|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$24,262.06
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$23,106.72 |
| Max. Negotiated Rate |
$24,262.06 |
| Rate for Payer: BCBS Complete |
$24,262.06
|
| Rate for Payer: Mclaren Medicaid |
$23,106.72
|
| Rate for Payer: Meridian Medicaid |
$24,262.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,106.72
|
| Rate for Payer: UHC Medicaid |
$23,106.72
|
| Rate for Payer: UHCCP Medicaid |
$23,106.72
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$15,465.34
|
|
|
Service Code
|
APR-DRG 3153
|
| Min. Negotiated Rate |
$14,728.90 |
| Max. Negotiated Rate |
$15,465.34 |
| Rate for Payer: BCBS Complete |
$15,465.34
|
| Rate for Payer: Mclaren Medicaid |
$14,728.90
|
| Rate for Payer: Meridian Medicaid |
$15,465.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,728.90
|
| Rate for Payer: UHC Medicaid |
$14,728.90
|
| Rate for Payer: UHCCP Medicaid |
$14,728.90
|
|
|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$11,621.94
|
|
|
Service Code
|
APR-DRG 3152
|
| Min. Negotiated Rate |
$11,068.51 |
| Max. Negotiated Rate |
$11,621.94 |
| Rate for Payer: BCBS Complete |
$11,621.94
|
| Rate for Payer: Mclaren Medicaid |
$11,068.51
|
| Rate for Payer: Meridian Medicaid |
$11,621.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,068.51
|
| Rate for Payer: UHC Medicaid |
$11,068.51
|
| Rate for Payer: UHCCP Medicaid |
$11,068.51
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$4,779.60
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$4,552.00 |
| Max. Negotiated Rate |
$4,779.60 |
| Rate for Payer: BCBS Complete |
$4,779.60
|
| Rate for Payer: Mclaren Medicaid |
$4,552.00
|
| Rate for Payer: Meridian Medicaid |
$4,779.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,552.00
|
| Rate for Payer: UHC Medicaid |
$4,552.00
|
| Rate for Payer: UHCCP Medicaid |
$4,552.00
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$8,225.14
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$7,833.46 |
| Max. Negotiated Rate |
$8,225.14 |
| Rate for Payer: BCBS Complete |
$8,225.14
|
| Rate for Payer: Mclaren Medicaid |
$7,833.46
|
| Rate for Payer: Meridian Medicaid |
$8,225.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,833.46
|
| Rate for Payer: UHC Medicaid |
$7,833.46
|
| Rate for Payer: UHCCP Medicaid |
$7,833.46
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$3,294.18
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$3,137.32 |
| Max. Negotiated Rate |
$3,294.18 |
| Rate for Payer: BCBS Complete |
$3,294.18
|
| Rate for Payer: Mclaren Medicaid |
$3,137.32
|
| Rate for Payer: Meridian Medicaid |
$3,294.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,137.32
|
| Rate for Payer: UHC Medicaid |
$3,137.32
|
| Rate for Payer: UHCCP Medicaid |
$3,137.32
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$12,695.73
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$12,091.17 |
| Max. Negotiated Rate |
$12,695.73 |
| Rate for Payer: BCBS Complete |
$12,695.73
|
| Rate for Payer: Mclaren Medicaid |
$12,091.17
|
| Rate for Payer: Meridian Medicaid |
$12,695.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,091.17
|
| Rate for Payer: UHC Medicaid |
$12,091.17
|
| Rate for Payer: UHCCP Medicaid |
$12,091.17
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$685.19
|
| Rate for Payer: BCN Commercial |
$685.19
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$855.72
|
| Rate for Payer: BCN Commercial |
$855.72
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 45334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.98 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$542.98
|
| Rate for Payer: BCN Commercial |
$542.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 45335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.09 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$413.09
|
| Rate for Payer: BCN Commercial |
$413.09
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 45349
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$633.48 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$633.48
|
| Rate for Payer: BCN Commercial |
$633.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 45338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.61
|
| Rate for Payer: BCN Commercial |
$1,090.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC BALLOON DILATION
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 45340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$633.48
|
| Rate for Payer: BCN Commercial |
$633.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$623.59
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$29,458.97
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$10,254.46 |
| Max. Negotiated Rate |
$29,458.97 |
| Rate for Payer: Aetna Medicare |
$11,225.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,492.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,492.71
|
| Rate for Payer: BCBS MAPPO |
$10,794.17
|
| Rate for Payer: BCBS Trust/PPO |
$29,458.97
|
| Rate for Payer: BCN Commercial |
$29,458.97
|
| Rate for Payer: BCN Medicare Advantage |
$10,794.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,794.17
|
| Rate for Payer: Mclaren Medicare |
$10,794.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,333.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,413.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,873.59
|
| Rate for Payer: Nomi Health Commercial |
$17,051.22
|
| Rate for Payer: PACE Medicare |
$10,254.46
|
| Rate for Payer: PACE SWMI |
$10,794.17
|
| Rate for Payer: PHP Medicare Advantage |
$10,794.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,310.24
|
| Rate for Payer: Priority Health Medicare |
$10,794.17
|
| Rate for Payer: Priority Health Tiered Network |
$17,048.19
|
| Rate for Payer: Railroad Medicare Medicare |
$10,794.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,545.34
|
| Rate for Payer: UHC Core |
$18,025.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,794.17
|
| Rate for Payer: UHC Exchange |
$14,720.89
|
| Rate for Payer: VA VA |
$10,794.17
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$16,605.64
|
|
|
Service Code
|
MSDRG 556
|
| Min. Negotiated Rate |
$6,648.16 |
| Max. Negotiated Rate |
$16,605.64 |
| Rate for Payer: Aetna Medicare |
$7,277.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,747.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,747.58
|
| Rate for Payer: BCBS MAPPO |
$6,998.06
|
| Rate for Payer: BCBS Trust/PPO |
$16,605.64
|
| Rate for Payer: BCN Commercial |
$16,605.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,998.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,998.06
|
| Rate for Payer: Mclaren Medicare |
$6,998.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,347.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,047.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,697.87
|
| Rate for Payer: Nomi Health Commercial |
$10,714.74
|
| Rate for Payer: PACE Medicare |
$6,648.16
|
| Rate for Payer: PACE SWMI |
$6,998.06
|
| Rate for Payer: PHP Medicare Advantage |
$6,998.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,391.05
|
| Rate for Payer: Priority Health Medicare |
$6,998.06
|
| Rate for Payer: Priority Health Tiered Network |
$10,712.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6,998.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,538.78
|
| Rate for Payer: UHC Core |
$11,326.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,998.06
|
| Rate for Payer: UHC Exchange |
$9,250.39
|
| Rate for Payer: VA VA |
$6,998.06
|
|
|
SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$22,382.73
|
|
|
Service Code
|
MSDRG 947
|
| Min. Negotiated Rate |
$9,869.76 |
| Max. Negotiated Rate |
$22,382.73 |
| Rate for Payer: Aetna Medicare |
$10,804.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,986.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,986.52
|
| Rate for Payer: BCBS MAPPO |
$10,389.22
|
| Rate for Payer: BCBS Trust/PPO |
$22,382.73
|
| Rate for Payer: BCN Commercial |
$22,382.73
|
| Rate for Payer: BCN Medicare Advantage |
$10,389.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,389.22
|
| Rate for Payer: Mclaren Medicare |
$10,389.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,908.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,947.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,428.14
|
| Rate for Payer: Nomi Health Commercial |
$16,375.26
|
| Rate for Payer: PACE Medicare |
$9,869.76
|
| Rate for Payer: PACE SWMI |
$10,389.22
|
| Rate for Payer: PHP Medicare Advantage |
$10,389.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,465.44
|
| Rate for Payer: Priority Health Medicare |
$10,389.22
|
| Rate for Payer: Priority Health Tiered Network |
$16,372.35
|
| Rate for Payer: Railroad Medicare Medicare |
$10,389.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,691.22
|
| Rate for Payer: UHC Core |
$17,310.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,389.22
|
| Rate for Payer: UHC Exchange |
$14,137.31
|
| Rate for Payer: VA VA |
$10,389.22
|
|
|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$17,495.14
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$6,427.17 |
| Max. Negotiated Rate |
$17,495.14 |
| Rate for Payer: Aetna Medicare |
$7,036.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,456.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,456.80
|
| Rate for Payer: BCBS MAPPO |
$6,765.44
|
| Rate for Payer: BCBS Trust/PPO |
$17,495.14
|
| Rate for Payer: BCN Commercial |
$17,495.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,765.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,765.44
|
| Rate for Payer: Mclaren Medicare |
$6,765.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,103.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,780.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,441.98
|
| Rate for Payer: Nomi Health Commercial |
$10,326.45
|
| Rate for Payer: PACE Medicare |
$6,427.17
|
| Rate for Payer: PACE SWMI |
$6,765.44
|
| Rate for Payer: PHP Medicare Advantage |
$6,765.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,905.77
|
| Rate for Payer: Priority Health Medicare |
$6,765.44
|
| Rate for Payer: Priority Health Tiered Network |
$10,324.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6,765.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,048.15
|
| Rate for Payer: UHC Core |
$10,916.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,765.44
|
| Rate for Payer: UHC Exchange |
$8,915.17
|
| Rate for Payer: VA VA |
$6,765.44
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$4,202.29
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$4,002.18 |
| Max. Negotiated Rate |
$4,202.29 |
| Rate for Payer: BCBS Complete |
$4,202.29
|
| Rate for Payer: Mclaren Medicaid |
$4,002.18
|
| Rate for Payer: Meridian Medicaid |
$4,202.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,002.18
|
| Rate for Payer: UHC Medicaid |
$4,002.18
|
| Rate for Payer: UHCCP Medicaid |
$4,002.18
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$2,763.88
|
|
|
Service Code
|
APR-DRG 8611
|
| Min. Negotiated Rate |
$2,632.27 |
| Max. Negotiated Rate |
$2,763.88 |
| Rate for Payer: BCBS Complete |
$2,763.88
|
| Rate for Payer: Mclaren Medicaid |
$2,632.27
|
| Rate for Payer: Meridian Medicaid |
$2,763.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,632.27
|
| Rate for Payer: UHC Medicaid |
$2,632.27
|
| Rate for Payer: UHCCP Medicaid |
$2,632.27
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$6,795.32
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$6,471.74 |
| Max. Negotiated Rate |
$6,795.32 |
| Rate for Payer: BCBS Complete |
$6,795.32
|
| Rate for Payer: Mclaren Medicaid |
$6,471.74
|
| Rate for Payer: Meridian Medicaid |
$6,795.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,471.74
|
| Rate for Payer: UHC Medicaid |
$6,471.74
|
| Rate for Payer: UHCCP Medicaid |
$6,471.74
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$9,287.46
|
|
|
Service Code
|
APR-DRG 8614
|
| Min. Negotiated Rate |
$8,845.20 |
| Max. Negotiated Rate |
$9,287.46 |
| Rate for Payer: BCBS Complete |
$9,287.46
|
| Rate for Payer: Mclaren Medicaid |
$8,845.20
|
| Rate for Payer: Meridian Medicaid |
$9,287.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,845.20
|
| Rate for Payer: UHC Medicaid |
$8,845.20
|
| Rate for Payer: UHCCP Medicaid |
$8,845.20
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$20,113.54
|
|
|
Service Code
|
NDC 00069419068
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,904.62 |
| Max. Negotiated Rate |
$18,102.19 |
| Rate for Payer: Aetna Commercial |
$17,096.51
|
| Rate for Payer: Aetna Medicare |
$10,056.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,073.80
|
| Rate for Payer: BCBS Complete |
$8,045.42
|
| Rate for Payer: Cash Price |
$16,090.83
|
| Rate for Payer: Cofinity Advantage |
$14,079.48
|
| Rate for Payer: Cofinity Commercial |
$17,297.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,090.83
|
| Rate for Payer: Healthscope Commercial |
$18,102.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,090.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,096.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,085.16
|
| Rate for Payer: PHP Commercial |
$17,096.51
|
| Rate for Payer: Priority Health SBD |
$12,671.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,073.80
|
| Rate for Payer: UHC Core |
$10,479.15
|
| Rate for Payer: UHC Exchange |
$7,904.62
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$131.76
|
|
|
Service Code
|
NDC 00904667106
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.01 |
| Max. Negotiated Rate |
$118.58 |
| Rate for Payer: Aetna Commercial |
$112.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.64
|
| Rate for Payer: Cash Price |
$105.41
|
| Rate for Payer: Cofinity Advantage |
$92.23
|
| Rate for Payer: Cofinity Commercial |
$113.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.41
|
| Rate for Payer: Healthscope Commercial |
$118.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.82
|
| Rate for Payer: PHP Commercial |
$112.00
|
| Rate for Payer: Priority Health SBD |
$83.01
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
OP
|
$144.96
|
|
|
Service Code
|
NDC 50268071715
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$130.46 |
| Rate for Payer: Aetna Commercial |
$123.22
|
| Rate for Payer: Aetna Medicare |
$72.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.22
|
| Rate for Payer: BCBS Complete |
$57.98
|
| Rate for Payer: Cash Price |
$115.97
|
| Rate for Payer: Cofinity Advantage |
$101.47
|
| Rate for Payer: Cofinity Commercial |
$124.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.97
|
| Rate for Payer: Healthscope Commercial |
$130.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.72
|
| Rate for Payer: PHP Commercial |
$123.22
|
| Rate for Payer: Priority Health SBD |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.22
|
| Rate for Payer: UHC Core |
$75.52
|
| Rate for Payer: UHC Exchange |
$56.97
|
|
