|
AMPICILLIN 250 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$14.65
|
|
|
Service Code
|
NDC 0781-3402-95
|
| Hospital Charge Code |
473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$13.18 |
| Rate for Payer: Aetna Commercial |
$12.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.52
|
| Rate for Payer: Cash Price |
$11.72
|
| Rate for Payer: Cofinity Commercial |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.45
|
| Rate for Payer: PHP Commercial |
$12.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.26
|
| Rate for Payer: Priority Health SBD |
$9.23
|
|
|
AMPICILLIN 2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.04 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Commercial |
$25.02
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Aetna Commercial |
$47.49
|
| Rate for Payer: Aetna Commercial |
$16.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.57
|
| Rate for Payer: Cash Price |
$15.65
|
| Rate for Payer: Cash Price |
$14.22
|
| Rate for Payer: Cash Price |
$19.16
|
| Rate for Payer: Cash Price |
$44.70
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$12.45
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Cofinity Commercial |
$13.69
|
| Rate for Payer: Cofinity Commercial |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Cofinity Commercial |
$48.05
|
| Rate for Payer: Healthscope Commercial |
$26.49
|
| Rate for Payer: Healthscope Commercial |
$17.60
|
| Rate for Payer: Healthscope Commercial |
$50.28
|
| Rate for Payer: Healthscope Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.02
|
| Rate for Payer: PHP Commercial |
$47.49
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$25.02
|
| Rate for Payer: PHP Commercial |
$15.11
|
| Rate for Payer: PHP Commercial |
$20.36
|
| Rate for Payer: PHP Commercial |
$16.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$15.09
|
| Rate for Payer: Priority Health SBD |
$11.20
|
| Rate for Payer: Priority Health SBD |
$18.54
|
| Rate for Payer: Priority Health SBD |
$35.20
|
| Rate for Payer: Priority Health SBD |
$12.32
|
|
|
AMPICILLIN 500 MG/5 ML INJECTION SOLUTION
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG IM
|
Facility
IP
|
$10.46
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
155218
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$9.41 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN 500 MG SOLUTION FOR INJECTION
|
Facility
IP
|
$10.44
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Aetna Commercial |
$8.87
|
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Cash Price |
$8.35
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$9.00
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$8.98
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$9.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.89
|
| Rate for Payer: PHP Commercial |
$8.87
|
| Rate for Payer: PHP Commercial |
$8.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.31
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$6.59
|
|
|
AMPICILLIN IV 0.0004 MG/ML SYRINGE FOR DESENSITIZATION
|
Facility
IP
|
$0.63
|
|
|
Service Code
|
HCPCS J0290
|
| Hospital Charge Code |
180548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.41
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.44
|
| Rate for Payer: Cofinity Commercial |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$0.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$0.54
|
| Rate for Payer: PHP Commercial |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.44
|
| Rate for Payer: Priority Health SBD |
$0.40
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$26.93
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$24.24 |
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$16.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.45
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$15.33
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$18.85
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$24.71
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$20.34
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Healthscope Commercial |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$17.24
|
| Rate for Payer: Healthscope Commercial |
$25.86
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.42
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$24.70
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: PHP Commercial |
$24.42
|
| Rate for Payer: PHP Commercial |
$16.29
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$11.23
|
| Rate for Payer: Priority Health SBD |
$12.07
|
| Rate for Payer: Priority Health SBD |
$12.78
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$18.10
|
| Rate for Payer: Priority Health SBD |
$18.31
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$36.42
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.78 |
| Rate for Payer: Aetna Commercial |
$30.96
|
| Rate for Payer: Aetna Commercial |
$28.54
|
| Rate for Payer: Aetna Commercial |
$21.65
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$29.14
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cofinity Commercial |
$25.49
|
| Rate for Payer: Cofinity Commercial |
$31.32
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$25.45
|
| Rate for Payer: Cofinity Commercial |
$22.46
|
| Rate for Payer: Cofinity Commercial |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$23.51
|
| Rate for Payer: Cofinity Commercial |
$28.88
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$32.78
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.39
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$28.54
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.65
|
| Rate for Payer: PHP Commercial |
$30.96
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.66
|
| Rate for Payer: Priority Health SBD |
$22.94
|
| Rate for Payer: Priority Health SBD |
$21.16
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$16.05
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$20.22
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
IP
|
$20.28
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.25 |
| Rate for Payer: Aetna Commercial |
$17.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.18
|
| Rate for Payer: Cash Price |
$16.22
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Healthscope Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.24
|
| Rate for Payer: PHP Commercial |
$17.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.78
|
|
|
AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY, ANY JOINT OR PHALANX, SINGLE, INCLUDING NEURECTOMIES; WITH DIRECT CLOSURE
|
Facility
OP
|
$3,600.14
|
|
|
Service Code
|
CPT 26951
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$700.73 |
| Max. Negotiated Rate |
$3,600.14 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,470.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.80
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$700.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
AMPUTATION, FOOT; TRANSMETATARSAL
|
Facility
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.19 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.51
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$693.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
IP
|
$42,851.54
|
|
|
Service Code
|
MS-DRG 240
|
| Min. Negotiated Rate |
$19,687.81 |
| Max. Negotiated Rate |
$42,851.54 |
| Rate for Payer: Aetna Medicare |
$21,552.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,905.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,905.01
|
| Rate for Payer: BCBS MAPPO |
$20,724.01
|
| Rate for Payer: BCBS Trust/PPO |
$41,728.69
|
| Rate for Payer: BCN Medicare Advantage |
$20,724.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,724.01
|
| Rate for Payer: Mclaren Medicare |
$20,724.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,760.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,832.61
|
| Rate for Payer: PACE Medicare |
$19,687.81
|
| Rate for Payer: PACE SWMI |
$20,724.01
|
| Rate for Payer: PHP Medicare Advantage |
$20,724.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,311.80
|
| Rate for Payer: Priority Health Medicare |
$20,724.01
|
| Rate for Payer: Priority Health Narrow Network |
$32,249.44
|
| Rate for Payer: Railroad Medicare Medicare |
$20,724.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42,851.54
|
| Rate for Payer: UHC Core |
$26,294.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,724.01
|
| Rate for Payer: UHC Exchange |
$28,162.23
|
| Rate for Payer: UHC Medicare Advantage |
$21,345.73
|
| Rate for Payer: VA VA |
$20,724.01
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
IP
|
$73,322.93
|
|
|
Service Code
|
MS-DRG 239
|
| Min. Negotiated Rate |
$33,354.78 |
| Max. Negotiated Rate |
$73,322.93 |
| Rate for Payer: Aetna Medicare |
$36,514.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,887.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,887.88
|
| Rate for Payer: BCBS MAPPO |
$35,110.30
|
| Rate for Payer: BCBS Trust/PPO |
$61,351.25
|
| Rate for Payer: BCN Medicare Advantage |
$35,110.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,110.30
|
| Rate for Payer: Mclaren Medicare |
$35,110.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,865.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,376.84
|
| Rate for Payer: PACE Medicare |
$33,354.78
|
| Rate for Payer: PACE SWMI |
$35,110.30
|
| Rate for Payer: PHP Medicare Advantage |
$35,110.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,977.20
|
| Rate for Payer: Priority Health Medicare |
$35,110.30
|
| Rate for Payer: Priority Health Narrow Network |
$55,181.76
|
| Rate for Payer: Railroad Medicare Medicare |
$35,110.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,322.93
|
| Rate for Payer: UHC Core |
$44,991.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,110.30
|
| Rate for Payer: UHC Exchange |
$48,188.17
|
| Rate for Payer: UHC Medicare Advantage |
$36,163.61
|
| Rate for Payer: VA VA |
$35,110.30
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
IP
|
$21,200.01
|
|
|
Service Code
|
MS-DRG 241
|
| Min. Negotiated Rate |
$10,005.43 |
| Max. Negotiated Rate |
$21,200.01 |
| Rate for Payer: Aetna Medicare |
$10,953.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,165.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,165.04
|
| Rate for Payer: BCBS MAPPO |
$10,532.03
|
| Rate for Payer: BCBS Trust/PPO |
$20,219.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,532.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,532.03
|
| Rate for Payer: Mclaren Medicare |
$10,532.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,058.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,111.83
|
| Rate for Payer: PACE Medicare |
$10,005.43
|
| Rate for Payer: PACE SWMI |
$10,532.03
|
| Rate for Payer: PHP Medicare Advantage |
$10,532.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,943.52
|
| Rate for Payer: Priority Health Medicare |
$10,532.03
|
| Rate for Payer: Priority Health Narrow Network |
$15,954.82
|
| Rate for Payer: Railroad Medicare Medicare |
$10,532.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,200.01
|
| Rate for Payer: UHC Core |
$13,008.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,532.03
|
| Rate for Payer: UHC Exchange |
$13,932.75
|
| Rate for Payer: UHC Medicare Advantage |
$10,847.99
|
| Rate for Payer: VA VA |
$10,532.03
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$33,724.63
|
|
|
Service Code
|
MS-DRG 475
|
| Min. Negotiated Rate |
$15,141.51 |
| Max. Negotiated Rate |
$33,724.63 |
| Rate for Payer: Aetna Medicare |
$16,575.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,923.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,923.04
|
| Rate for Payer: BCBS MAPPO |
$15,938.43
|
| Rate for Payer: BCBS Trust/PPO |
$33,724.63
|
| Rate for Payer: BCN Medicare Advantage |
$15,938.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,938.43
|
| Rate for Payer: Mclaren Medicare |
$15,938.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,735.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,329.19
|
| Rate for Payer: PACE Medicare |
$15,141.51
|
| Rate for Payer: PACE SWMI |
$15,938.43
|
| Rate for Payer: PHP Medicare Advantage |
$15,938.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,776.27
|
| Rate for Payer: Priority Health Medicare |
$15,938.43
|
| Rate for Payer: Priority Health Narrow Network |
$24,621.02
|
| Rate for Payer: Railroad Medicare Medicare |
$15,938.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,715.25
|
| Rate for Payer: UHC Core |
$20,074.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,938.43
|
| Rate for Payer: UHC Exchange |
$21,500.62
|
| Rate for Payer: UHC Medicare Advantage |
$16,416.58
|
| Rate for Payer: VA VA |
$15,938.43
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$70,328.09
|
|
|
Service Code
|
MS-DRG 474
|
| Min. Negotiated Rate |
$29,906.57 |
| Max. Negotiated Rate |
$70,328.09 |
| Rate for Payer: Aetna Medicare |
$32,739.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,350.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,350.75
|
| Rate for Payer: BCBS MAPPO |
$31,480.60
|
| Rate for Payer: BCBS Trust/PPO |
$70,328.09
|
| Rate for Payer: BCN Medicare Advantage |
$31,480.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,480.60
|
| Rate for Payer: Mclaren Medicare |
$31,480.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,054.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,202.69
|
| Rate for Payer: PACE Medicare |
$29,906.57
|
| Rate for Payer: PACE SWMI |
$31,480.60
|
| Rate for Payer: PHP Medicare Advantage |
$31,480.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,744.84
|
| Rate for Payer: Priority Health Medicare |
$31,480.60
|
| Rate for Payer: Priority Health Narrow Network |
$49,395.87
|
| Rate for Payer: Railroad Medicare Medicare |
$31,480.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65,634.91
|
| Rate for Payer: UHC Core |
$40,274.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,480.60
|
| Rate for Payer: UHC Exchange |
$43,135.57
|
| Rate for Payer: UHC Medicare Advantage |
$32,425.02
|
| Rate for Payer: VA VA |
$31,480.60
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$18,728.83
|
|
|
Service Code
|
MS-DRG 476
|
| Min. Negotiated Rate |
$8,520.09 |
| Max. Negotiated Rate |
$18,728.83 |
| Rate for Payer: Aetna Medicare |
$9,327.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,210.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,210.65
|
| Rate for Payer: BCBS MAPPO |
$8,968.52
|
| Rate for Payer: BCBS Trust/PPO |
$18,728.83
|
| Rate for Payer: BCN Medicare Advantage |
$8,968.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,968.52
|
| Rate for Payer: Mclaren Medicare |
$8,968.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,416.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,313.80
|
| Rate for Payer: PACE Medicare |
$8,520.09
|
| Rate for Payer: PACE SWMI |
$8,968.52
|
| Rate for Payer: PHP Medicare Advantage |
$8,968.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,888.42
|
| Rate for Payer: Priority Health Medicare |
$8,968.52
|
| Rate for Payer: Priority Health Narrow Network |
$13,510.74
|
| Rate for Payer: Railroad Medicare Medicare |
$8,968.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,952.43
|
| Rate for Payer: UHC Core |
$11,015.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,968.52
|
| Rate for Payer: UHC Exchange |
$11,798.42
|
| Rate for Payer: UHC Medicare Advantage |
$9,237.58
|
| Rate for Payer: VA VA |
$8,968.52
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.16 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.88
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$417.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$30,271.56
|
|
|
Service Code
|
MS-DRG 617
|
| Min. Negotiated Rate |
$14,045.46 |
| Max. Negotiated Rate |
$30,271.56 |
| Rate for Payer: Aetna Medicare |
$15,376.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,480.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,480.86
|
| Rate for Payer: BCBS MAPPO |
$14,784.69
|
| Rate for Payer: BCBS Trust/PPO |
$25,103.53
|
| Rate for Payer: BCN Medicare Advantage |
$14,784.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,784.69
|
| Rate for Payer: Mclaren Medicare |
$14,784.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,523.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,002.39
|
| Rate for Payer: PACE Medicare |
$14,045.46
|
| Rate for Payer: PACE SWMI |
$14,784.69
|
| Rate for Payer: PHP Medicare Advantage |
$14,784.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,477.42
|
| Rate for Payer: Priority Health Medicare |
$14,784.69
|
| Rate for Payer: Priority Health Narrow Network |
$22,781.94
|
| Rate for Payer: Railroad Medicare Medicare |
$14,784.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,271.56
|
| Rate for Payer: UHC Core |
$18,574.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,784.69
|
| Rate for Payer: UHC Exchange |
$19,894.61
|
| Rate for Payer: UHC Medicare Advantage |
$15,228.23
|
| Rate for Payer: VA VA |
$14,784.69
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
IP
|
$60,370.76
|
|
|
Service Code
|
MS-DRG 616
|
| Min. Negotiated Rate |
$27,545.49 |
| Max. Negotiated Rate |
$60,370.76 |
| Rate for Payer: Aetna Medicare |
$30,155.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,244.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,244.06
|
| Rate for Payer: BCBS MAPPO |
$28,995.25
|
| Rate for Payer: BCBS Trust/PPO |
$39,420.80
|
| Rate for Payer: BCN Medicare Advantage |
$28,995.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,995.25
|
| Rate for Payer: Mclaren Medicare |
$28,995.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,445.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,344.54
|
| Rate for Payer: PACE Medicare |
$27,545.49
|
| Rate for Payer: PACE SWMI |
$28,995.25
|
| Rate for Payer: PHP Medicare Advantage |
$28,995.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,792.68
|
| Rate for Payer: Priority Health Medicare |
$28,995.25
|
| Rate for Payer: Priority Health Narrow Network |
$45,434.14
|
| Rate for Payer: Railroad Medicare Medicare |
$28,995.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60,370.76
|
| Rate for Payer: UHC Core |
$37,044.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,995.25
|
| Rate for Payer: UHC Exchange |
$39,675.94
|
| Rate for Payer: UHC Medicare Advantage |
$29,865.11
|
| Rate for Payer: VA VA |
$28,995.25
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$17,717.52
|
|
|
Service Code
|
MS-DRG 618
|
| Min. Negotiated Rate |
$8,414.73 |
| Max. Negotiated Rate |
$17,717.52 |
| Rate for Payer: Aetna Medicare |
$9,211.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,072.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,072.01
|
| Rate for Payer: BCBS MAPPO |
$8,857.61
|
| Rate for Payer: BCBS Trust/PPO |
$17,367.37
|
| Rate for Payer: BCN Medicare Advantage |
$8,857.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,857.61
|
| Rate for Payer: Mclaren Medicare |
$8,857.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,300.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,186.25
|
| Rate for Payer: PACE Medicare |
$8,414.73
|
| Rate for Payer: PACE SWMI |
$8,857.61
|
| Rate for Payer: PHP Medicare Advantage |
$8,857.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,667.43
|
| Rate for Payer: Priority Health Medicare |
$8,857.61
|
| Rate for Payer: Priority Health Narrow Network |
$13,333.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8,857.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,717.52
|
| Rate for Payer: UHC Core |
$10,871.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,857.61
|
| Rate for Payer: UHC Exchange |
$11,644.04
|
| Rate for Payer: UHC Medicare Advantage |
$9,123.34
|
| Rate for Payer: VA VA |
$8,857.61
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,418.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.22
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$169.29
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.89
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$173.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
IP
|
$23,412.69
|
|
|
Service Code
|
MS-DRG 348
|
| Min. Negotiated Rate |
$9,371.88 |
| Max. Negotiated Rate |
$23,412.69 |
| Rate for Payer: Aetna Medicare |
$10,259.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,331.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,331.42
|
| Rate for Payer: BCBS MAPPO |
$9,865.14
|
| Rate for Payer: BCBS Trust/PPO |
$23,412.69
|
| Rate for Payer: BCN Medicare Advantage |
$9,865.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,865.14
|
| Rate for Payer: Mclaren Medicare |
$9,865.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,358.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,344.91
|
| Rate for Payer: PACE Medicare |
$9,371.88
|
| Rate for Payer: PACE SWMI |
$9,865.14
|
| Rate for Payer: PHP Medicare Advantage |
$9,865.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,674.99
|
| Rate for Payer: Priority Health Medicare |
$9,865.14
|
| Rate for Payer: Priority Health Narrow Network |
$14,939.99
|
| Rate for Payer: Railroad Medicare Medicare |
$9,865.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,851.56
|
| Rate for Payer: UHC Core |
$12,181.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,865.14
|
| Rate for Payer: UHC Exchange |
$13,046.54
|
| Rate for Payer: UHC Medicare Advantage |
$10,161.09
|
| Rate for Payer: VA VA |
$9,865.14
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
IP
|
$60,870.35
|
|
|
Service Code
|
MS-DRG 347
|
| Min. Negotiated Rate |
$17,908.26 |
| Max. Negotiated Rate |
$60,870.35 |
| Rate for Payer: Aetna Medicare |
$19,604.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,563.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,563.50
|
| Rate for Payer: BCBS MAPPO |
$18,850.80
|
| Rate for Payer: BCBS Trust/PPO |
$60,870.35
|
| Rate for Payer: BCN Medicare Advantage |
$18,850.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,850.80
|
| Rate for Payer: Mclaren Medicare |
$18,850.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,793.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,678.42
|
| Rate for Payer: PACE Medicare |
$17,908.26
|
| Rate for Payer: PACE SWMI |
$18,850.80
|
| Rate for Payer: PHP Medicare Advantage |
$18,850.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,579.38
|
| Rate for Payer: Priority Health Medicare |
$18,850.80
|
| Rate for Payer: Priority Health Narrow Network |
$29,263.50
|
| Rate for Payer: Railroad Medicare Medicare |
$18,850.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,883.97
|
| Rate for Payer: UHC Core |
$23,859.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,850.80
|
| Rate for Payer: UHC Exchange |
$25,554.73
|
| Rate for Payer: UHC Medicare Advantage |
$19,416.32
|
| Rate for Payer: VA VA |
$18,850.80
|
|
