|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$222,387.70
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$80,385.68 |
| Max. Negotiated Rate |
$222,387.70 |
| Rate for Payer: Aetna Medicare |
$88,001.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105,770.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105,770.64
|
| Rate for Payer: BCBS MAPPO |
$84,616.51
|
| Rate for Payer: BCBS Trust/PPO |
$222,387.70
|
| Rate for Payer: BCN Commercial |
$222,387.70
|
| Rate for Payer: BCN Medicare Advantage |
$84,616.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84,616.51
|
| Rate for Payer: Mclaren Medicare |
$84,616.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88,847.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97,308.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$93,078.16
|
| Rate for Payer: Nomi Health Commercial |
$140,275.89
|
| Rate for Payer: PACE Medicare |
$80,385.68
|
| Rate for Payer: PACE SWMI |
$84,616.51
|
| Rate for Payer: PHP Medicare Advantage |
$84,616.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175,313.76
|
| Rate for Payer: Priority Health Medicare |
$84,616.51
|
| Rate for Payer: Priority Health Tiered Network |
$140,250.99
|
| Rate for Payer: Railroad Medicare Medicare |
$84,616.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177,247.83
|
| Rate for Payer: UHC Core |
$148,290.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84,616.51
|
| Rate for Payer: UHC Exchange |
$121,104.85
|
| Rate for Payer: VA VA |
$84,616.51
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$108,989.95
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$49,641.10 |
| Max. Negotiated Rate |
$108,989.95 |
| Rate for Payer: Aetna Medicare |
$54,343.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65,317.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65,317.24
|
| Rate for Payer: BCBS MAPPO |
$52,253.79
|
| Rate for Payer: BCBS Trust/PPO |
$108,372.02
|
| Rate for Payer: BCN Commercial |
$108,372.02
|
| Rate for Payer: BCN Medicare Advantage |
$52,253.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52,253.79
|
| Rate for Payer: Mclaren Medicare |
$52,253.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54,866.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60,091.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$57,479.17
|
| Rate for Payer: Nomi Health Commercial |
$86,255.85
|
| Rate for Payer: PACE Medicare |
$49,641.10
|
| Rate for Payer: PACE SWMI |
$52,253.79
|
| Rate for Payer: PHP Medicare Advantage |
$52,253.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107,800.69
|
| Rate for Payer: Priority Health Medicare |
$52,253.79
|
| Rate for Payer: Priority Health Tiered Network |
$86,240.54
|
| Rate for Payer: Railroad Medicare Medicare |
$52,253.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108,989.95
|
| Rate for Payer: UHC Core |
$91,183.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52,253.79
|
| Rate for Payer: UHC Exchange |
$74,467.55
|
| Rate for Payer: VA VA |
$52,253.79
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$21,666.44
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$8,615.78 |
| Max. Negotiated Rate |
$21,666.44 |
| Rate for Payer: Aetna Medicare |
$9,432.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,336.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,336.55
|
| Rate for Payer: BCBS MAPPO |
$9,069.24
|
| Rate for Payer: BCBS Trust/PPO |
$21,666.44
|
| Rate for Payer: BCN Commercial |
$21,666.44
|
| Rate for Payer: BCN Medicare Advantage |
$9,069.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,069.24
|
| Rate for Payer: Mclaren Medicare |
$9,069.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,522.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,429.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,976.16
|
| Rate for Payer: Nomi Health Commercial |
$14,171.94
|
| Rate for Payer: PACE Medicare |
$8,615.78
|
| Rate for Payer: PACE SWMI |
$9,069.24
|
| Rate for Payer: PHP Medicare Advantage |
$9,069.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,711.78
|
| Rate for Payer: Priority Health Medicare |
$9,069.24
|
| Rate for Payer: Priority Health Tiered Network |
$14,169.42
|
| Rate for Payer: Railroad Medicare Medicare |
$9,069.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,907.18
|
| Rate for Payer: UHC Core |
$14,981.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,069.24
|
| Rate for Payer: UHC Exchange |
$12,235.11
|
| Rate for Payer: VA VA |
$9,069.24
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$38,971.98
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$10,474.73 |
| Max. Negotiated Rate |
$38,971.98 |
| Rate for Payer: Aetna Medicare |
$11,467.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,782.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,782.54
|
| Rate for Payer: BCBS MAPPO |
$11,026.03
|
| Rate for Payer: BCBS Trust/PPO |
$38,971.98
|
| Rate for Payer: BCN Commercial |
$38,971.98
|
| Rate for Payer: BCN Medicare Advantage |
$11,026.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,026.03
|
| Rate for Payer: Mclaren Medicare |
$11,026.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,577.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,679.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,128.63
|
| Rate for Payer: Nomi Health Commercial |
$17,438.22
|
| Rate for Payer: PACE Medicare |
$10,474.73
|
| Rate for Payer: PACE SWMI |
$11,026.03
|
| Rate for Payer: PHP Medicare Advantage |
$11,026.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,793.91
|
| Rate for Payer: Priority Health Medicare |
$11,026.03
|
| Rate for Payer: Priority Health Tiered Network |
$17,435.12
|
| Rate for Payer: Railroad Medicare Medicare |
$11,026.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,034.34
|
| Rate for Payer: UHC Core |
$18,434.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,026.03
|
| Rate for Payer: UHC Exchange |
$15,055.00
|
| Rate for Payer: VA VA |
$11,026.03
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,226.85
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$6,593.84 |
| Max. Negotiated Rate |
$20,226.85 |
| Rate for Payer: Aetna Medicare |
$7,218.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,676.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,676.10
|
| Rate for Payer: BCBS MAPPO |
$6,940.88
|
| Rate for Payer: BCBS Trust/PPO |
$20,226.85
|
| Rate for Payer: BCN Commercial |
$20,226.85
|
| Rate for Payer: BCN Medicare Advantage |
$6,940.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,940.88
|
| Rate for Payer: Mclaren Medicare |
$6,940.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,287.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,982.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,634.97
|
| Rate for Payer: Nomi Health Commercial |
$10,619.28
|
| Rate for Payer: PACE Medicare |
$6,593.84
|
| Rate for Payer: PACE SWMI |
$6,940.88
|
| Rate for Payer: PHP Medicare Advantage |
$6,940.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,271.75
|
| Rate for Payer: Priority Health Medicare |
$6,940.88
|
| Rate for Payer: Priority Health Tiered Network |
$10,617.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6,940.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,418.16
|
| Rate for Payer: UHC Core |
$11,225.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,940.88
|
| Rate for Payer: UHC Exchange |
$9,167.98
|
| Rate for Payer: VA VA |
$6,940.88
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,188.75
|
| Rate for Payer: BCCCP Commercial |
$342.31
|
| Rate for Payer: BCN Commercial |
$2,188.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$293.81 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,697.01
|
| Rate for Payer: BCCCP Commercial |
$293.81
|
| Rate for Payer: BCN Commercial |
$1,697.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,650.58 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,619.97
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,029.65 |
| Max. Negotiated Rate |
$2,357.97 |
| Rate for Payer: Aetna Commercial |
$2,226.97
|
| Rate for Payer: Aetna Medicare |
$1,309.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,702.98
|
| Rate for Payer: BCBS Complete |
$1,047.99
|
| Rate for Payer: Cash Price |
$2,095.98
|
| Rate for Payer: Cofinity Advantage |
$1,833.98
|
| Rate for Payer: Cofinity Commercial |
$2,253.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,095.98
|
| Rate for Payer: Healthscope Commercial |
$2,357.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,095.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,226.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,964.98
|
| Rate for Payer: PHP Commercial |
$2,226.97
|
| Rate for Payer: Priority Health SBD |
$1,650.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.98
|
| Rate for Payer: UHC Core |
$1,365.00
|
| Rate for Payer: UHC Exchange |
$1,029.65
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,017.52 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,049.82
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Advantage |
$1,130.58
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: Priority Health SBD |
$1,017.52
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,615.11
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$634.74 |
| Max. Negotiated Rate |
$1,453.60 |
| Rate for Payer: Aetna Commercial |
$1,372.84
|
| Rate for Payer: Aetna Medicare |
$807.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,049.82
|
| Rate for Payer: BCBS Complete |
$646.04
|
| Rate for Payer: Cash Price |
$1,292.09
|
| Rate for Payer: Cofinity Advantage |
$1,130.58
|
| Rate for Payer: Cofinity Commercial |
$1,388.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,292.09
|
| Rate for Payer: Healthscope Commercial |
$1,453.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,292.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,372.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,211.33
|
| Rate for Payer: PHP Commercial |
$1,372.84
|
| Rate for Payer: Priority Health SBD |
$1,017.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,049.82
|
| Rate for Payer: UHC Core |
$841.47
|
| Rate for Payer: UHC Exchange |
$634.74
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$204.87 |
| Max. Negotiated Rate |
$1,236.55 |
| Rate for Payer: Aetna Commercial |
$1,026.48
|
| Rate for Payer: Aetna Medicare |
$407.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.65
|
| Rate for Payer: BCBS Complete |
$215.13
|
| Rate for Payer: BCBS MAPPO |
$391.72
|
| Rate for Payer: BCBS Trust/PPO |
$982.87
|
| Rate for Payer: BCN Commercial |
$982.87
|
| Rate for Payer: BCN Medicare Advantage |
$391.72
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cofinity Advantage |
$845.33
|
| Rate for Payer: Cofinity Commercial |
$1,038.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.72
|
| Rate for Payer: Healthscope Commercial |
$1,086.86
|
| Rate for Payer: Mclaren Medicaid |
$204.87
|
| Rate for Payer: Mclaren Medicare |
$391.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.31
|
| Rate for Payer: Meridian Medicaid |
$411.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$430.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.48
|
| Rate for Payer: Nomi Health Commercial |
$1,175.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.72
|
| Rate for Payer: PACE Medicare |
$372.13
|
| Rate for Payer: PACE SWMI |
$391.72
|
| Rate for Payer: PHP Commercial |
$1,026.48
|
| Rate for Payer: PHP Medicare Advantage |
$391.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,236.55
|
| Rate for Payer: Priority Health Medicare |
$391.72
|
| Rate for Payer: Priority Health SBD |
$760.80
|
| Rate for Payer: Priority Health Tiered Network |
$989.24
|
| Rate for Payer: Railroad Medicare Medicare |
$391.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.40
|
| Rate for Payer: UHC Core |
$646.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$391.72
|
| Rate for Payer: UHC Exchange |
$646.40
|
| Rate for Payer: UHC Medicaid |
$204.87
|
| Rate for Payer: UHCCP Medicaid |
$204.87
|
| Rate for Payer: VA VA |
$391.72
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,207.62
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$760.80 |
| Max. Negotiated Rate |
$1,086.86 |
| Rate for Payer: Aetna Commercial |
$1,026.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.95
|
| Rate for Payer: Cash Price |
$966.10
|
| Rate for Payer: Cofinity Advantage |
$845.33
|
| Rate for Payer: Cofinity Commercial |
$1,038.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$966.10
|
| Rate for Payer: Healthscope Commercial |
$1,086.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,026.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$905.72
|
| Rate for Payer: PHP Commercial |
$1,026.48
|
| Rate for Payer: Priority Health SBD |
$760.80
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$5,245.69
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$4,995.90 |
| Max. Negotiated Rate |
$5,245.69 |
| Rate for Payer: BCBS Complete |
$5,245.69
|
| Rate for Payer: Mclaren Medicaid |
$4,995.90
|
| Rate for Payer: Meridian Medicaid |
$5,245.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,995.90
|
| Rate for Payer: UHC Medicaid |
$4,995.90
|
| Rate for Payer: UHCCP Medicaid |
$4,995.90
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$6,265.02
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$5,966.69 |
| Max. Negotiated Rate |
$6,265.02 |
| Rate for Payer: BCBS Complete |
$6,265.02
|
| Rate for Payer: Mclaren Medicaid |
$5,966.69
|
| Rate for Payer: Meridian Medicaid |
$6,265.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,966.69
|
| Rate for Payer: UHC Medicaid |
$5,966.69
|
| Rate for Payer: UHCCP Medicaid |
$5,966.69
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$8,654.54
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$8,242.42 |
| Max. Negotiated Rate |
$8,654.54 |
| Rate for Payer: BCBS Complete |
$8,654.54
|
| Rate for Payer: Mclaren Medicaid |
$8,242.42
|
| Rate for Payer: Meridian Medicaid |
$8,654.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,242.42
|
| Rate for Payer: UHC Medicaid |
$8,242.42
|
| Rate for Payer: UHCCP Medicaid |
$8,242.42
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$16,055.27
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$15,290.73 |
| Max. Negotiated Rate |
$16,055.27 |
| Rate for Payer: BCBS Complete |
$16,055.27
|
| Rate for Payer: Mclaren Medicaid |
$15,290.73
|
| Rate for Payer: Meridian Medicaid |
$16,055.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,290.73
|
| Rate for Payer: UHC Medicaid |
$15,290.73
|
| Rate for Payer: UHCCP Medicaid |
$15,290.73
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$24,047.04
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$9,018.09 |
| Max. Negotiated Rate |
$24,047.04 |
| Rate for Payer: Aetna Medicare |
$9,872.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,865.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,865.91
|
| Rate for Payer: BCBS MAPPO |
$9,492.73
|
| Rate for Payer: BCBS Trust/PPO |
$24,047.04
|
| Rate for Payer: BCN Commercial |
$24,047.04
|
| Rate for Payer: BCN Medicare Advantage |
$9,492.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,492.73
|
| Rate for Payer: Mclaren Medicare |
$9,492.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,967.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,916.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,442.00
|
| Rate for Payer: Nomi Health Commercial |
$14,878.86
|
| Rate for Payer: PACE Medicare |
$9,018.09
|
| Rate for Payer: PACE SWMI |
$9,492.73
|
| Rate for Payer: PHP Medicare Advantage |
$9,492.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,595.28
|
| Rate for Payer: Priority Health Medicare |
$9,492.73
|
| Rate for Payer: Priority Health Tiered Network |
$14,876.22
|
| Rate for Payer: Railroad Medicare Medicare |
$9,492.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,800.42
|
| Rate for Payer: UHC Core |
$15,728.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,492.73
|
| Rate for Payer: UHC Exchange |
$12,845.42
|
| Rate for Payer: VA VA |
$9,492.73
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$49,154.46
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$18,770.23 |
| Max. Negotiated Rate |
$49,154.46 |
| Rate for Payer: Aetna Medicare |
$20,548.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,697.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,697.67
|
| Rate for Payer: BCBS MAPPO |
$19,758.14
|
| Rate for Payer: BCBS Trust/PPO |
$49,154.46
|
| Rate for Payer: BCN Commercial |
$49,154.46
|
| Rate for Payer: BCN Medicare Advantage |
$19,758.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,758.14
|
| Rate for Payer: Mclaren Medicare |
$19,758.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,746.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,721.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,733.95
|
| Rate for Payer: Nomi Health Commercial |
$32,013.93
|
| Rate for Payer: PACE Medicare |
$18,770.23
|
| Rate for Payer: PACE SWMI |
$19,758.14
|
| Rate for Payer: PHP Medicare Advantage |
$19,758.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$40,010.31
|
| Rate for Payer: Priority Health Medicare |
$19,758.14
|
| Rate for Payer: Priority Health Tiered Network |
$32,008.25
|
| Rate for Payer: Railroad Medicare Medicare |
$19,758.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,451.71
|
| Rate for Payer: UHC Core |
$33,842.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,758.14
|
| Rate for Payer: UHC Exchange |
$27,638.69
|
| Rate for Payer: VA VA |
$19,758.14
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,545.68
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$6,689.27 |
| Max. Negotiated Rate |
$19,545.68 |
| Rate for Payer: Aetna Medicare |
$7,322.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,801.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,801.67
|
| Rate for Payer: BCBS MAPPO |
$7,041.34
|
| Rate for Payer: BCBS Trust/PPO |
$19,545.68
|
| Rate for Payer: BCN Commercial |
$19,545.68
|
| Rate for Payer: BCN Medicare Advantage |
$7,041.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,041.34
|
| Rate for Payer: Mclaren Medicare |
$7,041.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,393.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,097.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,745.47
|
| Rate for Payer: Nomi Health Commercial |
$10,786.98
|
| Rate for Payer: PACE Medicare |
$6,689.27
|
| Rate for Payer: PACE SWMI |
$7,041.34
|
| Rate for Payer: PHP Medicare Advantage |
$7,041.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,481.33
|
| Rate for Payer: Priority Health Medicare |
$7,041.34
|
| Rate for Payer: Priority Health Tiered Network |
$10,785.07
|
| Rate for Payer: Railroad Medicare Medicare |
$7,041.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,630.06
|
| Rate for Payer: UHC Core |
$11,403.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,041.34
|
| Rate for Payer: UHC Exchange |
$9,312.76
|
| Rate for Payer: VA VA |
$7,041.34
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$4,065.27
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$3,871.69 |
| Max. Negotiated Rate |
$4,065.27 |
| Rate for Payer: BCBS Complete |
$4,065.27
|
| Rate for Payer: Mclaren Medicaid |
$3,871.69
|
| Rate for Payer: Meridian Medicaid |
$4,065.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,871.69
|
| Rate for Payer: UHC Medicaid |
$3,871.69
|
| Rate for Payer: UHCCP Medicaid |
$3,871.69
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$14,820.38
|
|
|
Service Code
|
APR-DRG 3844
|
| Min. Negotiated Rate |
$14,114.65 |
| Max. Negotiated Rate |
$14,820.38 |
| Rate for Payer: BCBS Complete |
$14,820.38
|
| Rate for Payer: Mclaren Medicaid |
$14,114.65
|
| Rate for Payer: Meridian Medicaid |
$14,820.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,114.65
|
| Rate for Payer: UHC Medicaid |
$14,114.65
|
| Rate for Payer: UHCCP Medicaid |
$14,114.65
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$5,109.25
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$4,865.95 |
| Max. Negotiated Rate |
$5,109.25 |
| Rate for Payer: BCBS Complete |
$5,109.25
|
| Rate for Payer: Mclaren Medicaid |
$4,865.95
|
| Rate for Payer: Meridian Medicaid |
$5,109.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,865.95
|
| Rate for Payer: UHC Medicaid |
$4,865.95
|
| Rate for Payer: UHCCP Medicaid |
$4,865.95
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$8,215.96
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$7,824.73 |
| Max. Negotiated Rate |
$8,215.96 |
| Rate for Payer: BCBS Complete |
$8,215.96
|
| Rate for Payer: Mclaren Medicaid |
$7,824.73
|
| Rate for Payer: Meridian Medicaid |
$8,215.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,824.73
|
| Rate for Payer: UHC Medicaid |
$7,824.73
|
| Rate for Payer: UHCCP Medicaid |
$7,824.73
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,373.42
|
| Rate for Payer: BCN Commercial |
$8,373.42
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$6,690.48
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
