|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$29,283.41
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$12,462.88 |
| Max. Negotiated Rate |
$29,283.41 |
| Rate for Payer: Aetna Medicare |
$13,643.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,398.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,398.53
|
| Rate for Payer: BCBS MAPPO |
$13,118.82
|
| Rate for Payer: BCBS Trust/PPO |
$29,283.41
|
| Rate for Payer: BCN Commercial |
$29,283.41
|
| Rate for Payer: BCN Medicare Advantage |
$13,118.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,118.82
|
| Rate for Payer: Mclaren Medicare |
$13,118.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,774.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,086.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,430.70
|
| Rate for Payer: Nomi Health Commercial |
$20,931.54
|
| Rate for Payer: PACE Medicare |
$12,462.88
|
| Rate for Payer: PACE SWMI |
$13,118.82
|
| Rate for Payer: PHP Medicare Advantage |
$13,118.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,159.78
|
| Rate for Payer: Priority Health Medicare |
$13,118.82
|
| Rate for Payer: Priority Health Tiered Network |
$20,927.82
|
| Rate for Payer: Railroad Medicare Medicare |
$13,118.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,448.38
|
| Rate for Payer: UHC Core |
$22,127.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,118.82
|
| Rate for Payer: UHC Exchange |
$18,070.90
|
| Rate for Payer: VA VA |
$13,118.82
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,661.23
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$24,720.04 |
| Max. Negotiated Rate |
$53,661.23 |
| Rate for Payer: Aetna Medicare |
$27,061.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,526.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,526.38
|
| Rate for Payer: BCBS MAPPO |
$26,021.10
|
| Rate for Payer: BCBS Trust/PPO |
$44,426.04
|
| Rate for Payer: BCN Commercial |
$44,426.04
|
| Rate for Payer: BCN Medicare Advantage |
$26,021.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,021.10
|
| Rate for Payer: Mclaren Medicare |
$26,021.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,322.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,924.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,623.21
|
| Rate for Payer: Nomi Health Commercial |
$42,468.09
|
| Rate for Payer: PACE Medicare |
$24,720.04
|
| Rate for Payer: PACE SWMI |
$26,021.10
|
| Rate for Payer: PHP Medicare Advantage |
$26,021.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,075.70
|
| Rate for Payer: Priority Health Medicare |
$26,021.10
|
| Rate for Payer: Priority Health Tiered Network |
$42,460.55
|
| Rate for Payer: Railroad Medicare Medicare |
$26,021.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,661.23
|
| Rate for Payer: UHC Core |
$44,894.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,021.10
|
| Rate for Payer: UHC Exchange |
$36,664.12
|
| Rate for Payer: VA VA |
$26,021.10
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$28,288.57
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$9,180.36 |
| Max. Negotiated Rate |
$28,288.57 |
| Rate for Payer: Aetna Medicare |
$10,050.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,079.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,079.42
|
| Rate for Payer: BCBS MAPPO |
$9,663.54
|
| Rate for Payer: BCBS Trust/PPO |
$28,288.57
|
| Rate for Payer: BCN Commercial |
$28,288.57
|
| Rate for Payer: BCN Medicare Advantage |
$9,663.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,663.54
|
| Rate for Payer: Mclaren Medicare |
$9,663.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,146.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,113.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,629.89
|
| Rate for Payer: Nomi Health Commercial |
$15,163.95
|
| Rate for Payer: PACE Medicare |
$9,180.36
|
| Rate for Payer: PACE SWMI |
$9,663.54
|
| Rate for Payer: PHP Medicare Advantage |
$9,663.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,951.58
|
| Rate for Payer: Priority Health Medicare |
$9,663.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,161.26
|
| Rate for Payer: Railroad Medicare Medicare |
$9,663.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,160.65
|
| Rate for Payer: UHC Core |
$16,030.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,663.54
|
| Rate for Payer: UHC Exchange |
$13,091.54
|
| Rate for Payer: VA VA |
$9,663.54
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$25,018.87
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$11,819.01 |
| Max. Negotiated Rate |
$25,018.87 |
| Rate for Payer: Aetna Medicare |
$12,938.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,551.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,551.33
|
| Rate for Payer: BCBS MAPPO |
$12,441.06
|
| Rate for Payer: BCBS Trust/PPO |
$17,717.52
|
| Rate for Payer: BCN Commercial |
$17,717.52
|
| Rate for Payer: BCN Medicare Advantage |
$12,441.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,441.06
|
| Rate for Payer: Mclaren Medicare |
$12,441.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,063.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,307.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,685.17
|
| Rate for Payer: Nomi Health Commercial |
$19,800.21
|
| Rate for Payer: PACE Medicare |
$11,819.01
|
| Rate for Payer: PACE SWMI |
$12,441.06
|
| Rate for Payer: PHP Medicare Advantage |
$12,441.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,745.87
|
| Rate for Payer: Priority Health Medicare |
$12,441.06
|
| Rate for Payer: Priority Health Tiered Network |
$19,796.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12,441.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,018.87
|
| Rate for Payer: UHC Core |
$20,931.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,441.06
|
| Rate for Payer: UHC Exchange |
$17,094.18
|
| Rate for Payer: VA VA |
$12,441.06
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$142,435.34
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$44,186.12 |
| Max. Negotiated Rate |
$142,435.34 |
| Rate for Payer: Aetna Medicare |
$48,372.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,139.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,139.64
|
| Rate for Payer: BCBS MAPPO |
$46,511.71
|
| Rate for Payer: BCBS Trust/PPO |
$142,435.34
|
| Rate for Payer: BCN Commercial |
$142,435.34
|
| Rate for Payer: BCN Medicare Advantage |
$46,511.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,511.71
|
| Rate for Payer: Mclaren Medicare |
$46,511.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,837.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,488.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$51,162.88
|
| Rate for Payer: Nomi Health Commercial |
$76,671.15
|
| Rate for Payer: PACE Medicare |
$44,186.12
|
| Rate for Payer: PACE SWMI |
$46,511.71
|
| Rate for Payer: PHP Medicare Advantage |
$46,511.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$137,831.40
|
| Rate for Payer: Priority Health Medicare |
$46,511.71
|
| Rate for Payer: Priority Health Tiered Network |
$110,265.10
|
| Rate for Payer: Railroad Medicare Medicare |
$46,511.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96,879.05
|
| Rate for Payer: UHC Core |
$81,051.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46,511.71
|
| Rate for Payer: UHC Exchange |
$66,192.76
|
| Rate for Payer: VA VA |
$46,511.71
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$15,465.34
|
|
|
Service Code
|
APR-DRG 0824
|
| 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
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$5,528.91
|
|
|
Service Code
|
APR-DRG 0822
|
| Min. Negotiated Rate |
$5,265.62 |
| Max. Negotiated Rate |
$5,528.91 |
| Rate for Payer: BCBS Complete |
$5,528.91
|
| Rate for Payer: Mclaren Medicaid |
$5,265.62
|
| Rate for Payer: Meridian Medicaid |
$5,528.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,265.62
|
| Rate for Payer: UHC Medicaid |
$5,265.62
|
| Rate for Payer: UHCCP Medicaid |
$5,265.62
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$10,195.57
|
|
|
Service Code
|
APR-DRG 0823
|
| Min. Negotiated Rate |
$9,710.06 |
| Max. Negotiated Rate |
$10,195.57 |
| Rate for Payer: BCBS Complete |
$10,195.57
|
| Rate for Payer: Mclaren Medicaid |
$9,710.06
|
| Rate for Payer: Meridian Medicaid |
$10,195.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,710.06
|
| Rate for Payer: UHC Medicaid |
$9,710.06
|
| Rate for Payer: UHCCP Medicaid |
$9,710.06
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$3,359.54
|
|
|
Service Code
|
APR-DRG 0821
|
| Min. Negotiated Rate |
$3,199.56 |
| Max. Negotiated Rate |
$3,359.54 |
| Rate for Payer: BCBS Complete |
$3,359.54
|
| Rate for Payer: Mclaren Medicaid |
$3,199.56
|
| Rate for Payer: Meridian Medicaid |
$3,359.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,199.56
|
| Rate for Payer: UHC Medicaid |
$3,199.56
|
| Rate for Payer: UHCCP Medicaid |
$3,199.56
|
|
|
EYELASH TINTING
|
Professional
|
Both
|
$32.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$69.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.17
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Advantage |
$57.26
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Healthscope Commercial |
$73.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.35
|
| Rate for Payer: PHP Commercial |
$69.53
|
| Rate for Payer: Priority Health SBD |
$51.53
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$76.95
|
|
|
Service Code
|
NDC 00781569031
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: Aetna Medicare |
$38.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.02
|
| Rate for Payer: BCBS Complete |
$30.78
|
| Rate for Payer: Cash Price |
$61.56
|
| Rate for Payer: Cofinity Advantage |
$53.87
|
| Rate for Payer: Cofinity Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.56
|
| Rate for Payer: Healthscope Commercial |
$69.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.71
|
| Rate for Payer: PHP Commercial |
$65.41
|
| Rate for Payer: Priority Health SBD |
$48.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.02
|
| Rate for Payer: UHC Core |
$40.09
|
| Rate for Payer: UHC Exchange |
$30.24
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$76.95
|
|
|
Service Code
|
NDC 00781569031
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$69.25 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.02
|
| Rate for Payer: Cash Price |
$61.56
|
| Rate for Payer: Cofinity Advantage |
$53.87
|
| Rate for Payer: Cofinity Commercial |
$66.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.56
|
| Rate for Payer: Healthscope Commercial |
$69.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.71
|
| Rate for Payer: PHP Commercial |
$65.41
|
| Rate for Payer: Priority Health SBD |
$48.48
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$800.43
|
|
|
Service Code
|
NDC 60687037321
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$504.27 |
| Max. Negotiated Rate |
$720.39 |
| Rate for Payer: Aetna Commercial |
$680.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.28
|
| Rate for Payer: Cash Price |
$640.34
|
| Rate for Payer: Cofinity Advantage |
$560.30
|
| Rate for Payer: Cofinity Commercial |
$688.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.34
|
| Rate for Payer: Healthscope Commercial |
$720.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.32
|
| Rate for Payer: PHP Commercial |
$680.37
|
| Rate for Payer: Priority Health SBD |
$504.27
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$26.69
|
|
|
Service Code
|
NDC 60687037311
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$24.02 |
| Rate for Payer: Aetna Commercial |
$22.69
|
| Rate for Payer: Aetna Medicare |
$13.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.35
|
| Rate for Payer: BCBS Complete |
$10.68
|
| Rate for Payer: Cash Price |
$21.35
|
| Rate for Payer: Cofinity Advantage |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$24.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$22.69
|
| Rate for Payer: Priority Health SBD |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.35
|
| Rate for Payer: UHC Core |
$13.91
|
| Rate for Payer: UHC Exchange |
$10.49
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$26.69
|
|
|
Service Code
|
NDC 60687037311
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.81 |
| Max. Negotiated Rate |
$24.02 |
| Rate for Payer: Aetna Commercial |
$22.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.35
|
| Rate for Payer: Cash Price |
$21.35
|
| Rate for Payer: Cofinity Advantage |
$18.68
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.35
|
| Rate for Payer: Healthscope Commercial |
$24.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.02
|
| Rate for Payer: PHP Commercial |
$22.69
|
| Rate for Payer: Priority Health SBD |
$16.81
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$800.43
|
|
|
Service Code
|
NDC 60687037321
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.57 |
| Max. Negotiated Rate |
$720.39 |
| Rate for Payer: Aetna Commercial |
$680.37
|
| Rate for Payer: Aetna Medicare |
$400.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.28
|
| Rate for Payer: BCBS Complete |
$320.17
|
| Rate for Payer: Cash Price |
$640.34
|
| Rate for Payer: Cofinity Advantage |
$560.30
|
| Rate for Payer: Cofinity Commercial |
$688.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.34
|
| Rate for Payer: Healthscope Commercial |
$720.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.32
|
| Rate for Payer: PHP Commercial |
$680.37
|
| Rate for Payer: Priority Health SBD |
$504.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.28
|
| Rate for Payer: UHC Core |
$417.02
|
| Rate for Payer: UHC Exchange |
$314.57
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
OP
|
$81.80
|
|
|
Service Code
|
NDC 67877049030
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.15 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$69.53
|
| Rate for Payer: Aetna Medicare |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.17
|
| Rate for Payer: BCBS Complete |
$32.72
|
| Rate for Payer: Cash Price |
$65.44
|
| Rate for Payer: Cofinity Advantage |
$57.26
|
| Rate for Payer: Cofinity Commercial |
$70.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.44
|
| Rate for Payer: Healthscope Commercial |
$73.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.35
|
| Rate for Payer: PHP Commercial |
$69.53
|
| Rate for Payer: Priority Health SBD |
$51.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.17
|
| Rate for Payer: UHC Core |
$42.62
|
| Rate for Payer: UHC Exchange |
$32.15
|
|
|
FACIAL
|
Professional
|
Both
|
$68.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$22,480.24
|
|
|
Service Code
|
APR-DRG 0923
|
| Min. Negotiated Rate |
$21,409.75 |
| Max. Negotiated Rate |
$22,480.24 |
| Rate for Payer: BCBS Complete |
$22,480.24
|
| Rate for Payer: Mclaren Medicaid |
$21,409.75
|
| Rate for Payer: Meridian Medicaid |
$22,480.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,409.75
|
| Rate for Payer: UHC Medicaid |
$21,409.75
|
| Rate for Payer: UHCCP Medicaid |
$21,409.75
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$35,613.97
|
|
|
Service Code
|
APR-DRG 0924
|
| Min. Negotiated Rate |
$33,918.07 |
| Max. Negotiated Rate |
$35,613.97 |
| Rate for Payer: BCBS Complete |
$35,613.97
|
| Rate for Payer: Mclaren Medicaid |
$33,918.07
|
| Rate for Payer: Meridian Medicaid |
$35,613.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,918.07
|
| Rate for Payer: UHC Medicaid |
$33,918.07
|
| Rate for Payer: UHCCP Medicaid |
$33,918.07
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$12,608.01
|
|
|
Service Code
|
APR-DRG 0922
|
| Min. Negotiated Rate |
$12,007.63 |
| Max. Negotiated Rate |
$12,608.01 |
| Rate for Payer: BCBS Complete |
$12,608.01
|
| Rate for Payer: Mclaren Medicaid |
$12,007.63
|
| Rate for Payer: Meridian Medicaid |
$12,608.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,007.63
|
| Rate for Payer: UHC Medicaid |
$12,007.63
|
| Rate for Payer: UHCCP Medicaid |
$12,007.63
|
|
|
FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIAL OR FACIAL BONE PROCEDURES
|
Facility
|
IP
|
$11,207.44
|
|
|
Service Code
|
APR-DRG 0921
|
| Min. Negotiated Rate |
$10,673.75 |
| Max. Negotiated Rate |
$11,207.44 |
| Rate for Payer: BCBS Complete |
$11,207.44
|
| Rate for Payer: Mclaren Medicaid |
$10,673.75
|
| Rate for Payer: Meridian Medicaid |
$11,207.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,673.75
|
| Rate for Payer: UHC Medicaid |
$10,673.75
|
| Rate for Payer: UHCCP Medicaid |
$10,673.75
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna Commercial |
$173.82
|
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: Aetna Medicare |
$102.25
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: BCBS Complete |
$81.80
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cash Price |
$163.60
|
| Rate for Payer: Cash Price |
$163.60
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Advantage |
$143.15
|
| Rate for Payer: Cofinity Advantage |
$26.18
|
| Rate for Payer: Cofinity Advantage |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Cofinity Commercial |
$175.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Healthscope Commercial |
$184.05
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.05
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: PHP Commercial |
$173.82
|
| Rate for Payer: Priority Health SBD |
$58.59
|
| Rate for Payer: Priority Health SBD |
$128.84
|
| Rate for Payer: Priority Health SBD |
$23.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$204.50
|
|
|
Service Code
|
HCPCS J1308
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$128.84 |
| Max. Negotiated Rate |
$184.05 |
| Rate for Payer: Aetna Commercial |
$173.82
|
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.45
|
| Rate for Payer: Cash Price |
$163.60
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Advantage |
$143.15
|
| Rate for Payer: Cofinity Advantage |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$175.87
|
| Rate for Payer: Cofinity Commercial |
$79.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.60
|
| Rate for Payer: Healthscope Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$184.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.75
|
| Rate for Payer: PHP Commercial |
$173.82
|
| Rate for Payer: PHP Commercial |
$79.05
|
| Rate for Payer: Priority Health SBD |
$128.84
|
| Rate for Payer: Priority Health SBD |
$58.59
|
|
