|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$138.62
|
|
|
Service Code
|
HCPCS J0675
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$161.03 |
| Rate for Payer: Aetna Commercial |
$117.83
|
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna Commercial |
$378.85
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.45
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS Complete |
$8.55
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS Trust/PPO |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$61.56
|
| Rate for Payer: BCBS Trust/PPO |
$61.56
|
| Rate for Payer: BCN Commercial |
$61.56
|
| Rate for Payer: BCN Commercial |
$61.56
|
| Rate for Payer: BCN Commercial |
$61.56
|
| Rate for Payer: BCN Commercial |
$61.56
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: Cash Price |
$356.57
|
| Rate for Payer: Cash Price |
$356.57
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cash Price |
$110.90
|
| Rate for Payer: Cash Price |
$110.90
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Advantage |
$312.00
|
| Rate for Payer: Cofinity Advantage |
$97.03
|
| Rate for Payer: Cofinity Advantage |
$115.21
|
| Rate for Payer: Cofinity Advantage |
$385.47
|
| Rate for Payer: Cofinity Commercial |
$383.31
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Commercial |
$119.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Healthscope Commercial |
$124.76
|
| Rate for Payer: Healthscope Commercial |
$401.14
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Mclaren Medicaid |
$8.14
|
| Rate for Payer: Mclaren Medicare |
$15.56
|
| Rate for Payer: Mclaren Medicare |
$15.56
|
| Rate for Payer: Mclaren Medicare |
$15.56
|
| Rate for Payer: Mclaren Medicare |
$15.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: Meridian Medicaid |
$16.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.83
|
| Rate for Payer: Nomi Health Commercial |
$46.68
|
| Rate for Payer: Nomi Health Commercial |
$46.68
|
| Rate for Payer: Nomi Health Commercial |
$46.68
|
| Rate for Payer: Nomi Health Commercial |
$46.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.44
|
| Rate for Payer: PACE Medicare |
$14.78
|
| Rate for Payer: PACE Medicare |
$14.78
|
| Rate for Payer: PACE Medicare |
$14.78
|
| Rate for Payer: PACE Medicare |
$14.78
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$117.83
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$378.85
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$161.03
|
| Rate for Payer: Priority Health Medicare |
$15.56
|
| Rate for Payer: Priority Health Medicare |
$15.56
|
| Rate for Payer: Priority Health Medicare |
$15.56
|
| Rate for Payer: Priority Health Medicare |
$15.56
|
| Rate for Payer: Priority Health SBD |
$346.92
|
| Rate for Payer: Priority Health SBD |
$87.33
|
| Rate for Payer: Priority Health SBD |
$280.80
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: Priority Health Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Tiered Network |
$128.82
|
| Rate for Payer: Priority Health Tiered Network |
$128.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.61
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.56
|
| Rate for Payer: UHC Exchange |
$22.61
|
| Rate for Payer: UHC Exchange |
$22.61
|
| Rate for Payer: UHC Exchange |
$22.61
|
| Rate for Payer: UHC Exchange |
$22.61
|
| Rate for Payer: UHC Medicaid |
$8.14
|
| Rate for Payer: UHC Medicaid |
$8.14
|
| Rate for Payer: UHC Medicaid |
$8.14
|
| Rate for Payer: UHC Medicaid |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: UHCCP Medicaid |
$8.14
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: VA VA |
$15.56
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$550.67
|
|
|
Service Code
|
HCPCS J0675
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$346.92 |
| Max. Negotiated Rate |
$495.60 |
| Rate for Payer: Aetna Commercial |
$468.07
|
| Rate for Payer: Aetna Commercial |
$378.85
|
| Rate for Payer: Aetna Commercial |
$117.83
|
| Rate for Payer: Aetna Commercial |
$139.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.94
|
| Rate for Payer: Cash Price |
$110.90
|
| Rate for Payer: Cash Price |
$131.67
|
| Rate for Payer: Cash Price |
$356.57
|
| Rate for Payer: Cash Price |
$440.54
|
| Rate for Payer: Cofinity Advantage |
$115.21
|
| Rate for Payer: Cofinity Advantage |
$312.00
|
| Rate for Payer: Cofinity Advantage |
$385.47
|
| Rate for Payer: Cofinity Advantage |
$97.03
|
| Rate for Payer: Cofinity Commercial |
$383.31
|
| Rate for Payer: Cofinity Commercial |
$141.55
|
| Rate for Payer: Cofinity Commercial |
$473.58
|
| Rate for Payer: Cofinity Commercial |
$119.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$356.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$440.54
|
| Rate for Payer: Healthscope Commercial |
$124.76
|
| Rate for Payer: Healthscope Commercial |
$401.14
|
| Rate for Payer: Healthscope Commercial |
$148.13
|
| Rate for Payer: Healthscope Commercial |
$495.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$334.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$413.00
|
| Rate for Payer: PHP Commercial |
$139.90
|
| Rate for Payer: PHP Commercial |
$117.83
|
| Rate for Payer: PHP Commercial |
$468.07
|
| Rate for Payer: PHP Commercial |
$378.85
|
| Rate for Payer: Priority Health SBD |
$280.80
|
| Rate for Payer: Priority Health SBD |
$103.69
|
| Rate for Payer: Priority Health SBD |
$346.92
|
| Rate for Payer: Priority Health SBD |
$87.33
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS
|
Facility
|
IP
|
$27.41
|
|
|
Service Code
|
NDC 50268006815
|
| Hospital Charge Code |
109090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.56
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: Priority Health SBD |
$17.27
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS
|
Facility
|
OP
|
$27.41
|
|
|
Service Code
|
NDC 50268006815
|
| Hospital Charge Code |
109090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.56
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.82
|
| Rate for Payer: UHC Core |
$14.28
|
| Rate for Payer: UHC Exchange |
$10.77
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 70000070501
|
| Hospital Charge Code |
109090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.77
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.93
|
| Rate for Payer: UHC Core |
$9.57
|
| Rate for Payer: UHC Exchange |
$7.22
|
|
|
CARBOXYMETHYLCELLULOSE SODIUM 0.5 % EYE DROPS
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 70000070501
|
| Hospital Charge Code |
109090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.77
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health SBD |
$11.57
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$1,980.75
|
|
|
Service Code
|
APR-DRG 1961
|
| Min. Negotiated Rate |
$1,886.43 |
| Max. Negotiated Rate |
$1,980.75 |
| Rate for Payer: BCBS Complete |
$1,980.75
|
| Rate for Payer: Mclaren Medicaid |
$1,886.43
|
| Rate for Payer: Meridian Medicaid |
$1,980.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,886.43
|
| Rate for Payer: UHC Medicaid |
$1,886.43
|
| Rate for Payer: UHCCP Medicaid |
$1,886.43
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$3,831.94
|
|
|
Service Code
|
APR-DRG 1962
|
| Min. Negotiated Rate |
$3,649.46 |
| Max. Negotiated Rate |
$3,831.94 |
| Rate for Payer: BCBS Complete |
$3,831.94
|
| Rate for Payer: Mclaren Medicaid |
$3,649.46
|
| Rate for Payer: Meridian Medicaid |
$3,831.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,649.46
|
| Rate for Payer: UHC Medicaid |
$3,649.46
|
| Rate for Payer: UHCCP Medicaid |
$3,649.46
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$8,406.87
|
|
|
Service Code
|
APR-DRG 1963
|
| Min. Negotiated Rate |
$8,006.54 |
| Max. Negotiated Rate |
$8,406.87 |
| Rate for Payer: BCBS Complete |
$8,406.87
|
| Rate for Payer: Mclaren Medicaid |
$8,006.54
|
| Rate for Payer: Meridian Medicaid |
$8,406.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,006.54
|
| Rate for Payer: UHC Medicaid |
$8,006.54
|
| Rate for Payer: UHCCP Medicaid |
$8,006.54
|
|
|
CARDIAC ARREST AND SHOCK
|
Facility
|
IP
|
$14,049.29
|
|
|
Service Code
|
APR-DRG 1964
|
| Min. Negotiated Rate |
$13,380.28 |
| Max. Negotiated Rate |
$14,049.29 |
| Rate for Payer: BCBS Complete |
$14,049.29
|
| Rate for Payer: Mclaren Medicaid |
$13,380.28
|
| Rate for Payer: Meridian Medicaid |
$14,049.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,380.28
|
| Rate for Payer: UHC Medicaid |
$13,380.28
|
| Rate for Payer: UHCCP Medicaid |
$13,380.28
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH CC
|
Facility
|
IP
|
$11,090.71
|
|
|
Service Code
|
MSDRG 297
|
| Min. Negotiated Rate |
$5,204.77 |
| Max. Negotiated Rate |
$11,090.71 |
| Rate for Payer: Aetna Medicare |
$5,697.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,848.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,848.39
|
| Rate for Payer: BCBS MAPPO |
$5,478.71
|
| Rate for Payer: BCBS Trust/PPO |
$11,090.71
|
| Rate for Payer: BCN Commercial |
$11,090.71
|
| Rate for Payer: BCN Medicare Advantage |
$5,478.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,478.71
|
| Rate for Payer: Mclaren Medicare |
$5,478.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,752.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,300.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,026.58
|
| Rate for Payer: Nomi Health Commercial |
$8,043.15
|
| Rate for Payer: PACE Medicare |
$5,204.77
|
| Rate for Payer: PACE SWMI |
$5,478.71
|
| Rate for Payer: PHP Medicare Advantage |
$5,478.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,221.44
|
| Rate for Payer: Priority Health Medicare |
$5,478.71
|
| Rate for Payer: Priority Health Tiered Network |
$8,177.15
|
| Rate for Payer: Railroad Medicare Medicare |
$5,478.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,163.05
|
| Rate for Payer: UHC Core |
$8,502.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,478.71
|
| Rate for Payer: UHC Exchange |
$6,943.92
|
| Rate for Payer: VA VA |
$5,478.71
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
|
IP
|
$32,857.81
|
|
|
Service Code
|
MSDRG 296
|
| Min. Negotiated Rate |
$12,017.23 |
| Max. Negotiated Rate |
$32,857.81 |
| Rate for Payer: Aetna Medicare |
$13,155.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,812.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,812.15
|
| Rate for Payer: BCBS MAPPO |
$12,649.72
|
| Rate for Payer: BCBS Trust/PPO |
$32,857.81
|
| Rate for Payer: BCN Commercial |
$32,857.81
|
| Rate for Payer: BCN Medicare Advantage |
$12,649.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,649.72
|
| Rate for Payer: Mclaren Medicare |
$12,649.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,282.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,547.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,914.69
|
| Rate for Payer: Nomi Health Commercial |
$20,148.51
|
| Rate for Payer: PACE Medicare |
$12,017.23
|
| Rate for Payer: PACE SWMI |
$12,649.72
|
| Rate for Payer: PHP Medicare Advantage |
$12,649.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,181.17
|
| Rate for Payer: Priority Health Medicare |
$12,649.72
|
| Rate for Payer: Priority Health Tiered Network |
$20,144.93
|
| Rate for Payer: Railroad Medicare Medicare |
$12,649.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,458.97
|
| Rate for Payer: UHC Core |
$21,299.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,649.72
|
| Rate for Payer: UHC Exchange |
$17,394.88
|
| Rate for Payer: VA VA |
$12,649.72
|
|
|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
|
IP
|
$10,184.82
|
|
|
Service Code
|
MSDRG 298
|
| Min. Negotiated Rate |
$3,891.31 |
| Max. Negotiated Rate |
$10,184.82 |
| Rate for Payer: Aetna Medicare |
$4,259.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,120.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,120.15
|
| Rate for Payer: BCBS MAPPO |
$4,096.12
|
| Rate for Payer: BCBS Trust/PPO |
$10,184.82
|
| Rate for Payer: BCN Commercial |
$10,184.82
|
| Rate for Payer: BCN Medicare Advantage |
$4,096.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,096.12
|
| Rate for Payer: Mclaren Medicare |
$4,096.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,300.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,710.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,505.73
|
| Rate for Payer: Nomi Health Commercial |
$5,870.79
|
| Rate for Payer: PACE Medicare |
$3,891.31
|
| Rate for Payer: PACE SWMI |
$4,096.12
|
| Rate for Payer: PHP Medicare Advantage |
$4,096.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,337.19
|
| Rate for Payer: Priority Health Medicare |
$4,096.12
|
| Rate for Payer: Priority Health Tiered Network |
$5,869.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,096.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,418.13
|
| Rate for Payer: UHC Core |
$6,206.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,096.12
|
| Rate for Payer: UHC Exchange |
$5,068.45
|
| Rate for Payer: VA VA |
$4,096.12
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$5,974.93
|
|
|
Service Code
|
APR-DRG 2013
|
| Min. Negotiated Rate |
$5,690.41 |
| Max. Negotiated Rate |
$5,974.93 |
| Rate for Payer: BCBS Complete |
$5,974.93
|
| Rate for Payer: Mclaren Medicaid |
$5,690.41
|
| Rate for Payer: Meridian Medicaid |
$5,974.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,690.41
|
| Rate for Payer: UHC Medicaid |
$5,690.41
|
| Rate for Payer: UHCCP Medicaid |
$5,690.41
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$3,103.85
|
|
|
Service Code
|
APR-DRG 2011
|
| Min. Negotiated Rate |
$2,956.04 |
| Max. Negotiated Rate |
$3,103.85 |
| Rate for Payer: BCBS Complete |
$3,103.85
|
| Rate for Payer: Mclaren Medicaid |
$2,956.04
|
| Rate for Payer: Meridian Medicaid |
$3,103.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,956.04
|
| Rate for Payer: UHC Medicaid |
$2,956.04
|
| Rate for Payer: UHCCP Medicaid |
$2,956.04
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$10,340.61
|
|
|
Service Code
|
APR-DRG 2014
|
| Min. Negotiated Rate |
$9,848.20 |
| Max. Negotiated Rate |
$10,340.61 |
| Rate for Payer: BCBS Complete |
$10,340.61
|
| Rate for Payer: Mclaren Medicaid |
$9,848.20
|
| Rate for Payer: Meridian Medicaid |
$10,340.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,848.20
|
| Rate for Payer: UHC Medicaid |
$9,848.20
|
| Rate for Payer: UHCCP Medicaid |
$9,848.20
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS
|
Facility
|
IP
|
$4,202.29
|
|
|
Service Code
|
APR-DRG 2012
|
| Min. Negotiated Rate |
$4,002.18 |
| Max. Negotiated Rate |
$4,202.29 |
| Rate for Payer: BCBS Complete |
$4,202.29
|
| Rate for Payer: Mclaren Medicaid |
$4,002.18
|
| Rate for Payer: Meridian Medicaid |
$4,202.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,002.18
|
| Rate for Payer: UHC Medicaid |
$4,002.18
|
| Rate for Payer: UHCCP Medicaid |
$4,002.18
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
|
IP
|
$13,012.51
|
|
|
Service Code
|
MSDRG 309
|
| Min. Negotiated Rate |
$5,951.43 |
| Max. Negotiated Rate |
$13,012.51 |
| Rate for Payer: Aetna Medicare |
$6,515.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,830.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,830.82
|
| Rate for Payer: BCBS MAPPO |
$6,264.66
|
| Rate for Payer: BCBS Trust/PPO |
$13,012.51
|
| Rate for Payer: BCN Commercial |
$13,012.51
|
| Rate for Payer: BCN Medicare Advantage |
$6,264.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,264.66
|
| Rate for Payer: Mclaren Medicare |
$6,264.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,577.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,204.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,891.13
|
| Rate for Payer: Nomi Health Commercial |
$9,490.53
|
| Rate for Payer: PACE Medicare |
$5,951.43
|
| Rate for Payer: PACE SWMI |
$6,264.66
|
| Rate for Payer: PHP Medicare Advantage |
$6,264.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,861.06
|
| Rate for Payer: Priority Health Medicare |
$6,264.66
|
| Rate for Payer: Priority Health Tiered Network |
$9,488.85
|
| Rate for Payer: Railroad Medicare Medicare |
$6,264.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,991.91
|
| Rate for Payer: UHC Core |
$10,032.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,264.66
|
| Rate for Payer: UHC Exchange |
$8,193.49
|
| Rate for Payer: VA VA |
$6,264.66
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
|
IP
|
$19,819.55
|
|
|
Service Code
|
MSDRG 308
|
| Min. Negotiated Rate |
$9,389.59 |
| Max. Negotiated Rate |
$19,819.55 |
| Rate for Payer: Aetna Medicare |
$10,279.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,354.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,354.73
|
| Rate for Payer: BCBS MAPPO |
$9,883.78
|
| Rate for Payer: BCBS Trust/PPO |
$19,819.55
|
| Rate for Payer: BCN Commercial |
$19,819.55
|
| Rate for Payer: BCN Medicare Advantage |
$9,883.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,883.78
|
| Rate for Payer: Mclaren Medicare |
$9,883.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,377.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,366.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,872.16
|
| Rate for Payer: Nomi Health Commercial |
$15,531.60
|
| Rate for Payer: PACE Medicare |
$9,389.59
|
| Rate for Payer: PACE SWMI |
$9,883.78
|
| Rate for Payer: PHP Medicare Advantage |
$9,883.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,411.06
|
| Rate for Payer: Priority Health Medicare |
$9,883.78
|
| Rate for Payer: Priority Health Tiered Network |
$15,528.84
|
| Rate for Payer: Railroad Medicare Medicare |
$9,883.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,625.20
|
| Rate for Payer: UHC Core |
$16,418.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,883.78
|
| Rate for Payer: UHC Exchange |
$13,408.95
|
| Rate for Payer: VA VA |
$9,883.78
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,004.58
|
|
|
Service Code
|
MSDRG 310
|
| Min. Negotiated Rate |
$4,706.26 |
| Max. Negotiated Rate |
$10,004.58 |
| Rate for Payer: Aetna Medicare |
$5,152.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,192.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,192.45
|
| Rate for Payer: BCBS MAPPO |
$4,953.96
|
| Rate for Payer: BCBS Trust/PPO |
$10,004.58
|
| Rate for Payer: BCN Commercial |
$10,004.58
|
| Rate for Payer: BCN Medicare Advantage |
$4,953.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,953.96
|
| Rate for Payer: Mclaren Medicare |
$4,953.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,201.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,697.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,449.36
|
| Rate for Payer: Nomi Health Commercial |
$7,302.69
|
| Rate for Payer: PACE Medicare |
$4,706.26
|
| Rate for Payer: PACE SWMI |
$4,953.96
|
| Rate for Payer: PHP Medicare Advantage |
$4,953.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,126.74
|
| Rate for Payer: Priority Health Medicare |
$4,953.96
|
| Rate for Payer: Priority Health Tiered Network |
$7,301.39
|
| Rate for Payer: Railroad Medicare Medicare |
$4,953.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,227.43
|
| Rate for Payer: UHC Core |
$7,719.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,953.96
|
| Rate for Payer: UHC Exchange |
$6,304.66
|
| Rate for Payer: VA VA |
$4,953.96
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$5,303.02
|
|
|
Service Code
|
APR-DRG 1911
|
| Min. Negotiated Rate |
$5,050.50 |
| Max. Negotiated Rate |
$5,303.02 |
| Rate for Payer: BCBS Complete |
$5,303.02
|
| Rate for Payer: Mclaren Medicaid |
$5,050.50
|
| Rate for Payer: Meridian Medicaid |
$5,303.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,050.50
|
| Rate for Payer: UHC Medicaid |
$5,050.50
|
| Rate for Payer: UHCCP Medicaid |
$5,050.50
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$12,414.81
|
|
|
Service Code
|
APR-DRG 1914
|
| Min. Negotiated Rate |
$11,823.63 |
| Max. Negotiated Rate |
$12,414.81 |
| Rate for Payer: BCBS Complete |
$12,414.81
|
| Rate for Payer: Mclaren Medicaid |
$11,823.63
|
| Rate for Payer: Meridian Medicaid |
$12,414.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,823.63
|
| Rate for Payer: UHC Medicaid |
$11,823.63
|
| Rate for Payer: UHCCP Medicaid |
$11,823.63
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$9,083.94
|
|
|
Service Code
|
APR-DRG 1913
|
| Min. Negotiated Rate |
$8,651.37 |
| Max. Negotiated Rate |
$9,083.94 |
| Rate for Payer: BCBS Complete |
$9,083.94
|
| Rate for Payer: Mclaren Medicaid |
$8,651.37
|
| Rate for Payer: Meridian Medicaid |
$9,083.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,651.37
|
| Rate for Payer: UHC Medicaid |
$8,651.37
|
| Rate for Payer: UHCCP Medicaid |
$8,651.37
|
|
|
CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE
|
Facility
|
IP
|
$6,614.74
|
|
|
Service Code
|
APR-DRG 1912
|
| Min. Negotiated Rate |
$6,299.75 |
| Max. Negotiated Rate |
$6,614.74 |
| Rate for Payer: BCBS Complete |
$6,614.74
|
| Rate for Payer: Mclaren Medicaid |
$6,299.75
|
| Rate for Payer: Meridian Medicaid |
$6,614.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,299.75
|
| Rate for Payer: UHC Medicaid |
$6,299.75
|
| Rate for Payer: UHCCP Medicaid |
$6,299.75
|
|
|
CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS
|
Facility
|
IP
|
$8,334.06
|
|
|
Service Code
|
APR-DRG 1922
|
| Min. Negotiated Rate |
$7,937.20 |
| Max. Negotiated Rate |
$8,334.06 |
| Rate for Payer: BCBS Complete |
$8,334.06
|
| Rate for Payer: Mclaren Medicaid |
$7,937.20
|
| Rate for Payer: Meridian Medicaid |
$8,334.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,937.20
|
| Rate for Payer: UHC Medicaid |
$7,937.20
|
| Rate for Payer: UHCCP Medicaid |
$7,937.20
|
|
