|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$28.32
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$25.49 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$26.65
|
| Rate for Payer: Aetna Commercial |
$16.97
|
| Rate for Payer: Aetna Commercial |
$18.14
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$22.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.50
|
| Rate for Payer: Cash Price |
$21.54
|
| Rate for Payer: Cash Price |
$25.08
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cash Price |
$17.07
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$14.26
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Cofinity Advantage |
$18.85
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$21.95
|
| Rate for Payer: Cofinity Advantage |
$13.97
|
| Rate for Payer: Cofinity Advantage |
$19.82
|
| Rate for Payer: Cofinity Advantage |
$14.94
|
| Rate for Payer: Cofinity Advantage |
$12.48
|
| Rate for Payer: Cofinity Commercial |
$26.96
|
| Rate for Payer: Cofinity Commercial |
$17.17
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$18.35
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$24.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.97
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$16.05
|
| Rate for Payer: Healthscope Commercial |
$25.49
|
| Rate for Payer: Healthscope Commercial |
$24.24
|
| Rate for Payer: Healthscope Commercial |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$28.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.07
|
| Rate for Payer: PHP Commercial |
$16.97
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$22.89
|
| Rate for Payer: PHP Commercial |
$26.65
|
| Rate for Payer: PHP Commercial |
$15.16
|
| Rate for Payer: PHP Commercial |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.84
|
| Rate for Payer: Priority Health SBD |
$12.57
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$13.44
|
| Rate for Payer: Priority Health SBD |
$19.75
|
| Rate for Payer: Priority Health SBD |
$16.97
|
| Rate for Payer: Priority Health SBD |
$11.23
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPICILLIN-SULBACTAM 1.5 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$26.96
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.53
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Advantage |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$13.47
|
| Rate for Payer: Cofinity Advantage |
$25.45
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$22.46
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$41.49
|
| Rate for Payer: Cofinity Advantage |
$25.48
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$37.34
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
32471
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$30.94
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Commercial |
$27.28
|
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Commercial |
$16.36
|
| Rate for Payer: Aetna Medicare |
$16.05
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna Medicare |
$29.64
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna Medicare |
$18.20
|
| Rate for Payer: Aetna Medicare |
$18.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: BCBS Complete |
$12.84
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: BCBS Complete |
$14.56
|
| Rate for Payer: BCBS Complete |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$21.57
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$25.67
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.09
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cash Price |
$47.42
|
| Rate for Payer: Cofinity Advantage |
$41.49
|
| Rate for Payer: Cofinity Advantage |
$22.46
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$25.45
|
| Rate for Payer: Cofinity Advantage |
$18.87
|
| Rate for Payer: Cofinity Advantage |
$13.47
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Advantage |
$25.48
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Commercial |
$27.60
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Cofinity Commercial |
$31.27
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Cofinity Commercial |
$31.30
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.42
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Healthscope Commercial |
$53.34
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Healthscope Commercial |
$24.26
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Healthscope Commercial |
$32.76
|
| Rate for Payer: Healthscope Commercial |
$32.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.07
|
| Rate for Payer: PHP Commercial |
$16.36
|
| Rate for Payer: PHP Commercial |
$27.28
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: PHP Commercial |
$30.94
|
| Rate for Payer: PHP Commercial |
$30.91
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: PHP Commercial |
$50.38
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: Priority Health SBD |
$22.93
|
| Rate for Payer: Priority Health SBD |
$20.22
|
| Rate for Payer: Priority Health SBD |
$12.13
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: Priority Health SBD |
$22.91
|
| Rate for Payer: Priority Health SBD |
$37.34
|
| Rate for Payer: Priority Health SBD |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
IP
|
$25.17
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.86 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health SBD |
$15.86
|
|
|
AMPICILLIN-SULBACTAM 3 GRAM SOLUTION MINI-BAG PLUS COMPONENT CUSTOM
|
Facility
|
OP
|
$25.17
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
301729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$21.39
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cash Price |
$20.14
|
| Rate for Payer: Cofinity Advantage |
$17.62
|
| Rate for Payer: Cofinity Commercial |
$21.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.14
|
| Rate for Payer: Healthscope Commercial |
$22.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.88
|
| Rate for Payer: PHP Commercial |
$21.39
|
| Rate for Payer: Priority Health SBD |
$15.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.19
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
AMPICILLIN-SULBACTAM IM INJECTION
|
Facility
|
IP
|
$28.86
|
|
|
Service Code
|
HCPCS J0295
|
| Hospital Charge Code |
181600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.97 |
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health SBD |
$18.18
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC
|
Facility
|
IP
|
$46,463.15
|
|
|
Service Code
|
MSDRG 240
|
| Min. Negotiated Rate |
$21,477.90 |
| Max. Negotiated Rate |
$46,463.15 |
| Rate for Payer: Aetna Medicare |
$23,512.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,260.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,260.40
|
| Rate for Payer: BCBS MAPPO |
$22,608.32
|
| Rate for Payer: BCBS Trust/PPO |
$44,482.22
|
| Rate for Payer: BCN Commercial |
$44,482.22
|
| Rate for Payer: BCN Medicare Advantage |
$22,608.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,608.32
|
| Rate for Payer: Mclaren Medicare |
$22,608.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,738.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,999.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$24,869.15
|
| Rate for Payer: Nomi Health Commercial |
$36,771.45
|
| Rate for Payer: PACE Medicare |
$21,477.90
|
| Rate for Payer: PACE SWMI |
$22,608.32
|
| Rate for Payer: PHP Medicare Advantage |
$22,608.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45,956.16
|
| Rate for Payer: Priority Health Medicare |
$22,608.32
|
| Rate for Payer: Priority Health Tiered Network |
$36,764.92
|
| Rate for Payer: Railroad Medicare Medicare |
$22,608.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,463.15
|
| Rate for Payer: UHC Core |
$38,872.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22,608.32
|
| Rate for Payer: UHC Exchange |
$31,746.02
|
| Rate for Payer: VA VA |
$22,608.32
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
|
IP
|
$80,223.71
|
|
|
Service Code
|
MSDRG 239
|
| Min. Negotiated Rate |
$36,684.26 |
| Max. Negotiated Rate |
$80,223.71 |
| Rate for Payer: Aetna Medicare |
$40,159.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,268.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,268.76
|
| Rate for Payer: BCBS MAPPO |
$38,615.01
|
| Rate for Payer: BCBS Trust/PPO |
$60,041.52
|
| Rate for Payer: BCN Commercial |
$60,041.52
|
| Rate for Payer: BCN Medicare Advantage |
$38,615.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,615.01
|
| Rate for Payer: Mclaren Medicare |
$38,615.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,545.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,407.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,476.51
|
| Rate for Payer: Nomi Health Commercial |
$63,489.93
|
| Rate for Payer: PACE Medicare |
$36,684.26
|
| Rate for Payer: PACE SWMI |
$38,615.01
|
| Rate for Payer: PHP Medicare Advantage |
$38,615.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$79,348.34
|
| Rate for Payer: Priority Health Medicare |
$38,615.01
|
| Rate for Payer: Priority Health Tiered Network |
$63,478.66
|
| Rate for Payer: Railroad Medicare Medicare |
$38,615.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80,223.71
|
| Rate for Payer: UHC Core |
$67,117.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,615.01
|
| Rate for Payer: UHC Exchange |
$54,812.97
|
| Rate for Payer: VA VA |
$38,615.01
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
|
IP
|
$22,565.72
|
|
|
Service Code
|
MSDRG 241
|
| Min. Negotiated Rate |
$10,714.07 |
| Max. Negotiated Rate |
$22,565.72 |
| Rate for Payer: Aetna Medicare |
$11,729.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,097.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,097.46
|
| Rate for Payer: BCBS MAPPO |
$11,277.97
|
| Rate for Payer: BCBS Trust/PPO |
$20,563.93
|
| Rate for Payer: BCN Commercial |
$20,563.93
|
| Rate for Payer: BCN Medicare Advantage |
$11,277.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,277.97
|
| Rate for Payer: Mclaren Medicare |
$11,277.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,841.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,969.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,405.77
|
| Rate for Payer: Nomi Health Commercial |
$17,858.76
|
| Rate for Payer: PACE Medicare |
$10,714.07
|
| Rate for Payer: PACE SWMI |
$11,277.97
|
| Rate for Payer: PHP Medicare Advantage |
$11,277.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,319.49
|
| Rate for Payer: Priority Health Medicare |
$11,277.97
|
| Rate for Payer: Priority Health Tiered Network |
$17,855.59
|
| Rate for Payer: Railroad Medicare Medicare |
$11,277.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,565.72
|
| Rate for Payer: UHC Core |
$18,879.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,277.97
|
| Rate for Payer: UHC Exchange |
$15,418.06
|
| Rate for Payer: VA VA |
$11,277.97
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$37,093.91
|
|
|
Service Code
|
MSDRG 475
|
| Min. Negotiated Rate |
$17,257.81 |
| Max. Negotiated Rate |
$37,093.91 |
| Rate for Payer: Aetna Medicare |
$18,892.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,707.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,707.65
|
| Rate for Payer: BCBS MAPPO |
$18,166.12
|
| Rate for Payer: BCBS Trust/PPO |
$35,950.01
|
| Rate for Payer: BCN Commercial |
$35,950.01
|
| Rate for Payer: BCN Medicare Advantage |
$18,166.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,166.12
|
| Rate for Payer: Mclaren Medicare |
$18,166.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,074.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,891.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,982.73
|
| Rate for Payer: Nomi Health Commercial |
$29,356.53
|
| Rate for Payer: PACE Medicare |
$17,257.81
|
| Rate for Payer: PACE SWMI |
$18,166.12
|
| Rate for Payer: PHP Medicare Advantage |
$18,166.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36,689.15
|
| Rate for Payer: Priority Health Medicare |
$18,166.12
|
| Rate for Payer: Priority Health Tiered Network |
$29,351.32
|
| Rate for Payer: Railroad Medicare Medicare |
$18,166.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37,093.91
|
| Rate for Payer: UHC Core |
$31,033.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,166.12
|
| Rate for Payer: UHC Exchange |
$25,344.47
|
| Rate for Payer: VA VA |
$18,166.12
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$74,968.80
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$32,067.72 |
| Max. Negotiated Rate |
$74,968.80 |
| Rate for Payer: Aetna Medicare |
$35,105.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,194.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,194.38
|
| Rate for Payer: BCBS MAPPO |
$33,755.50
|
| Rate for Payer: BCBS Trust/PPO |
$74,968.80
|
| Rate for Payer: BCN Commercial |
$74,968.80
|
| Rate for Payer: BCN Medicare Advantage |
$33,755.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,755.50
|
| Rate for Payer: Mclaren Medicare |
$33,755.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35,443.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,818.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,131.05
|
| Rate for Payer: Nomi Health Commercial |
$55,378.41
|
| Rate for Payer: PACE Medicare |
$32,067.72
|
| Rate for Payer: PACE SWMI |
$33,755.50
|
| Rate for Payer: PHP Medicare Advantage |
$33,755.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69,210.73
|
| Rate for Payer: Priority Health Medicare |
$33,755.50
|
| Rate for Payer: Priority Health Tiered Network |
$55,368.58
|
| Rate for Payer: Railroad Medicare Medicare |
$33,755.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,974.27
|
| Rate for Payer: UHC Core |
$58,542.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33,755.50
|
| Rate for Payer: UHC Exchange |
$47,810.03
|
| Rate for Payer: VA VA |
$33,755.50
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,964.68
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$9,214.87 |
| Max. Negotiated Rate |
$19,964.68 |
| Rate for Payer: Aetna Medicare |
$10,087.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,124.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,124.83
|
| Rate for Payer: BCBS MAPPO |
$9,699.86
|
| Rate for Payer: BCBS Trust/PPO |
$19,964.68
|
| Rate for Payer: BCN Commercial |
$19,964.68
|
| Rate for Payer: BCN Medicare Advantage |
$9,699.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,699.86
|
| Rate for Payer: Mclaren Medicare |
$9,699.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,184.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,154.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,669.85
|
| Rate for Payer: Nomi Health Commercial |
$15,224.58
|
| Rate for Payer: PACE Medicare |
$9,214.87
|
| Rate for Payer: PACE SWMI |
$9,699.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,699.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,027.35
|
| Rate for Payer: Priority Health Medicare |
$9,699.86
|
| Rate for Payer: Priority Health Tiered Network |
$15,221.88
|
| Rate for Payer: Railroad Medicare Medicare |
$9,699.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,237.26
|
| Rate for Payer: UHC Core |
$16,094.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,699.86
|
| Rate for Payer: UHC Exchange |
$13,143.89
|
| Rate for Payer: VA VA |
$9,699.86
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.52
|
| Rate for Payer: BCN Commercial |
$1,395.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$9,340.20
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$8,895.43 |
| Max. Negotiated Rate |
$9,340.20 |
| Rate for Payer: BCBS Complete |
$9,340.20
|
| Rate for Payer: Mclaren Medicaid |
$8,895.43
|
| Rate for Payer: Meridian Medicaid |
$9,340.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,895.43
|
| Rate for Payer: UHC Medicaid |
$8,895.43
|
| Rate for Payer: UHCCP Medicaid |
$8,895.43
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$15,304.82
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$14,576.02 |
| Max. Negotiated Rate |
$15,304.82 |
| Rate for Payer: BCBS Complete |
$15,304.82
|
| Rate for Payer: Mclaren Medicaid |
$14,576.02
|
| Rate for Payer: Meridian Medicaid |
$15,304.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,576.02
|
| Rate for Payer: UHC Medicaid |
$14,576.02
|
| Rate for Payer: UHCCP Medicaid |
$14,576.02
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$10,315.96
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$9,824.72 |
| Max. Negotiated Rate |
$10,315.96 |
| Rate for Payer: BCBS Complete |
$10,315.96
|
| Rate for Payer: Mclaren Medicaid |
$9,824.72
|
| Rate for Payer: Meridian Medicaid |
$10,315.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,824.72
|
| Rate for Payer: UHC Medicaid |
$9,824.72
|
| Rate for Payer: UHCCP Medicaid |
$9,824.72
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$20,927.17
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$19,930.64 |
| Max. Negotiated Rate |
$20,927.17 |
| Rate for Payer: BCBS Complete |
$20,927.17
|
| Rate for Payer: Mclaren Medicaid |
$19,930.64
|
| Rate for Payer: Meridian Medicaid |
$20,927.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,930.64
|
| Rate for Payer: UHC Medicaid |
$19,930.64
|
| Rate for Payer: UHCCP Medicaid |
$19,930.64
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$30,485.89
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$14,281.45 |
| Max. Negotiated Rate |
$30,485.89 |
| Rate for Payer: Aetna Medicare |
$15,634.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,791.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,791.39
|
| Rate for Payer: BCBS MAPPO |
$15,033.11
|
| Rate for Payer: BCBS Trust/PPO |
$26,631.28
|
| Rate for Payer: BCN Commercial |
$26,631.28
|
| Rate for Payer: BCN Medicare Advantage |
$15,033.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,033.11
|
| Rate for Payer: Mclaren Medicare |
$15,033.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,784.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,288.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,536.42
|
| Rate for Payer: Nomi Health Commercial |
$24,126.87
|
| Rate for Payer: PACE Medicare |
$14,281.45
|
| Rate for Payer: PACE SWMI |
$15,033.11
|
| Rate for Payer: PHP Medicare Advantage |
$15,033.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,153.24
|
| Rate for Payer: Priority Health Medicare |
$15,033.11
|
| Rate for Payer: Priority Health Tiered Network |
$24,122.59
|
| Rate for Payer: Railroad Medicare Medicare |
$15,033.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,485.89
|
| Rate for Payer: UHC Core |
$25,505.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,033.11
|
| Rate for Payer: UHC Exchange |
$20,829.53
|
| Rate for Payer: VA VA |
$15,033.11
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$56,844.62
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$26,153.89 |
| Max. Negotiated Rate |
$56,844.62 |
| Rate for Payer: Aetna Medicare |
$28,631.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,413.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,413.01
|
| Rate for Payer: BCBS MAPPO |
$27,530.41
|
| Rate for Payer: BCBS Trust/PPO |
$40,619.90
|
| Rate for Payer: BCN Commercial |
$40,619.90
|
| Rate for Payer: BCN Medicare Advantage |
$27,530.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,530.41
|
| Rate for Payer: Mclaren Medicare |
$27,530.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,906.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,659.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,283.45
|
| Rate for Payer: Nomi Health Commercial |
$44,987.46
|
| Rate for Payer: PACE Medicare |
$26,153.89
|
| Rate for Payer: PACE SWMI |
$27,530.41
|
| Rate for Payer: PHP Medicare Advantage |
$27,530.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,224.35
|
| Rate for Payer: Priority Health Medicare |
$27,530.41
|
| Rate for Payer: Priority Health Tiered Network |
$44,979.47
|
| Rate for Payer: Railroad Medicare Medicare |
$27,530.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,844.62
|
| Rate for Payer: UHC Core |
$47,557.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,530.41
|
| Rate for Payer: UHC Exchange |
$38,839.17
|
| Rate for Payer: VA VA |
$27,530.41
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,118.29
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$10,962.93 |
| Max. Negotiated Rate |
$23,118.29 |
| Rate for Payer: Aetna Medicare |
$12,001.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,424.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,424.91
|
| Rate for Payer: BCBS MAPPO |
$11,539.93
|
| Rate for Payer: BCBS Trust/PPO |
$20,669.26
|
| Rate for Payer: BCN Commercial |
$20,669.26
|
| Rate for Payer: BCN Medicare Advantage |
$11,539.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,539.93
|
| Rate for Payer: Mclaren Medicare |
$11,539.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,116.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,270.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,693.92
|
| Rate for Payer: Nomi Health Commercial |
$18,296.07
|
| Rate for Payer: PACE Medicare |
$10,962.93
|
| Rate for Payer: PACE SWMI |
$11,539.93
|
| Rate for Payer: PHP Medicare Advantage |
$11,539.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,866.03
|
| Rate for Payer: Priority Health Medicare |
$11,539.93
|
| Rate for Payer: Priority Health Tiered Network |
$18,292.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11,539.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,118.29
|
| Rate for Payer: UHC Core |
$19,341.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,539.93
|
| Rate for Payer: UHC Exchange |
$15,795.61
|
| Rate for Payer: VA VA |
$11,539.93
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,871.43
|
| Rate for Payer: BCN Commercial |
$1,871.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$6,535.05
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$6,223.85 |
| Max. Negotiated Rate |
$6,535.05 |
| Rate for Payer: BCBS Complete |
$6,535.05
|
| Rate for Payer: Mclaren Medicaid |
$6,223.85
|
| Rate for Payer: Meridian Medicaid |
$6,535.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,223.85
|
| Rate for Payer: UHC Medicaid |
$6,223.85
|
| Rate for Payer: UHCCP Medicaid |
$6,223.85
|
|
