|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$26.33
|
|
|
Service Code
|
NDC 43598021025
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.74 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna Commercial |
$23.69
|
| Rate for Payer: ASR ASR |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$21.62
|
| Rate for Payer: BCN Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$25.54
|
| Rate for Payer: Healthscope Whirlpool |
$26.32
|
| Rate for Payer: Mclaren Commercial |
$23.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.38
|
| Rate for Payer: Nomi Health Commercial |
$21.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.17
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$35.98
|
|
|
Service Code
|
NDC 61570013120
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$35.98 |
| Rate for Payer: Aetna Commercial |
$32.38
|
| Rate for Payer: Aetna Medicare |
$13.31
|
| Rate for Payer: ASR ASR |
$34.90
|
| Rate for Payer: BCBS Complete |
$14.39
|
| Rate for Payer: BCBS Trust/PPO |
$29.67
|
| Rate for Payer: BCN Commercial |
$29.67
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cofinity Commercial |
$33.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.78
|
| Rate for Payer: Healthscope Commercial |
$34.90
|
| Rate for Payer: Healthscope Whirlpool |
$35.98
|
| Rate for Payer: Mclaren Commercial |
$32.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.58
|
| Rate for Payer: Nomi Health Commercial |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.53
|
| Rate for Payer: Priority Health Narrow Network |
$25.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.66
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 77333081210
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.44 |
| Max. Negotiated Rate |
$411.25 |
| Rate for Payer: Aetna Commercial |
$370.12
|
| Rate for Payer: ASR ASR |
$398.91
|
| Rate for Payer: BCBS Trust/PPO |
$337.72
|
| Rate for Payer: BCN Commercial |
$337.72
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$386.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$398.91
|
| Rate for Payer: Healthscope Whirlpool |
$411.25
|
| Rate for Payer: Mclaren Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.90
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$4.11
|
|
|
Service Code
|
NDC 77333081225
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: Aetna Medicare |
$1.52
|
| Rate for Payer: ASR ASR |
$3.99
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: BCBS Trust/PPO |
$3.39
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$3.99
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.60
|
| Rate for Payer: Priority Health Narrow Network |
$2.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.62
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 77333081210
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.16 |
| Max. Negotiated Rate |
$411.25 |
| Rate for Payer: Aetna Commercial |
$370.12
|
| Rate for Payer: Aetna Medicare |
$152.16
|
| Rate for Payer: ASR ASR |
$398.91
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: BCBS Trust/PPO |
$339.08
|
| Rate for Payer: BCN Commercial |
$339.08
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$386.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$398.91
|
| Rate for Payer: Healthscope Whirlpool |
$411.25
|
| Rate for Payer: Mclaren Commercial |
$370.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: Nomi Health Commercial |
$337.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$360.34
|
| Rate for Payer: Priority Health Narrow Network |
$288.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.90
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$54.05
|
|
|
Service Code
|
NDC 904720660
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.54 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: BCBS Trust/PPO |
$44.39
|
| Rate for Payer: BCN Commercial |
$44.39
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Healthscope Whirlpool |
$54.05
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
IP
|
$4.11
|
|
|
Service Code
|
NDC 77333081225
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Aetna Commercial |
$3.70
|
| Rate for Payer: ASR ASR |
$3.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.38
|
| Rate for Payer: BCN Commercial |
$3.38
|
| Rate for Payer: Cash Price |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.29
|
| Rate for Payer: Healthscope Commercial |
$3.99
|
| Rate for Payer: Healthscope Whirlpool |
$4.11
|
| Rate for Payer: Mclaren Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: Nomi Health Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.62
|
|
|
SIMETHICONE 80 MG CHEWABLE TABLET
|
Facility
|
OP
|
$54.05
|
|
|
Service Code
|
NDC 904720660
|
| Hospital Charge Code |
7227
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$54.05 |
| Rate for Payer: Aetna Commercial |
$48.65
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: ASR ASR |
$52.43
|
| Rate for Payer: BCBS Complete |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$44.56
|
| Rate for Payer: BCN Commercial |
$44.56
|
| Rate for Payer: Cash Price |
$43.24
|
| Rate for Payer: Cofinity Commercial |
$50.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.24
|
| Rate for Payer: Healthscope Commercial |
$52.43
|
| Rate for Payer: Healthscope Whirlpool |
$54.05
|
| Rate for Payer: Mclaren Commercial |
$48.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.94
|
| Rate for Payer: Nomi Health Commercial |
$44.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.36
|
| Rate for Payer: Priority Health Narrow Network |
$37.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.56
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$11,714.81
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$7,180.04 |
| Max. Negotiated Rate |
$11,714.81 |
| Rate for Payer: Aetna Medicare |
$7,557.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,447.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,447.42
|
| Rate for Payer: BCBS MAPPO |
$7,557.94
|
| Rate for Payer: BCN Medicare Advantage |
$7,557.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,557.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,557.94
|
| Rate for Payer: Mclaren Medicare |
$7,557.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,935.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,691.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,313.73
|
| Rate for Payer: PACE Medicare |
$7,180.04
|
| Rate for Payer: PACE SWMI |
$7,557.94
|
| Rate for Payer: PHP Commercial |
$8,313.73
|
| Rate for Payer: PHP Medicare Advantage |
$7,557.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,072.10
|
| Rate for Payer: Priority Health Medicare |
$7,557.94
|
| Rate for Payer: Priority Health Narrow Network |
$8,857.68
|
| Rate for Payer: Railroad Medicare Medicare |
$7,557.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,557.94
|
| Rate for Payer: UHC Exchange |
$11,714.81
|
| Rate for Payer: UHCCP DNSP |
$7,557.94
|
| Rate for Payer: VA VA |
$7,557.94
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$18,058.28
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$10,658.78 |
| Max. Negotiated Rate |
$18,058.28 |
| Rate for Payer: Aetna Medicare |
$11,219.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,024.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,024.71
|
| Rate for Payer: BCBS MAPPO |
$11,219.77
|
| Rate for Payer: BCN Medicare Advantage |
$11,219.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,219.77
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,219.77
|
| Rate for Payer: Mclaren Medicare |
$11,219.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,780.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,902.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,341.75
|
| Rate for Payer: PACE Medicare |
$10,658.78
|
| Rate for Payer: PACE SWMI |
$11,219.77
|
| Rate for Payer: PHP Commercial |
$12,341.75
|
| Rate for Payer: PHP Medicare Advantage |
$11,219.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,058.28
|
| Rate for Payer: Priority Health Medicare |
$11,219.77
|
| Rate for Payer: Priority Health Narrow Network |
$14,446.62
|
| Rate for Payer: Railroad Medicare Medicare |
$11,219.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,219.77
|
| Rate for Payer: UHC Exchange |
$17,390.64
|
| Rate for Payer: UHCCP DNSP |
$11,219.77
|
| Rate for Payer: VA VA |
$11,219.77
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC
|
Facility
|
IP
|
$9,734.70
|
|
|
Service Code
|
MSDRG 195
|
| Min. Negotiated Rate |
$5,966.43 |
| Max. Negotiated Rate |
$9,734.70 |
| Rate for Payer: Aetna Medicare |
$6,280.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,850.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,850.56
|
| Rate for Payer: BCBS MAPPO |
$6,280.45
|
| Rate for Payer: BCN Medicare Advantage |
$6,280.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,280.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,280.45
|
| Rate for Payer: Mclaren Medicare |
$6,280.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,594.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,222.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,908.49
|
| Rate for Payer: PACE Medicare |
$5,966.43
|
| Rate for Payer: PACE SWMI |
$6,280.45
|
| Rate for Payer: PHP Commercial |
$6,908.49
|
| Rate for Payer: PHP Medicare Advantage |
$6,280.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,634.84
|
| Rate for Payer: Priority Health Medicare |
$6,280.45
|
| Rate for Payer: Priority Health Narrow Network |
$6,907.87
|
| Rate for Payer: Railroad Medicare Medicare |
$6,280.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,280.45
|
| Rate for Payer: UHC Exchange |
$9,734.70
|
| Rate for Payer: UHCCP DNSP |
$6,280.45
|
| Rate for Payer: VA VA |
$6,280.45
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$309.86
|
|
|
Service Code
|
CPT 12011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$309.86
|
|
|
Service Code
|
CPT 12002
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$309.86 |
| Rate for Payer: Aetna Medicare |
$199.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$109.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$219.90
|
| Rate for Payer: PHP Medicaid |
$107.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$293.24
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Narrow Network |
$234.60
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Exchange |
$309.86
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP DNSP |
$199.91
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT
|
Facility
|
IP
|
$77,000.48
|
|
|
Service Code
|
MSDRG 008
|
| Min. Negotiated Rate |
$40,008.82 |
| Max. Negotiated Rate |
$77,000.48 |
| Rate for Payer: Aetna Medicare |
$42,114.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,643.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,643.19
|
| Rate for Payer: BCBS MAPPO |
$42,114.55
|
| Rate for Payer: BCN Medicare Advantage |
$42,114.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,114.55
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,114.55
|
| Rate for Payer: Mclaren Medicare |
$42,114.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,220.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,431.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$46,326.00
|
| Rate for Payer: PACE Medicare |
$40,008.82
|
| Rate for Payer: PACE SWMI |
$42,114.55
|
| Rate for Payer: PHP Commercial |
$46,326.00
|
| Rate for Payer: PHP Medicare Advantage |
$42,114.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$77,000.48
|
| Rate for Payer: Priority Health Medicare |
$42,114.55
|
| Rate for Payer: Priority Health Narrow Network |
$61,600.38
|
| Rate for Payer: Railroad Medicare Medicare |
$42,114.55
|
| Rate for Payer: UHCCP DNSP |
$42,114.55
|
| Rate for Payer: VA VA |
$42,114.55
|
|
|
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS
|
Facility
|
IP
|
$98,020.84
|
|
|
Service Code
|
MSDRG 019
|
| Min. Negotiated Rate |
$50,475.83 |
| Max. Negotiated Rate |
$98,020.84 |
| Rate for Payer: Aetna Medicare |
$53,132.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,415.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,415.56
|
| Rate for Payer: BCBS MAPPO |
$53,132.45
|
| Rate for Payer: BCN Medicare Advantage |
$53,132.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,132.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,132.45
|
| Rate for Payer: Mclaren Medicare |
$53,132.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55,789.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,102.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$58,445.69
|
| Rate for Payer: PACE Medicare |
$50,475.83
|
| Rate for Payer: PACE SWMI |
$53,132.45
|
| Rate for Payer: PHP Commercial |
$58,445.69
|
| Rate for Payer: PHP Medicare Advantage |
$53,132.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98,020.84
|
| Rate for Payer: Priority Health Medicare |
$53,132.45
|
| Rate for Payer: Priority Health Narrow Network |
$78,416.67
|
| Rate for Payer: Railroad Medicare Medicare |
$53,132.45
|
| Rate for Payer: UHCCP DNSP |
$53,132.45
|
| Rate for Payer: VA VA |
$53,132.45
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$253.80
|
|
|
Service Code
|
NDC 63739057110
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.91 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: Aetna Medicare |
$93.91
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: BCBS Complete |
$101.52
|
| Rate for Payer: BCBS Trust/PPO |
$209.26
|
| Rate for Payer: BCN Commercial |
$209.26
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$246.19
|
| Rate for Payer: Healthscope Whirlpool |
$253.80
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$222.38
|
| Rate for Payer: Priority Health Narrow Network |
$177.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
SIMVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$253.80
|
|
|
Service Code
|
NDC 63739057110
|
| Hospital Charge Code |
11364
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.35 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Aetna Commercial |
$228.42
|
| Rate for Payer: ASR ASR |
$246.19
|
| Rate for Payer: BCBS Trust/PPO |
$208.42
|
| Rate for Payer: BCN Commercial |
$208.42
|
| Rate for Payer: Cash Price |
$203.04
|
| Rate for Payer: Cofinity Commercial |
$238.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.04
|
| Rate for Payer: Healthscope Commercial |
$246.19
|
| Rate for Payer: Healthscope Whirlpool |
$253.80
|
| Rate for Payer: Mclaren Commercial |
$228.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.73
|
| Rate for Payer: Nomi Health Commercial |
$208.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.34
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$55,236.85
|
|
|
Service Code
|
MSDRG 402
|
| Min. Negotiated Rate |
$29,171.71 |
| Max. Negotiated Rate |
$55,236.85 |
| Rate for Payer: Aetna Medicare |
$30,707.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,383.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,383.82
|
| Rate for Payer: BCBS MAPPO |
$30,707.06
|
| Rate for Payer: BCN Medicare Advantage |
$30,707.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,707.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$30,707.06
|
| Rate for Payer: Mclaren Medicare |
$30,707.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,242.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,313.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,777.77
|
| Rate for Payer: PACE Medicare |
$29,171.71
|
| Rate for Payer: PACE SWMI |
$30,707.06
|
| Rate for Payer: PHP Commercial |
$33,777.77
|
| Rate for Payer: PHP Medicare Advantage |
$30,707.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55,236.85
|
| Rate for Payer: Priority Health Medicare |
$30,707.06
|
| Rate for Payer: Priority Health Narrow Network |
$44,189.48
|
| Rate for Payer: Railroad Medicare Medicare |
$30,707.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,707.06
|
| Rate for Payer: UHC Exchange |
$47,595.94
|
| Rate for Payer: UHCCP DNSP |
$30,707.06
|
| Rate for Payer: VA VA |
$30,707.06
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$13,092.97
|
|
|
Service Code
|
APR-DRG 3001
|
| Min. Negotiated Rate |
$11,837.61 |
| Max. Negotiated Rate |
$13,092.97 |
| Rate for Payer: BCBS Complete |
$13,092.97
|
| Rate for Payer: Mclaren Medicaid |
$12,469.49
|
| Rate for Payer: Meridian Medicaid |
$13,092.97
|
| Rate for Payer: PHP Medicaid |
$11,837.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,469.49
|
| Rate for Payer: UHC Medicaid |
$12,469.49
|
| Rate for Payer: UHCCP Medicaid |
$12,469.49
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$19,837.27
|
|
|
Service Code
|
APR-DRG 3003
|
| Min. Negotiated Rate |
$17,935.27 |
| Max. Negotiated Rate |
$19,837.27 |
| Rate for Payer: BCBS Complete |
$19,837.27
|
| Rate for Payer: Mclaren Medicaid |
$18,892.64
|
| Rate for Payer: Meridian Medicaid |
$19,837.27
|
| Rate for Payer: PHP Medicaid |
$17,935.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,892.64
|
| Rate for Payer: UHC Medicaid |
$18,892.64
|
| Rate for Payer: UHCCP Medicaid |
$18,892.64
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$26,008.28
|
|
|
Service Code
|
APR-DRG 3004
|
| Min. Negotiated Rate |
$23,514.60 |
| Max. Negotiated Rate |
$26,008.28 |
| Rate for Payer: BCBS Complete |
$26,008.28
|
| Rate for Payer: Mclaren Medicaid |
$24,769.79
|
| Rate for Payer: Meridian Medicaid |
$26,008.28
|
| Rate for Payer: PHP Medicaid |
$23,514.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,769.79
|
| Rate for Payer: UHC Medicaid |
$24,769.79
|
| Rate for Payer: UHCCP Medicaid |
$24,769.79
|
|
|
SINGLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$14,969.78
|
|
|
Service Code
|
APR-DRG 3002
|
| Min. Negotiated Rate |
$13,534.47 |
| Max. Negotiated Rate |
$14,969.78 |
| Rate for Payer: BCBS Complete |
$14,969.78
|
| Rate for Payer: Mclaren Medicaid |
$14,256.93
|
| Rate for Payer: Meridian Medicaid |
$14,969.78
|
| Rate for Payer: PHP Medicaid |
$13,534.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,256.93
|
| Rate for Payer: UHC Medicaid |
$14,256.93
|
| Rate for Payer: UHCCP Medicaid |
$14,256.93
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$73,222.31
|
|
|
Service Code
|
MSDRG 450
|
| Min. Negotiated Rate |
$38,127.49 |
| Max. Negotiated Rate |
$73,222.31 |
| Rate for Payer: Aetna Medicare |
$40,134.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,167.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,167.75
|
| Rate for Payer: BCBS MAPPO |
$40,134.20
|
| Rate for Payer: BCN Medicare Advantage |
$40,134.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,134.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$40,134.20
|
| Rate for Payer: Mclaren Medicare |
$40,134.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42,140.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,154.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$44,147.62
|
| Rate for Payer: PACE Medicare |
$38,127.49
|
| Rate for Payer: PACE SWMI |
$40,134.20
|
| Rate for Payer: PHP Commercial |
$44,147.62
|
| Rate for Payer: PHP Medicare Advantage |
$40,134.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73,222.31
|
| Rate for Payer: Priority Health Medicare |
$40,134.20
|
| Rate for Payer: Priority Health Narrow Network |
$58,577.85
|
| Rate for Payer: Railroad Medicare Medicare |
$40,134.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40,134.20
|
| Rate for Payer: UHC Exchange |
$62,208.01
|
| Rate for Payer: UHCCP DNSP |
$40,134.20
|
| Rate for Payer: VA VA |
$40,134.20
|
|
|
SINGLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$44,381.82
|
|
|
Service Code
|
MSDRG 451
|
| Min. Negotiated Rate |
$23,766.48 |
| Max. Negotiated Rate |
$44,381.82 |
| Rate for Payer: Aetna Medicare |
$25,017.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,271.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,271.69
|
| Rate for Payer: BCBS MAPPO |
$25,017.35
|
| Rate for Payer: BCN Medicare Advantage |
$25,017.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,017.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$25,017.35
|
| Rate for Payer: Mclaren Medicare |
$25,017.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,268.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,769.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,519.08
|
| Rate for Payer: PACE Medicare |
$23,766.48
|
| Rate for Payer: PACE SWMI |
$25,017.35
|
| Rate for Payer: PHP Commercial |
$27,519.08
|
| Rate for Payer: PHP Medicare Advantage |
$25,017.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,381.82
|
| Rate for Payer: Priority Health Medicare |
$25,017.35
|
| Rate for Payer: Priority Health Narrow Network |
$35,505.46
|
| Rate for Payer: Railroad Medicare Medicare |
$25,017.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,017.35
|
| Rate for Payer: UHC Exchange |
$38,776.89
|
| Rate for Payer: UHCCP DNSP |
$25,017.35
|
| Rate for Payer: VA VA |
$25,017.35
|
|
|
SINUS AND MASTOID PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$29,813.20
|
|
|
Service Code
|
MSDRG 135
|
| Min. Negotiated Rate |
$16,512.09 |
| Max. Negotiated Rate |
$29,813.20 |
| Rate for Payer: Aetna Medicare |
$17,381.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,726.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,726.44
|
| Rate for Payer: BCBS MAPPO |
$17,381.15
|
| Rate for Payer: BCN Medicare Advantage |
$17,381.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,381.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,381.15
|
| Rate for Payer: Mclaren Medicare |
$17,381.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,250.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,988.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,119.26
|
| Rate for Payer: PACE Medicare |
$16,512.09
|
| Rate for Payer: PACE SWMI |
$17,381.15
|
| Rate for Payer: PHP Commercial |
$19,119.26
|
| Rate for Payer: PHP Medicare Advantage |
$17,381.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,813.20
|
| Rate for Payer: Priority Health Medicare |
$17,381.15
|
| Rate for Payer: Priority Health Narrow Network |
$23,850.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17,381.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,381.15
|
| Rate for Payer: UHC Exchange |
$26,940.78
|
| Rate for Payer: UHCCP DNSP |
$17,381.15
|
| Rate for Payer: VA VA |
$17,381.15
|
|
