
|
MS-DRG 457
|
| Min. Negotiated Rate |
$50,461.00 |
| Max. Negotiated Rate |
$78,006.85 |
| Rate for Payer: Aetna Medicare |
$53,116.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,396.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,396.05
|
| Rate for Payer: BCBS MAPPO |
$53,116.84
|
| Rate for Payer: BCN Medicare Advantage |
$53,116.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,116.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,116.84
|
| Rate for Payer: Mclaren Medicare |
$53,116.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55,772.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,084.37
|
| Rate for Payer: PACE Medicare |
$50,461.00
|
| Rate for Payer: PACE SWMI |
$53,116.84
|
| Rate for Payer: PHP Commercial |
$58,428.52
|
| Rate for Payer: PHP Medicare Advantage |
$53,116.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78,006.85
|
| Rate for Payer: Priority Health Medicare |
$53,116.84
|
| Rate for Payer: Priority Health Narrow Network |
$62,405.48
|
| Rate for Payer: Railroad Medicare Medicare |
$53,116.84
|
| Rate for Payer: UHC Medicare Advantage |
$54,710.35
|
| Rate for Payer: VA VA |
$53,116.84
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
IP
|
$108,233.50
|
|
|
Service Code
|
MS-DRG 456
|
| Min. Negotiated Rate |
$69,395.20 |
| Max. Negotiated Rate |
$108,233.50 |
| Rate for Payer: Aetna Medicare |
$73,047.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$91,309.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$91,309.48
|
| Rate for Payer: BCBS MAPPO |
$73,047.58
|
| Rate for Payer: BCN Medicare Advantage |
$73,047.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73,047.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$73,047.58
|
| Rate for Payer: Mclaren Medicare |
$73,047.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76,699.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84,004.72
|
| Rate for Payer: PACE Medicare |
$69,395.20
|
| Rate for Payer: PACE SWMI |
$73,047.58
|
| Rate for Payer: PHP Commercial |
$80,352.34
|
| Rate for Payer: PHP Medicare Advantage |
$73,047.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108,233.50
|
| Rate for Payer: Priority Health Medicare |
$73,047.58
|
| Rate for Payer: Priority Health Narrow Network |
$86,586.80
|
| Rate for Payer: Railroad Medicare Medicare |
$73,047.58
|
| Rate for Payer: UHC Medicare Advantage |
$75,239.01
|
| Rate for Payer: VA VA |
$73,047.58
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
IP
|
$58,178.04
|
|
|
Service Code
|
MS-DRG 458
|
| Min. Negotiated Rate |
$38,040.07 |
| Max. Negotiated Rate |
$58,178.04 |
| Rate for Payer: Aetna Medicare |
$40,042.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,052.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,052.72
|
| Rate for Payer: BCBS MAPPO |
$40,042.18
|
| Rate for Payer: BCN Medicare Advantage |
$40,042.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,042.18
|
| Rate for Payer: Humana Choice PPO Medicare |
$40,042.18
|
| Rate for Payer: Mclaren Medicare |
$40,042.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,044.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,048.51
|
| Rate for Payer: PACE Medicare |
$38,040.07
|
| Rate for Payer: PACE SWMI |
$40,042.18
|
| Rate for Payer: PHP Commercial |
$44,046.40
|
| Rate for Payer: PHP Medicare Advantage |
$40,042.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58,178.04
|
| Rate for Payer: Priority Health Medicare |
$40,042.18
|
| Rate for Payer: Priority Health Narrow Network |
$46,542.43
|
| Rate for Payer: Railroad Medicare Medicare |
$40,042.18
|
| Rate for Payer: UHC Medicare Advantage |
$41,243.45
|
| Rate for Payer: VA VA |
$40,042.18
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
IP
|
$44,018.09
|
|
|
Service Code
|
MS-DRG 029
|
| Min. Negotiated Rate |
$29,170.17 |
| Max. Negotiated Rate |
$44,018.09 |
| Rate for Payer: Aetna Medicare |
$30,705.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,381.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,381.80
|
| Rate for Payer: BCBS MAPPO |
$30,705.44
|
| Rate for Payer: BCN Medicare Advantage |
$30,705.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,705.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,705.44
|
| Rate for Payer: Mclaren Medicare |
$30,705.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,240.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,311.26
|
| Rate for Payer: PACE Medicare |
$29,170.17
|
| Rate for Payer: PACE SWMI |
$30,705.44
|
| Rate for Payer: PHP Commercial |
$33,775.98
|
| Rate for Payer: PHP Medicare Advantage |
$30,705.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,018.09
|
| Rate for Payer: Priority Health Medicare |
$30,705.44
|
| Rate for Payer: Priority Health Narrow Network |
$35,214.47
|
| Rate for Payer: Railroad Medicare Medicare |
$30,705.44
|
| Rate for Payer: UHC Medicare Advantage |
$31,626.60
|
| Rate for Payer: VA VA |
$30,705.44
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
IP
|
$77,375.12
|
|
|
Service Code
|
MS-DRG 028
|
| Min. Negotiated Rate |
$50,065.28 |
| Max. Negotiated Rate |
$77,375.12 |
| Rate for Payer: Aetna Medicare |
$52,700.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65,875.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65,875.36
|
| Rate for Payer: BCBS MAPPO |
$52,700.29
|
| Rate for Payer: BCN Medicare Advantage |
$52,700.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52,700.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$52,700.29
|
| Rate for Payer: Mclaren Medicare |
$52,700.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55,335.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60,605.33
|
| Rate for Payer: PACE Medicare |
$50,065.28
|
| Rate for Payer: PACE SWMI |
$52,700.29
|
| Rate for Payer: PHP Commercial |
$57,970.32
|
| Rate for Payer: PHP Medicare Advantage |
$52,700.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77,375.12
|
| Rate for Payer: Priority Health Medicare |
$52,700.29
|
| Rate for Payer: Priority Health Narrow Network |
$61,900.10
|
| Rate for Payer: Railroad Medicare Medicare |
$52,700.29
|
| Rate for Payer: UHC Medicare Advantage |
$54,281.30
|
| Rate for Payer: VA VA |
$52,700.29
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$29,775.96
|
|
|
Service Code
|
MS-DRG 030
|
| Min. Negotiated Rate |
$20,248.78 |
| Max. Negotiated Rate |
$29,775.96 |
| Rate for Payer: Aetna Medicare |
$21,314.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,643.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,643.14
|
| Rate for Payer: BCBS MAPPO |
$21,314.51
|
| Rate for Payer: BCN Medicare Advantage |
$21,314.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,314.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,314.51
|
| Rate for Payer: Mclaren Medicare |
$21,314.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,380.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,511.69
|
| Rate for Payer: PACE Medicare |
$20,248.78
|
| Rate for Payer: PACE SWMI |
$21,314.51
|
| Rate for Payer: PHP Commercial |
$23,445.96
|
| Rate for Payer: PHP Medicare Advantage |
$21,314.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,775.96
|
| Rate for Payer: Priority Health Medicare |
$21,314.51
|
| Rate for Payer: Priority Health Narrow Network |
$23,820.77
|
| Rate for Payer: Railroad Medicare Medicare |
$21,314.51
|
| Rate for Payer: UHC Medicare Advantage |
$21,953.95
|
| Rate for Payer: VA VA |
$21,314.51
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
OP
|
$768.38
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$336.24 |
| Max. Negotiated Rate |
$768.38 |
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.01
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$439.21
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$3.83
|
|
|
Service Code
|
NDC 51079-103-01
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: ASR ASR |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.97
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.06
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Healthscope Whirlpool |
$3.72
|
| Rate for Payer: Mclaren Commercial |
$3.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.37
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$303.15
|
|
|
Service Code
|
NDC 63739-544-10
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.20 |
| Max. Negotiated Rate |
$303.15 |
| Rate for Payer: Aetna Commercial |
$272.84
|
| Rate for Payer: ASR ASR |
$294.06
|
| Rate for Payer: BCBS Trust/PPO |
$235.03
|
| Rate for Payer: BCN Commercial |
$235.03
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$284.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$303.15
|
| Rate for Payer: Healthscope Whirlpool |
$294.06
|
| Rate for Payer: Mclaren Commercial |
$272.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.77
|
|
|
SPIRONOLACTONE 25 MG TABLET
|
Facility
IP
|
$251.45
|
|
|
Service Code
|
NDC 0904-6927-61
|
| Hospital Charge Code |
7437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.02 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.30
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
SPLENIC PROCEDURES WITH CC
|
Facility
IP
|
$36,179.27
|
|
|
Service Code
|
MS-DRG 800
|
| Min. Negotiated Rate |
$24,259.87 |
| Max. Negotiated Rate |
$36,179.27 |
| Rate for Payer: Aetna Medicare |
$25,536.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,920.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,920.89
|
| Rate for Payer: BCBS MAPPO |
$25,536.71
|
| Rate for Payer: BCN Medicare Advantage |
$25,536.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,536.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,536.71
|
| Rate for Payer: Mclaren Medicare |
$25,536.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,813.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,367.22
|
| Rate for Payer: PACE Medicare |
$24,259.87
|
| Rate for Payer: PACE SWMI |
$25,536.71
|
| Rate for Payer: PHP Commercial |
$28,090.38
|
| Rate for Payer: PHP Medicare Advantage |
$25,536.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,179.27
|
| Rate for Payer: Priority Health Medicare |
$25,536.71
|
| Rate for Payer: Priority Health Narrow Network |
$28,943.42
|
| Rate for Payer: Railroad Medicare Medicare |
$25,536.71
|
| Rate for Payer: UHC Medicare Advantage |
$26,302.81
|
| Rate for Payer: VA VA |
$25,536.71
|
|
|
SPLENIC PROCEDURES WITH MCC
|
Facility
IP
|
$63,617.06
|
|
|
Service Code
|
MS-DRG 799
|
| Min. Negotiated Rate |
$41,447.12 |
| Max. Negotiated Rate |
$63,617.06 |
| Rate for Payer: Aetna Medicare |
$43,628.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54,535.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54,535.69
|
| Rate for Payer: BCBS MAPPO |
$43,628.55
|
| Rate for Payer: BCN Medicare Advantage |
$43,628.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,628.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$43,628.55
|
| Rate for Payer: Mclaren Medicare |
$43,628.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45,809.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,172.83
|
| Rate for Payer: PACE Medicare |
$41,447.12
|
| Rate for Payer: PACE SWMI |
$43,628.55
|
| Rate for Payer: PHP Commercial |
$47,991.40
|
| Rate for Payer: PHP Medicare Advantage |
$43,628.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63,617.06
|
| Rate for Payer: Priority Health Medicare |
$43,628.55
|
| Rate for Payer: Priority Health Narrow Network |
$50,893.65
|
| Rate for Payer: Railroad Medicare Medicare |
$43,628.55
|
| Rate for Payer: UHC Medicare Advantage |
$44,937.41
|
| Rate for Payer: VA VA |
$43,628.55
|
|
|
SPLENIC PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$22,979.75
|
|
|
Service Code
|
MS-DRG 801
|
| Min. Negotiated Rate |
$15,991.59 |
| Max. Negotiated Rate |
$22,979.75 |
| Rate for Payer: Aetna Medicare |
$16,833.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,041.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,041.56
|
| Rate for Payer: BCBS MAPPO |
$16,833.25
|
| Rate for Payer: BCN Medicare Advantage |
$16,833.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,833.25
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,833.25
|
| Rate for Payer: Mclaren Medicare |
$16,833.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,674.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,358.24
|
| Rate for Payer: PACE Medicare |
$15,991.59
|
| Rate for Payer: PACE SWMI |
$16,833.25
|
| Rate for Payer: PHP Commercial |
$18,516.58
|
| Rate for Payer: PHP Medicare Advantage |
$16,833.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,979.75
|
| Rate for Payer: Priority Health Medicare |
$16,833.25
|
| Rate for Payer: Priority Health Narrow Network |
$18,383.80
|
| Rate for Payer: Railroad Medicare Medicare |
$16,833.25
|
| Rate for Payer: UHC Medicare Advantage |
$17,338.25
|
| Rate for Payer: VA VA |
$16,833.25
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC
|
Facility
IP
|
$12,416.28
|
|
|
Service Code
|
MS-DRG 537
|
| Min. Negotiated Rate |
$9,374.54 |
| Max. Negotiated Rate |
$12,416.28 |
| Rate for Payer: Aetna Medicare |
$9,867.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,334.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,334.92
|
| Rate for Payer: BCBS MAPPO |
$9,867.94
|
| Rate for Payer: BCN Medicare Advantage |
$9,867.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,867.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,867.94
|
| Rate for Payer: Mclaren Medicare |
$9,867.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,361.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,348.13
|
| Rate for Payer: PACE Medicare |
$9,374.54
|
| Rate for Payer: PACE SWMI |
$9,867.94
|
| Rate for Payer: PHP Commercial |
$10,854.73
|
| Rate for Payer: PHP Medicare Advantage |
$9,867.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,416.28
|
| Rate for Payer: Priority Health Medicare |
$9,867.94
|
| Rate for Payer: Priority Health Narrow Network |
$9,933.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,867.94
|
| Rate for Payer: UHC Medicare Advantage |
$10,163.98
|
| Rate for Payer: VA VA |
$9,867.94
|
|
|
SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC
|
Facility
IP
|
$9,605.56
|
|
|
Service Code
|
MS-DRG 538
|
| Min. Negotiated Rate |
$7,283.87 |
| Max. Negotiated Rate |
$9,605.56 |
| Rate for Payer: Aetna Medicare |
$7,684.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,605.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,605.56
|
| Rate for Payer: BCBS MAPPO |
$7,684.45
|
| Rate for Payer: BCN Medicare Advantage |
$7,684.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,684.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,684.45
|
| Rate for Payer: Mclaren Medicare |
$7,684.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,068.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,837.12
|
| Rate for Payer: PACE Medicare |
$7,300.23
|
| Rate for Payer: PACE SWMI |
$7,684.45
|
| Rate for Payer: PHP Commercial |
$8,452.90
|
| Rate for Payer: PHP Medicare Advantage |
$7,684.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,104.84
|
| Rate for Payer: Priority Health Medicare |
$7,684.45
|
| Rate for Payer: Priority Health Narrow Network |
$7,283.87
|
| Rate for Payer: Railroad Medicare Medicare |
$7,684.45
|
| Rate for Payer: UHC Medicare Advantage |
$7,914.98
|
| Rate for Payer: VA VA |
$7,684.45
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
IP
|
$32,066.62
|
|
|
Service Code
|
MS-DRG 327
|
| Min. Negotiated Rate |
$21,683.66 |
| Max. Negotiated Rate |
$32,066.62 |
| Rate for Payer: Aetna Medicare |
$22,824.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,531.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,531.14
|
| Rate for Payer: BCBS MAPPO |
$22,824.91
|
| Rate for Payer: BCN Medicare Advantage |
$22,824.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,824.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$22,824.91
|
| Rate for Payer: Mclaren Medicare |
$22,824.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,966.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,248.65
|
| Rate for Payer: PACE Medicare |
$21,683.66
|
| Rate for Payer: PACE SWMI |
$22,824.91
|
| Rate for Payer: PHP Commercial |
$25,107.40
|
| Rate for Payer: PHP Medicare Advantage |
$22,824.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,066.62
|
| Rate for Payer: Priority Health Medicare |
$22,824.91
|
| Rate for Payer: Priority Health Narrow Network |
$25,653.30
|
| Rate for Payer: Railroad Medicare Medicare |
$22,824.91
|
| Rate for Payer: UHC Medicare Advantage |
$23,509.66
|
| Rate for Payer: VA VA |
$22,824.91
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
IP
|
$65,214.36
|
|
|
Service Code
|
MS-DRG 326
|
| Min. Negotiated Rate |
$42,447.67 |
| Max. Negotiated Rate |
$65,214.36 |
| Rate for Payer: Aetna Medicare |
$44,681.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,852.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,852.20
|
| Rate for Payer: BCBS MAPPO |
$44,681.76
|
| Rate for Payer: BCN Medicare Advantage |
$44,681.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,681.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$44,681.76
|
| Rate for Payer: Mclaren Medicare |
$44,681.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,915.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,384.02
|
| Rate for Payer: PACE Medicare |
$42,447.67
|
| Rate for Payer: PACE SWMI |
$44,681.76
|
| Rate for Payer: PHP Commercial |
$49,149.94
|
| Rate for Payer: PHP Medicare Advantage |
$44,681.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,214.36
|
| Rate for Payer: Priority Health Medicare |
$44,681.76
|
| Rate for Payer: Priority Health Narrow Network |
$52,171.49
|
| Rate for Payer: Railroad Medicare Medicare |
$44,681.76
|
| Rate for Payer: UHC Medicare Advantage |
$46,022.21
|
| Rate for Payer: VA VA |
$44,681.76
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$20,509.33
|
|
|
Service Code
|
MS-DRG 328
|
| Min. Negotiated Rate |
$14,444.09 |
| Max. Negotiated Rate |
$20,509.33 |
| Rate for Payer: Aetna Medicare |
$15,204.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,005.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,005.39
|
| Rate for Payer: BCBS MAPPO |
$15,204.31
|
| Rate for Payer: BCN Medicare Advantage |
$15,204.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,204.31
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,204.31
|
| Rate for Payer: Mclaren Medicare |
$15,204.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,964.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,484.96
|
| Rate for Payer: PACE Medicare |
$14,444.09
|
| Rate for Payer: PACE SWMI |
$15,204.31
|
| Rate for Payer: PHP Commercial |
$16,724.74
|
| Rate for Payer: PHP Medicare Advantage |
$15,204.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,509.33
|
| Rate for Payer: Priority Health Medicare |
$15,204.31
|
| Rate for Payer: Priority Health Narrow Network |
$16,407.46
|
| Rate for Payer: Railroad Medicare Medicare |
$15,204.31
|
| Rate for Payer: UHC Medicare Advantage |
$15,660.44
|
| Rate for Payer: VA VA |
$15,204.31
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION (CODE)
|
Facility
IP
|
$79.34
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
163722
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.54 |
| Max. Negotiated Rate |
$79.34 |
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$61.51
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
|
|
SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$24.79
|
|
|
Service Code
|
HCPCS J0330
|
| Hospital Charge Code |
7536
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$21.91
|
| Rate for Payer: Aetna Commercial |
$30.08
|
| Rate for Payer: Aetna Commercial |
$71.41
|
| Rate for Payer: ASR ASR |
$24.05
|
| Rate for Payer: ASR ASR |
$32.42
|
| Rate for Payer: ASR ASR |
$76.96
|
| Rate for Payer: ASR ASR |
$23.61
|
| Rate for Payer: ASR ASR |
$19.68
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCBS Trust/PPO |
$61.51
|
| Rate for Payer: BCBS Trust/PPO |
$25.91
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCBS Trust/PPO |
$15.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.87
|
| Rate for Payer: BCN Commercial |
$18.87
|
| Rate for Payer: BCN Commercial |
$25.91
|
| Rate for Payer: BCN Commercial |
$15.73
|
| Rate for Payer: BCN Commercial |
$16.04
|
| Rate for Payer: BCN Commercial |
$61.51
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: Cash Price |
$19.83
|
| Rate for Payer: Cash Price |
$63.48
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$16.23
|
| Rate for Payer: Cash Price |
$26.74
|
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$19.07
|
| Rate for Payer: Cofinity Commercial |
$22.88
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$74.58
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.74
|
| Rate for Payer: Healthscope Commercial |
$79.34
|
| Rate for Payer: Healthscope Commercial |
$33.42
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Healthscope Commercial |
$20.69
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$32.42
|
| Rate for Payer: Healthscope Whirlpool |
$23.61
|
| Rate for Payer: Healthscope Whirlpool |
$20.07
|
| Rate for Payer: Healthscope Whirlpool |
$76.96
|
| Rate for Payer: Healthscope Whirlpool |
$24.05
|
| Rate for Payer: Mclaren Commercial |
$21.91
|
| Rate for Payer: Mclaren Commercial |
$71.41
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$22.31
|
| Rate for Payer: Mclaren Commercial |
$30.08
|
| Rate for Payer: Mclaren Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$69.82
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$2.79
|
|
|
Service Code
|
NDC 51079-753-01
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna Commercial |
$2.51
|
| Rate for Payer: ASR ASR |
$2.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| Rate for Payer: BCN Commercial |
$2.16
|
| Rate for Payer: Cash Price |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.23
|
| Rate for Payer: Healthscope Commercial |
$2.79
|
| Rate for Payer: Healthscope Whirlpool |
$2.71
|
| Rate for Payer: Mclaren Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.46
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$279.30
|
|
|
Service Code
|
NDC 51079-753-20
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$279.30 |
| Rate for Payer: Aetna Commercial |
$251.37
|
| Rate for Payer: ASR ASR |
$270.92
|
| Rate for Payer: BCBS Trust/PPO |
$216.54
|
| Rate for Payer: BCN Commercial |
$216.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$262.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$279.30
|
| Rate for Payer: Healthscope Whirlpool |
$270.92
|
| Rate for Payer: Mclaren Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.78
|
|
|
SUCRALFATE 1 GRAM TABLET
|
Facility
IP
|
$238.45
|
|
|
Service Code
|
NDC 0093-2210-01
|
| Hospital Charge Code |
11442
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$238.45 |
| Rate for Payer: Aetna Commercial |
$214.60
|
| Rate for Payer: ASR ASR |
$231.30
|
| Rate for Payer: BCBS Trust/PPO |
$184.87
|
| Rate for Payer: BCN Commercial |
$184.87
|
| Rate for Payer: Cash Price |
$190.76
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.76
|
| Rate for Payer: Healthscope Commercial |
$238.45
|
| Rate for Payer: Healthscope Whirlpool |
$231.30
|
| Rate for Payer: Mclaren Commercial |
$214.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$202.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$209.84
|
|
