|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG CAPSULE
|
Facility
IP
|
$2.59
|
|
|
Service Code
|
NDC 51079-935-01
|
| Hospital Charge Code |
12729
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.01
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Healthscope Whirlpool |
$2.51
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
IP
|
$91.44
|
|
|
Service Code
|
NDC 68084-750-25
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.01 |
| Max. Negotiated Rate |
$91.44 |
| Rate for Payer: Aetna Commercial |
$82.30
|
| Rate for Payer: ASR ASR |
$88.70
|
| Rate for Payer: BCBS Trust/PPO |
$70.89
|
| Rate for Payer: BCN Commercial |
$70.89
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cofinity Commercial |
$85.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.15
|
| Rate for Payer: Healthscope Commercial |
$91.44
|
| Rate for Payer: Healthscope Whirlpool |
$88.70
|
| Rate for Payer: Mclaren Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.47
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
IP
|
$3.05
|
|
|
Service Code
|
NDC 68084-750-95
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.74
|
| Rate for Payer: ASR ASR |
$2.96
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.44
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Healthscope Whirlpool |
$2.96
|
| Rate for Payer: Mclaren Commercial |
$2.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.68
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
IP
|
$2.43
|
|
|
Service Code
|
NDC 51079-433-01
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$2.43 |
| Rate for Payer: Aetna Commercial |
$2.19
|
| Rate for Payer: ASR ASR |
$2.36
|
| Rate for Payer: BCBS Trust/PPO |
$1.88
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Healthscope Whirlpool |
$2.36
|
| Rate for Payer: Mclaren Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.14
|
|
|
TRIAMTERENE 75 MG-HYDROCHLOROTHIAZIDE 50 MG TABLET
|
Facility
IP
|
$248.90
|
|
|
Service Code
|
NDC 60505-2657-1
|
| Hospital Charge Code |
8134
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$224.01
|
| Rate for Payer: ASR ASR |
$241.43
|
| Rate for Payer: BCBS Trust/PPO |
$192.97
|
| Rate for Payer: BCN Commercial |
$192.97
|
| Rate for Payer: Cash Price |
$199.12
|
| Rate for Payer: Cofinity Commercial |
$233.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.12
|
| Rate for Payer: Healthscope Commercial |
$248.90
|
| Rate for Payer: Healthscope Whirlpool |
$241.43
|
| Rate for Payer: Mclaren Commercial |
$224.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$219.03
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
IP
|
$16.88
|
|
|
Service Code
|
NDC 24208-585-64
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$16.88 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: ASR ASR |
$16.37
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Commercial |
$15.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$16.88
|
| Rate for Payer: Healthscope Whirlpool |
$16.37
|
| Rate for Payer: Mclaren Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.85
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
IP
|
$31.08
|
|
|
Service Code
|
NDC 61314-355-01
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$31.08 |
| Rate for Payer: Aetna Commercial |
$27.97
|
| Rate for Payer: ASR ASR |
$30.15
|
| Rate for Payer: BCBS Trust/PPO |
$24.10
|
| Rate for Payer: BCN Commercial |
$24.10
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cofinity Commercial |
$29.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Healthscope Commercial |
$31.08
|
| Rate for Payer: Healthscope Whirlpool |
$30.15
|
| Rate for Payer: Mclaren Commercial |
$27.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.35
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
IP
|
$23.13
|
|
|
Service Code
|
NDC 24208-585-59
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Aetna Commercial |
$20.82
|
| Rate for Payer: ASR ASR |
$22.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$21.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.50
|
| Rate for Payer: Healthscope Commercial |
$23.13
|
| Rate for Payer: Healthscope Whirlpool |
$22.44
|
| Rate for Payer: Mclaren Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.35
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
IP
|
$297.88
|
|
|
Service Code
|
NDC 0998-0355-15
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.52 |
| Max. Negotiated Rate |
$297.88 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: ASR ASR |
$288.94
|
| Rate for Payer: BCBS Trust/PPO |
$230.95
|
| Rate for Payer: BCN Commercial |
$230.95
|
| Rate for Payer: Cash Price |
$238.31
|
| Rate for Payer: Cofinity Commercial |
$280.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.30
|
| Rate for Payer: Healthscope Commercial |
$297.88
|
| Rate for Payer: Healthscope Whirlpool |
$288.94
|
| Rate for Payer: Mclaren Commercial |
$268.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.13
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
IP
|
$26.20
|
|
|
Service Code
|
NDC 17478-102-12
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$20.31
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$26.20
|
| Rate for Payer: Healthscope Whirlpool |
$25.41
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.06
|
|
|
TRYPAN BLUE 0.06 % INTRAOCULAR SYRINGE
|
Facility
IP
|
$182.04
|
|
|
Service Code
|
NDC 68803-612-10
|
| Hospital Charge Code |
88317
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.43 |
| Max. Negotiated Rate |
$182.04 |
| Rate for Payer: Aetna Commercial |
$163.84
|
| Rate for Payer: ASR ASR |
$176.58
|
| Rate for Payer: BCBS Trust/PPO |
$141.14
|
| Rate for Payer: BCN Commercial |
$141.14
|
| Rate for Payer: Cash Price |
$145.63
|
| Rate for Payer: Cofinity Commercial |
$171.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.63
|
| Rate for Payer: Healthscope Commercial |
$182.04
|
| Rate for Payer: Healthscope Whirlpool |
$176.58
|
| Rate for Payer: Mclaren Commercial |
$163.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$154.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.20
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$909.62
|
|
|
Service Code
|
NDC 49281-752-98
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$636.73 |
| Max. Negotiated Rate |
$909.62 |
| Rate for Payer: Aetna Commercial |
$818.66
|
| Rate for Payer: ASR ASR |
$882.33
|
| Rate for Payer: BCBS Trust/PPO |
$705.23
|
| Rate for Payer: BCN Commercial |
$705.23
|
| Rate for Payer: Cash Price |
$727.69
|
| Rate for Payer: Cofinity Commercial |
$855.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$727.70
|
| Rate for Payer: Healthscope Commercial |
$909.62
|
| Rate for Payer: Healthscope Whirlpool |
$882.33
|
| Rate for Payer: Mclaren Commercial |
$818.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$773.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$636.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$800.47
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$1,058.15
|
|
|
Service Code
|
NDC 42023-104-05
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$740.70 |
| Max. Negotiated Rate |
$1,058.15 |
| Rate for Payer: Aetna Commercial |
$952.34
|
| Rate for Payer: ASR ASR |
$1,026.41
|
| Rate for Payer: BCBS Trust/PPO |
$820.38
|
| Rate for Payer: BCN Commercial |
$820.38
|
| Rate for Payer: Cash Price |
$846.52
|
| Rate for Payer: Cofinity Commercial |
$994.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$846.52
|
| Rate for Payer: Healthscope Commercial |
$1,058.15
|
| Rate for Payer: Healthscope Whirlpool |
$1,026.41
|
| Rate for Payer: Mclaren Commercial |
$952.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$899.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$740.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$931.17
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$271.61
|
|
|
Service Code
|
NDC 42023-104-01
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$190.13 |
| Max. Negotiated Rate |
$271.61 |
| Rate for Payer: Aetna Commercial |
$244.45
|
| Rate for Payer: ASR ASR |
$263.46
|
| Rate for Payer: BCBS Trust/PPO |
$210.58
|
| Rate for Payer: BCN Commercial |
$210.58
|
| Rate for Payer: Cash Price |
$217.29
|
| Rate for Payer: Cofinity Commercial |
$255.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.29
|
| Rate for Payer: Healthscope Commercial |
$271.61
|
| Rate for Payer: Healthscope Whirlpool |
$263.46
|
| Rate for Payer: Mclaren Commercial |
$244.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.02
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
IP
|
$57,271.54
|
|
|
Service Code
|
MS-DRG 278
|
| Min. Negotiated Rate |
$37,472.23 |
| Max. Negotiated Rate |
$57,271.54 |
| Rate for Payer: Aetna Medicare |
$39,444.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,305.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,305.56
|
| Rate for Payer: BCBS MAPPO |
$39,444.45
|
| Rate for Payer: BCN Medicare Advantage |
$39,444.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,444.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$39,444.45
|
| Rate for Payer: Mclaren Medicare |
$39,444.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41,416.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,361.12
|
| Rate for Payer: PACE Medicare |
$37,472.23
|
| Rate for Payer: PACE SWMI |
$39,444.45
|
| Rate for Payer: PHP Commercial |
$43,388.90
|
| Rate for Payer: PHP Medicare Advantage |
$39,444.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,271.54
|
| Rate for Payer: Priority Health Medicare |
$39,444.45
|
| Rate for Payer: Priority Health Narrow Network |
$45,817.23
|
| Rate for Payer: Railroad Medicare Medicare |
$39,444.45
|
| Rate for Payer: UHC Medicare Advantage |
$40,627.78
|
| Rate for Payer: VA VA |
$39,444.45
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
IP
|
$41,095.70
|
|
|
Service Code
|
MS-DRG 279
|
| Min. Negotiated Rate |
$27,339.57 |
| Max. Negotiated Rate |
$41,095.70 |
| Rate for Payer: Aetna Medicare |
$28,778.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,973.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,973.11
|
| Rate for Payer: BCBS MAPPO |
$28,778.49
|
| Rate for Payer: BCN Medicare Advantage |
$28,778.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,778.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$28,778.49
|
| Rate for Payer: Mclaren Medicare |
$28,778.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,217.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,095.26
|
| Rate for Payer: PACE Medicare |
$27,339.57
|
| Rate for Payer: PACE SWMI |
$28,778.49
|
| Rate for Payer: PHP Commercial |
$31,656.34
|
| Rate for Payer: PHP Medicare Advantage |
$28,778.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,095.70
|
| Rate for Payer: Priority Health Medicare |
$28,778.49
|
| Rate for Payer: Priority Health Narrow Network |
$32,876.56
|
| Rate for Payer: Railroad Medicare Medicare |
$28,778.49
|
| Rate for Payer: UHC Medicare Advantage |
$29,641.84
|
| Rate for Payer: VA VA |
$28,778.49
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
IP
|
$39,483.00
|
|
|
Service Code
|
MS-DRG 173
|
| Min. Negotiated Rate |
$26,329.35 |
| Max. Negotiated Rate |
$39,483.00 |
| Rate for Payer: Aetna Medicare |
$27,715.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,643.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,643.89
|
| Rate for Payer: BCBS MAPPO |
$27,715.11
|
| Rate for Payer: BCN Medicare Advantage |
$27,715.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,715.11
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,715.11
|
| Rate for Payer: Mclaren Medicare |
$27,715.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,100.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,872.38
|
| Rate for Payer: PACE Medicare |
$26,329.35
|
| Rate for Payer: PACE SWMI |
$27,715.11
|
| Rate for Payer: PHP Commercial |
$30,486.62
|
| Rate for Payer: PHP Medicare Advantage |
$27,715.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,483.00
|
| Rate for Payer: Priority Health Medicare |
$27,715.11
|
| Rate for Payer: Priority Health Narrow Network |
$31,586.40
|
| Rate for Payer: Railroad Medicare Medicare |
$27,715.11
|
| Rate for Payer: UHC Medicare Advantage |
$28,546.56
|
| Rate for Payer: VA VA |
$27,715.11
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
IP
|
$134.68
|
|
|
Service Code
|
NDC 0173-0873-06
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$121.21
|
| Rate for Payer: ASR ASR |
$130.64
|
| Rate for Payer: BCBS Trust/PPO |
$104.42
|
| Rate for Payer: BCN Commercial |
$104.42
|
| Rate for Payer: Cash Price |
$107.74
|
| Rate for Payer: Cofinity Commercial |
$126.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.74
|
| Rate for Payer: Healthscope Commercial |
$134.68
|
| Rate for Payer: Healthscope Whirlpool |
$130.64
|
| Rate for Payer: Mclaren Commercial |
$121.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.52
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
IP
|
$17,952.89
|
|
|
Service Code
|
MS-DRG 383
|
| Min. Negotiated Rate |
$12,842.71 |
| Max. Negotiated Rate |
$17,952.89 |
| Rate for Payer: Aetna Medicare |
$13,518.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,898.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,898.30
|
| Rate for Payer: BCBS MAPPO |
$13,518.64
|
| Rate for Payer: BCN Medicare Advantage |
$13,518.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,518.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,518.64
|
| Rate for Payer: Mclaren Medicare |
$13,518.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,194.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,546.44
|
| Rate for Payer: PACE Medicare |
$12,842.71
|
| Rate for Payer: PACE SWMI |
$13,518.64
|
| Rate for Payer: PHP Commercial |
$14,870.50
|
| Rate for Payer: PHP Medicare Advantage |
$13,518.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,952.89
|
| Rate for Payer: Priority Health Medicare |
$13,518.64
|
| Rate for Payer: Priority Health Narrow Network |
$14,362.31
|
| Rate for Payer: Railroad Medicare Medicare |
$13,518.64
|
| Rate for Payer: UHC Medicare Advantage |
$13,924.20
|
| Rate for Payer: VA VA |
$13,518.64
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
IP
|
$11,368.70
|
|
|
Service Code
|
MS-DRG 384
|
| Min. Negotiated Rate |
$8,640.21 |
| Max. Negotiated Rate |
$11,368.70 |
| Rate for Payer: Aetna Medicare |
$9,094.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,368.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,368.70
|
| Rate for Payer: BCBS MAPPO |
$9,094.96
|
| Rate for Payer: BCN Medicare Advantage |
$9,094.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,094.96
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,094.96
|
| Rate for Payer: Mclaren Medicare |
$9,094.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,549.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,459.20
|
| Rate for Payer: PACE Medicare |
$8,640.21
|
| Rate for Payer: PACE SWMI |
$9,094.96
|
| Rate for Payer: PHP Commercial |
$10,004.46
|
| Rate for Payer: PHP Medicare Advantage |
$9,094.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,243.99
|
| Rate for Payer: Priority Health Medicare |
$9,094.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,995.19
|
| Rate for Payer: Railroad Medicare Medicare |
$9,094.96
|
| Rate for Payer: UHC Medicare Advantage |
$9,367.81
|
| Rate for Payer: VA VA |
$9,094.96
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
IP
|
$21,053.75
|
|
|
Service Code
|
MS-DRG 256
|
| Min. Negotiated Rate |
$14,785.12 |
| Max. Negotiated Rate |
$21,053.75 |
| Rate for Payer: Aetna Medicare |
$15,563.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,454.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,454.10
|
| Rate for Payer: BCBS MAPPO |
$15,563.28
|
| Rate for Payer: BCN Medicare Advantage |
$15,563.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,563.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,563.28
|
| Rate for Payer: Mclaren Medicare |
$15,563.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,341.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,897.77
|
| Rate for Payer: PACE Medicare |
$14,785.12
|
| Rate for Payer: PACE SWMI |
$15,563.28
|
| Rate for Payer: PHP Commercial |
$17,119.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,563.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,053.75
|
| Rate for Payer: Priority Health Medicare |
$15,563.28
|
| Rate for Payer: Priority Health Narrow Network |
$16,843.00
|
| Rate for Payer: Railroad Medicare Medicare |
$15,563.28
|
| Rate for Payer: UHC Medicare Advantage |
$16,030.18
|
| Rate for Payer: VA VA |
$15,563.28
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$35,276.62
|
|
|
Service Code
|
MS-DRG 255
|
| Min. Negotiated Rate |
$23,694.43 |
| Max. Negotiated Rate |
$35,276.62 |
| Rate for Payer: Aetna Medicare |
$24,941.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,176.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,176.89
|
| Rate for Payer: BCBS MAPPO |
$24,941.51
|
| Rate for Payer: BCN Medicare Advantage |
$24,941.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,941.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,941.51
|
| Rate for Payer: Mclaren Medicare |
$24,941.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,188.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,682.74
|
| Rate for Payer: PACE Medicare |
$23,694.43
|
| Rate for Payer: PACE SWMI |
$24,941.51
|
| Rate for Payer: PHP Commercial |
$27,435.66
|
| Rate for Payer: PHP Medicare Advantage |
$24,941.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,276.62
|
| Rate for Payer: Priority Health Medicare |
$24,941.51
|
| Rate for Payer: Priority Health Narrow Network |
$28,221.30
|
| Rate for Payer: Railroad Medicare Medicare |
$24,941.51
|
| Rate for Payer: UHC Medicare Advantage |
$25,689.76
|
| Rate for Payer: VA VA |
$24,941.51
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$12,724.44
|
|
|
Service Code
|
MS-DRG 257
|
| Min. Negotiated Rate |
$9,567.58 |
| Max. Negotiated Rate |
$12,724.44 |
| Rate for Payer: Aetna Medicare |
$10,071.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,588.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,588.92
|
| Rate for Payer: BCBS MAPPO |
$10,071.14
|
| Rate for Payer: BCN Medicare Advantage |
$10,071.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,071.14
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,071.14
|
| Rate for Payer: Mclaren Medicare |
$10,071.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,574.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,581.81
|
| Rate for Payer: PACE Medicare |
$9,567.58
|
| Rate for Payer: PACE SWMI |
$10,071.14
|
| Rate for Payer: PHP Commercial |
$11,078.25
|
| Rate for Payer: PHP Medicare Advantage |
$10,071.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,724.44
|
| Rate for Payer: Priority Health Medicare |
$10,071.14
|
| Rate for Payer: Priority Health Narrow Network |
$10,179.55
|
| Rate for Payer: Railroad Medicare Medicare |
$10,071.14
|
| Rate for Payer: UHC Medicare Advantage |
$10,373.27
|
| Rate for Payer: VA VA |
$10,071.14
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
IP
|
$21,980.80
|
|
|
Service Code
|
MS-DRG 671
|
| Min. Negotiated Rate |
$15,365.83 |
| Max. Negotiated Rate |
$21,980.80 |
| Rate for Payer: Aetna Medicare |
$16,174.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,218.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,218.20
|
| Rate for Payer: BCBS MAPPO |
$16,174.56
|
| Rate for Payer: BCN Medicare Advantage |
$16,174.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,174.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,174.56
|
| Rate for Payer: Mclaren Medicare |
$16,174.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,983.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,600.74
|
| Rate for Payer: PACE Medicare |
$15,365.83
|
| Rate for Payer: PACE SWMI |
$16,174.56
|
| Rate for Payer: PHP Commercial |
$17,792.02
|
| Rate for Payer: PHP Medicare Advantage |
$16,174.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,980.80
|
| Rate for Payer: Priority Health Medicare |
$16,174.56
|
| Rate for Payer: Priority Health Narrow Network |
$17,584.64
|
| Rate for Payer: Railroad Medicare Medicare |
$16,174.56
|
| Rate for Payer: UHC Medicare Advantage |
$16,659.80
|
| Rate for Payer: VA VA |
$16,174.56
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$12,022.74
|
|
|
Service Code
|
MS-DRG 672
|
| Min. Negotiated Rate |
$9,137.28 |
| Max. Negotiated Rate |
$12,022.74 |
| Rate for Payer: Aetna Medicare |
$9,618.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,022.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,022.74
|
| Rate for Payer: BCBS MAPPO |
$9,618.19
|
| Rate for Payer: BCN Medicare Advantage |
$9,618.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,618.19
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,618.19
|
| Rate for Payer: Mclaren Medicare |
$9,618.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,099.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,060.92
|
| Rate for Payer: PACE Medicare |
$9,137.28
|
| Rate for Payer: PACE SWMI |
$9,618.19
|
| Rate for Payer: PHP Commercial |
$10,580.01
|
| Rate for Payer: PHP Medicare Advantage |
$9,618.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,847.47
|
| Rate for Payer: Priority Health Medicare |
$9,618.19
|
| Rate for Payer: Priority Health Narrow Network |
$9,477.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9,618.19
|
| Rate for Payer: UHC Medicare Advantage |
$9,906.74
|
| Rate for Payer: VA VA |
$9,618.19
|
|
