|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
OP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$965.87 |
| Max. Negotiated Rate |
$2,945.40 |
| Rate for Payer: Aetna Commercial |
$2,286.41
|
| Rate for Payer: Aetna Medicare |
$1,344.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.43
|
| Rate for Payer: BCBS Complete |
$1,075.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,945.40
|
| Rate for Payer: BCN Commercial |
$2,945.40
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Advantage |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,151.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,017.42
|
| Rate for Payer: PHP Commercial |
$2,286.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,207.34
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
| Rate for Payer: Priority Health Tiered Network |
$965.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,349.60
|
| Rate for Payer: UHC Core |
$2,349.60
|
| Rate for Payer: UHC Exchange |
$2,349.60
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
IP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,694.64 |
| Max. Negotiated Rate |
$2,420.91 |
| Rate for Payer: Aetna Commercial |
$2,286.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.43
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Advantage |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,017.42
|
| Rate for Payer: PHP Commercial |
$2,286.41
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$26,432.57
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$25,173.88 |
| Max. Negotiated Rate |
$26,432.57 |
| Rate for Payer: BCBS Complete |
$26,432.57
|
| Rate for Payer: Mclaren Medicaid |
$25,173.88
|
| Rate for Payer: Meridian Medicaid |
$26,432.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,173.88
|
| Rate for Payer: UHC Medicaid |
$25,173.88
|
| Rate for Payer: UHCCP Medicaid |
$25,173.88
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$35,829.53
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$34,123.36 |
| Max. Negotiated Rate |
$35,829.53 |
| Rate for Payer: BCBS Complete |
$35,829.53
|
| Rate for Payer: Mclaren Medicaid |
$34,123.36
|
| Rate for Payer: Meridian Medicaid |
$35,829.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$34,123.36
|
| Rate for Payer: UHC Medicaid |
$34,123.36
|
| Rate for Payer: UHCCP Medicaid |
$34,123.36
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,014.56
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$21,918.62 |
| Max. Negotiated Rate |
$23,014.56 |
| Rate for Payer: BCBS Complete |
$23,014.56
|
| Rate for Payer: Mclaren Medicaid |
$21,918.62
|
| Rate for Payer: Meridian Medicaid |
$23,014.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,918.62
|
| Rate for Payer: UHC Medicaid |
$21,918.62
|
| Rate for Payer: UHCCP Medicaid |
$21,918.62
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$31,691.45
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$30,182.33 |
| Max. Negotiated Rate |
$31,691.45 |
| Rate for Payer: BCBS Complete |
$31,691.45
|
| Rate for Payer: Mclaren Medicaid |
$30,182.33
|
| Rate for Payer: Meridian Medicaid |
$31,691.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,182.33
|
| Rate for Payer: UHC Medicaid |
$30,182.33
|
| Rate for Payer: UHCCP Medicaid |
$30,182.33
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$124,616.76
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$56,679.70 |
| Max. Negotiated Rate |
$124,616.76 |
| Rate for Payer: Aetna Medicare |
$62,049.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74,578.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74,578.55
|
| Rate for Payer: BCBS MAPPO |
$59,662.84
|
| Rate for Payer: BCBS Trust/PPO |
$113,519.44
|
| Rate for Payer: BCN Commercial |
$113,519.44
|
| Rate for Payer: BCN Medicare Advantage |
$59,662.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59,662.84
|
| Rate for Payer: Mclaren Medicare |
$59,662.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62,645.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68,612.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$65,629.12
|
| Rate for Payer: Nomi Health Commercial |
$98,623.08
|
| Rate for Payer: PACE Medicare |
$56,679.70
|
| Rate for Payer: PACE SWMI |
$59,662.84
|
| Rate for Payer: PHP Medicare Advantage |
$59,662.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123,256.98
|
| Rate for Payer: Priority Health Medicare |
$59,662.84
|
| Rate for Payer: Priority Health Tiered Network |
$98,605.57
|
| Rate for Payer: Railroad Medicare Medicare |
$59,662.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124,616.76
|
| Rate for Payer: UHC Core |
$104,257.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59,662.84
|
| Rate for Payer: UHC Exchange |
$85,144.59
|
| Rate for Payer: VA VA |
$59,662.84
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$93,718.61
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$40,656.20 |
| Max. Negotiated Rate |
$93,718.61 |
| Rate for Payer: Aetna Medicare |
$44,507.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,495.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,495.00
|
| Rate for Payer: BCBS MAPPO |
$42,796.00
|
| Rate for Payer: BCBS Trust/PPO |
$93,718.61
|
| Rate for Payer: BCN Commercial |
$93,718.61
|
| Rate for Payer: BCN Medicare Advantage |
$42,796.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,796.00
|
| Rate for Payer: Mclaren Medicare |
$42,796.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,935.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,215.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$47,075.60
|
| Rate for Payer: Nomi Health Commercial |
$70,468.83
|
| Rate for Payer: PACE Medicare |
$40,656.20
|
| Rate for Payer: PACE SWMI |
$42,796.00
|
| Rate for Payer: PHP Medicare Advantage |
$42,796.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88,070.41
|
| Rate for Payer: Priority Health Medicare |
$42,796.00
|
| Rate for Payer: Priority Health Tiered Network |
$70,456.32
|
| Rate for Payer: Railroad Medicare Medicare |
$42,796.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,042.01
|
| Rate for Payer: UHC Core |
$74,494.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42,796.00
|
| Rate for Payer: UHC Exchange |
$60,838.09
|
| Rate for Payer: VA VA |
$42,796.00
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$35,703.40
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$34,003.24 |
| Max. Negotiated Rate |
$35,703.40 |
| Rate for Payer: BCBS Complete |
$35,703.40
|
| Rate for Payer: Mclaren Medicaid |
$34,003.24
|
| Rate for Payer: Meridian Medicaid |
$35,703.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$34,003.24
|
| Rate for Payer: UHC Medicaid |
$34,003.24
|
| Rate for Payer: UHCCP Medicaid |
$34,003.24
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$18,635.69
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$17,748.28 |
| Max. Negotiated Rate |
$18,635.69 |
| Rate for Payer: BCBS Complete |
$18,635.69
|
| Rate for Payer: Mclaren Medicaid |
$17,748.28
|
| Rate for Payer: Meridian Medicaid |
$18,635.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,748.28
|
| Rate for Payer: UHC Medicaid |
$17,748.28
|
| Rate for Payer: UHCCP Medicaid |
$17,748.28
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,585.56
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$22,462.44 |
| Max. Negotiated Rate |
$23,585.56 |
| Rate for Payer: BCBS Complete |
$23,585.56
|
| Rate for Payer: Mclaren Medicaid |
$22,462.44
|
| Rate for Payer: Meridian Medicaid |
$23,585.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,462.44
|
| Rate for Payer: UHC Medicaid |
$22,462.44
|
| Rate for Payer: UHCCP Medicaid |
$22,462.44
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$22,365.01
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$21,300.01 |
| Max. Negotiated Rate |
$22,365.01 |
| Rate for Payer: BCBS Complete |
$22,365.01
|
| Rate for Payer: Mclaren Medicaid |
$21,300.01
|
| Rate for Payer: Meridian Medicaid |
$22,365.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,300.01
|
| Rate for Payer: UHC Medicaid |
$21,300.01
|
| Rate for Payer: UHCCP Medicaid |
$21,300.01
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$96,597.79
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$43,636.22 |
| Max. Negotiated Rate |
$96,597.79 |
| Rate for Payer: Aetna Medicare |
$47,770.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,416.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,416.07
|
| Rate for Payer: BCBS MAPPO |
$45,932.86
|
| Rate for Payer: BCBS Trust/PPO |
$96,597.79
|
| Rate for Payer: BCN Commercial |
$96,597.79
|
| Rate for Payer: BCN Medicare Advantage |
$45,932.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,932.86
|
| Rate for Payer: Mclaren Medicare |
$45,932.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,229.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,822.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$50,526.15
|
| Rate for Payer: Nomi Health Commercial |
$75,704.94
|
| Rate for Payer: PACE Medicare |
$43,636.22
|
| Rate for Payer: PACE SWMI |
$45,932.86
|
| Rate for Payer: PHP Medicare Advantage |
$45,932.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94,614.39
|
| Rate for Payer: Priority Health Medicare |
$45,932.86
|
| Rate for Payer: Priority Health Tiered Network |
$75,691.50
|
| Rate for Payer: Railroad Medicare Medicare |
$45,932.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95,658.18
|
| Rate for Payer: UHC Core |
$80,030.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45,932.86
|
| Rate for Payer: UHC Exchange |
$65,358.60
|
| Rate for Payer: VA VA |
$45,932.86
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$76,843.78
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$31,303.46 |
| Max. Negotiated Rate |
$76,843.78 |
| Rate for Payer: Aetna Medicare |
$34,269.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,188.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,188.76
|
| Rate for Payer: BCBS MAPPO |
$32,951.01
|
| Rate for Payer: BCBS Trust/PPO |
$76,843.78
|
| Rate for Payer: BCN Commercial |
$76,843.78
|
| Rate for Payer: BCN Medicare Advantage |
$32,951.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,951.01
|
| Rate for Payer: Mclaren Medicare |
$32,951.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,598.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,893.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,246.11
|
| Rate for Payer: Nomi Health Commercial |
$54,035.52
|
| Rate for Payer: PACE Medicare |
$31,303.46
|
| Rate for Payer: PACE SWMI |
$32,951.01
|
| Rate for Payer: PHP Medicare Advantage |
$32,951.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67,532.42
|
| Rate for Payer: Priority Health Medicare |
$32,951.01
|
| Rate for Payer: Priority Health Tiered Network |
$54,025.93
|
| Rate for Payer: Railroad Medicare Medicare |
$32,951.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,277.44
|
| Rate for Payer: UHC Core |
$57,122.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,951.01
|
| Rate for Payer: UHC Exchange |
$46,650.67
|
| Rate for Payer: VA VA |
$32,951.01
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$143,256.96
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$62,440.81 |
| Max. Negotiated Rate |
$143,256.96 |
| Rate for Payer: Aetna Medicare |
$68,356.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82,158.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82,158.96
|
| Rate for Payer: BCBS MAPPO |
$65,727.17
|
| Rate for Payer: BCBS Trust/PPO |
$143,256.96
|
| Rate for Payer: BCN Commercial |
$143,256.96
|
| Rate for Payer: BCN Medicare Advantage |
$65,727.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65,727.17
|
| Rate for Payer: Mclaren Medicare |
$65,727.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69,013.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75,586.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$72,299.89
|
| Rate for Payer: Nomi Health Commercial |
$108,745.71
|
| Rate for Payer: PACE Medicare |
$62,440.81
|
| Rate for Payer: PACE SWMI |
$65,727.17
|
| Rate for Payer: PHP Medicare Advantage |
$65,727.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$135,908.03
|
| Rate for Payer: Priority Health Medicare |
$65,727.17
|
| Rate for Payer: Priority Health Tiered Network |
$108,726.41
|
| Rate for Payer: Railroad Medicare Medicare |
$65,727.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137,407.37
|
| Rate for Payer: UHC Core |
$114,958.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65,727.17
|
| Rate for Payer: UHC Exchange |
$93,883.80
|
| Rate for Payer: VA VA |
$65,727.17
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$128,343.72
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$45,060.54 |
| Max. Negotiated Rate |
$128,343.72 |
| Rate for Payer: Aetna Medicare |
$49,329.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,290.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,290.19
|
| Rate for Payer: BCBS MAPPO |
$47,432.15
|
| Rate for Payer: BCBS Trust/PPO |
$128,343.72
|
| Rate for Payer: BCN Commercial |
$128,343.72
|
| Rate for Payer: BCN Medicare Advantage |
$47,432.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,432.15
|
| Rate for Payer: Mclaren Medicare |
$47,432.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,803.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,546.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$52,175.36
|
| Rate for Payer: Nomi Health Commercial |
$78,207.54
|
| Rate for Payer: PACE Medicare |
$45,060.54
|
| Rate for Payer: PACE SWMI |
$47,432.15
|
| Rate for Payer: PHP Medicare Advantage |
$47,432.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97,742.09
|
| Rate for Payer: Priority Health Medicare |
$47,432.15
|
| Rate for Payer: Priority Health Tiered Network |
$78,193.66
|
| Rate for Payer: Railroad Medicare Medicare |
$47,432.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98,820.38
|
| Rate for Payer: UHC Core |
$82,675.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47,432.15
|
| Rate for Payer: UHC Exchange |
$67,519.18
|
| Rate for Payer: VA VA |
$47,432.15
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$97,508.36
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$32,321.01 |
| Max. Negotiated Rate |
$97,508.36 |
| Rate for Payer: Aetna Medicare |
$35,383.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,527.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,527.65
|
| Rate for Payer: BCBS MAPPO |
$34,022.12
|
| Rate for Payer: BCBS Trust/PPO |
$97,508.36
|
| Rate for Payer: BCN Commercial |
$97,508.36
|
| Rate for Payer: BCN Medicare Advantage |
$34,022.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,022.12
|
| Rate for Payer: Mclaren Medicare |
$34,022.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35,723.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,125.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,424.33
|
| Rate for Payer: Nomi Health Commercial |
$55,823.46
|
| Rate for Payer: PACE Medicare |
$32,321.01
|
| Rate for Payer: PACE SWMI |
$34,022.12
|
| Rate for Payer: PHP Medicare Advantage |
$34,022.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69,766.95
|
| Rate for Payer: Priority Health Medicare |
$34,022.12
|
| Rate for Payer: Priority Health Tiered Network |
$55,813.55
|
| Rate for Payer: Railroad Medicare Medicare |
$34,022.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70,536.62
|
| Rate for Payer: UHC Core |
$59,012.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,022.12
|
| Rate for Payer: UHC Exchange |
$48,194.25
|
| Rate for Payer: VA VA |
$34,022.12
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$64,292.41
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$23,684.12 |
| Max. Negotiated Rate |
$64,292.41 |
| Rate for Payer: Aetna Medicare |
$25,927.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,163.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,163.31
|
| Rate for Payer: BCBS MAPPO |
$24,930.65
|
| Rate for Payer: BCBS Trust/PPO |
$64,292.41
|
| Rate for Payer: BCN Commercial |
$64,292.41
|
| Rate for Payer: BCN Medicare Advantage |
$24,930.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,930.65
|
| Rate for Payer: Mclaren Medicare |
$24,930.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,177.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,670.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,423.72
|
| Rate for Payer: Nomi Health Commercial |
$40,647.90
|
| Rate for Payer: PACE Medicare |
$23,684.12
|
| Rate for Payer: PACE SWMI |
$24,930.65
|
| Rate for Payer: PHP Medicare Advantage |
$24,930.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,800.86
|
| Rate for Payer: Priority Health Medicare |
$24,930.65
|
| Rate for Payer: Priority Health Tiered Network |
$40,640.68
|
| Rate for Payer: Railroad Medicare Medicare |
$24,930.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,361.30
|
| Rate for Payer: UHC Core |
$42,970.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,930.65
|
| Rate for Payer: UHC Exchange |
$35,092.69
|
| Rate for Payer: VA VA |
$24,930.65
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$52,329.52
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$24,120.22 |
| Max. Negotiated Rate |
$52,329.52 |
| Rate for Payer: Aetna Medicare |
$26,405.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,737.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,737.14
|
| Rate for Payer: BCBS MAPPO |
$25,389.71
|
| Rate for Payer: BCBS Trust/PPO |
$38,091.84
|
| Rate for Payer: BCN Commercial |
$38,091.84
|
| Rate for Payer: BCN Medicare Advantage |
$25,389.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,389.71
|
| Rate for Payer: Mclaren Medicare |
$25,389.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,659.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,198.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,928.68
|
| Rate for Payer: Nomi Health Commercial |
$41,414.16
|
| Rate for Payer: PACE Medicare |
$24,120.22
|
| Rate for Payer: PACE SWMI |
$25,389.71
|
| Rate for Payer: PHP Medicare Advantage |
$25,389.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,758.52
|
| Rate for Payer: Priority Health Medicare |
$25,389.71
|
| Rate for Payer: Priority Health Tiered Network |
$41,406.81
|
| Rate for Payer: Railroad Medicare Medicare |
$25,389.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,329.52
|
| Rate for Payer: UHC Core |
$43,780.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,389.71
|
| Rate for Payer: UHC Exchange |
$35,754.22
|
| Rate for Payer: VA VA |
$25,389.71
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,464.61 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,464.61
|
| Rate for Payer: BCN Commercial |
$3,464.61
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL PHALANX OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,106.25 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,106.25
|
| Rate for Payer: BCN Commercial |
$3,106.25
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$291.09
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.39 |
| Max. Negotiated Rate |
$261.98 |
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Advantage |
$57.94
|
| Rate for Payer: Cofinity Advantage |
$92.27
|
| Rate for Payer: Cofinity Advantage |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: Priority Health SBD |
$83.05
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$131.82
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.07 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Medicare |
$65.91
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Trust/PPO |
$51.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.81
|
| Rate for Payer: BCBS Trust/PPO |
$51.81
|
| Rate for Payer: BCN Commercial |
$51.81
|
| Rate for Payer: BCN Commercial |
$51.81
|
| Rate for Payer: BCN Commercial |
$51.81
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cofinity Advantage |
$203.76
|
| Rate for Payer: Cofinity Advantage |
$92.27
|
| Rate for Payer: Cofinity Advantage |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Core |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
| Rate for Payer: UHC Exchange |
$34.07
|
|
|
CPT 0255T
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Aetna Medicare |
$234.50
|
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.75
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$26,626.60
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$12,328.54 |
| Max. Negotiated Rate |
$26,626.60 |
| Rate for Payer: Aetna Medicare |
$13,496.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,221.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,221.76
|
| Rate for Payer: BCBS MAPPO |
$12,977.41
|
| Rate for Payer: BCBS Trust/PPO |
$26,626.60
|
| Rate for Payer: BCN Commercial |
$26,626.60
|
| Rate for Payer: BCN Medicare Advantage |
$12,977.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,977.41
|
| Rate for Payer: Mclaren Medicare |
$12,977.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,626.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,924.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,275.15
|
| Rate for Payer: Nomi Health Commercial |
$20,695.47
|
| Rate for Payer: PACE Medicare |
$12,328.54
|
| Rate for Payer: PACE SWMI |
$12,977.41
|
| Rate for Payer: PHP Medicare Advantage |
$12,977.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,864.75
|
| Rate for Payer: Priority Health Medicare |
$12,977.41
|
| Rate for Payer: Priority Health Tiered Network |
$20,691.80
|
| Rate for Payer: Railroad Medicare Medicare |
$12,977.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,150.09
|
| Rate for Payer: UHC Core |
$21,877.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,977.41
|
| Rate for Payer: UHC Exchange |
$17,867.09
|
| Rate for Payer: VA VA |
$12,977.41
|
|
