|
HC Z NEPHROSTOMY CATH
|
Facility
|
IP
|
$791.29
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200092
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.51 |
| Max. Negotiated Rate |
$712.16 |
| Rate for Payer: Aetna Commercial |
$672.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.34
|
| Rate for Payer: Cash Price |
$633.03
|
| Rate for Payer: Cofinity Advantage |
$553.90
|
| Rate for Payer: Cofinity Commercial |
$680.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$633.03
|
| Rate for Payer: Healthscope Commercial |
$712.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$672.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$593.47
|
| Rate for Payer: PHP Commercial |
$672.60
|
| Rate for Payer: Priority Health SBD |
$498.51
|
|
|
HC ZONISAMIDE
|
Facility
|
OP
|
$78.03
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.93 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.13
|
| Rate for Payer: BCN Commercial |
$14.13
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Mclaren Medicaid |
$6.93
|
| Rate for Payer: Mclaren Medicare |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Nomi Health Commercial |
$19.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PACE Medicare |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.25
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health SBD |
$49.16
|
| Rate for Payer: Priority Health Tiered Network |
$10.60
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.88
|
| Rate for Payer: UHC Core |
$19.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.25
|
| Rate for Payer: UHC Exchange |
$19.88
|
| Rate for Payer: UHC Medicaid |
$6.93
|
| Rate for Payer: UHCCP Medicaid |
$6.93
|
| Rate for Payer: VA VA |
$13.25
|
|
|
HC ZONISAMIDE
|
Facility
|
IP
|
$78.03
|
|
|
Service Code
|
CPT 80203
|
| Hospital Charge Code |
30100052
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.16 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.72
|
| Rate for Payer: Cash Price |
$62.42
|
| Rate for Payer: Cofinity Advantage |
$54.62
|
| Rate for Payer: Cofinity Commercial |
$67.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.42
|
| Rate for Payer: Healthscope Commercial |
$70.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.52
|
| Rate for Payer: PHP Commercial |
$66.33
|
| Rate for Payer: Priority Health SBD |
$49.16
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
IP
|
$178.29
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$160.46 |
| Rate for Payer: Aetna Commercial |
$151.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.89
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Advantage |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$153.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: PHP Commercial |
$151.55
|
| Rate for Payer: Priority Health SBD |
$112.32
|
|
|
HC ZOSTER VACCINE (HZV) RECOMB ADJ, IM
|
Facility
|
OP
|
$178.29
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
63600123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$530.67 |
| Rate for Payer: Aetna Commercial |
$151.55
|
| Rate for Payer: Aetna Medicare |
$89.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.89
|
| Rate for Payer: BCBS Complete |
$71.32
|
| Rate for Payer: BCBS Trust/PPO |
$530.67
|
| Rate for Payer: BCN Commercial |
$530.67
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cash Price |
$142.63
|
| Rate for Payer: Cofinity Advantage |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$153.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.63
|
| Rate for Payer: Healthscope Commercial |
$160.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.72
|
| Rate for Payer: PHP Commercial |
$151.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$245.68
|
| Rate for Payer: Priority Health SBD |
$112.32
|
| Rate for Payer: Priority Health Tiered Network |
$196.54
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
IP
|
$1,359.49
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$856.48 |
| Max. Negotiated Rate |
$1,223.54 |
| Rate for Payer: Aetna Commercial |
$1,155.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$883.67
|
| Rate for Payer: Cash Price |
$1,087.59
|
| Rate for Payer: Cofinity Advantage |
$951.64
|
| Rate for Payer: Cofinity Commercial |
$1,169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,087.59
|
| Rate for Payer: Healthscope Commercial |
$1,223.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,155.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,019.62
|
| Rate for Payer: PHP Commercial |
$1,155.57
|
| Rate for Payer: Priority Health SBD |
$856.48
|
|
|
HC Z RETRIEVAL SNARE
|
Facility
|
OP
|
$1,359.49
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
27200094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$534.28 |
| Max. Negotiated Rate |
$1,223.54 |
| Rate for Payer: Aetna Commercial |
$1,155.57
|
| Rate for Payer: Aetna Medicare |
$679.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$883.67
|
| Rate for Payer: BCBS Complete |
$543.80
|
| Rate for Payer: Cash Price |
$1,087.59
|
| Rate for Payer: Cofinity Advantage |
$951.64
|
| Rate for Payer: Cofinity Commercial |
$1,169.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,087.59
|
| Rate for Payer: Healthscope Commercial |
$1,223.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,087.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,155.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,019.62
|
| Rate for Payer: PHP Commercial |
$1,155.57
|
| Rate for Payer: Priority Health SBD |
$856.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.67
|
| Rate for Payer: UHC Core |
$708.29
|
| Rate for Payer: UHC Exchange |
$534.28
|
|
|
HC Z STENT URETERAL
|
Facility
|
IP
|
$1,237.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$779.39 |
| Max. Negotiated Rate |
$1,113.41 |
| Rate for Payer: Aetna Commercial |
$1,051.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.13
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cofinity Advantage |
$865.98
|
| Rate for Payer: Cofinity Commercial |
$1,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.70
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.84
|
| Rate for Payer: PHP Commercial |
$1,051.55
|
| Rate for Payer: Priority Health SBD |
$779.39
|
|
|
HC Z STENT URETERAL
|
Facility
|
OP
|
$1,237.12
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
27800041
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.19 |
| Max. Negotiated Rate |
$1,113.41 |
| Rate for Payer: Aetna Commercial |
$1,051.55
|
| Rate for Payer: Aetna Medicare |
$618.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.13
|
| Rate for Payer: BCBS Complete |
$494.85
|
| Rate for Payer: Cash Price |
$989.70
|
| Rate for Payer: Cofinity Advantage |
$865.98
|
| Rate for Payer: Cofinity Commercial |
$1,063.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$989.70
|
| Rate for Payer: Healthscope Commercial |
$1,113.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$989.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.84
|
| Rate for Payer: PHP Commercial |
$1,051.55
|
| Rate for Payer: Priority Health SBD |
$779.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.13
|
| Rate for Payer: UHC Core |
$644.54
|
| Rate for Payer: UHC Exchange |
$486.19
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
OP
|
$1,792.08
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1,612.87 |
| Rate for Payer: Aetna Commercial |
$1,523.27
|
| Rate for Payer: Aetna Medicare |
$896.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.85
|
| Rate for Payer: BCBS Complete |
$716.83
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1,433.66
|
| Rate for Payer: Cash Price |
$1,433.66
|
| Rate for Payer: Cofinity Advantage |
$1,254.46
|
| Rate for Payer: Cofinity Commercial |
$1,541.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.66
|
| Rate for Payer: Healthscope Commercial |
$1,612.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,433.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.06
|
| Rate for Payer: PHP Commercial |
$1,523.27
|
| Rate for Payer: Priority Health SBD |
$1,129.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.85
|
| Rate for Payer: UHC Core |
$933.67
|
| Rate for Payer: UHC Exchange |
$704.29
|
|
|
HC Z TUNNELED PLEURAL CATHETER
|
Facility
|
IP
|
$1,792.08
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
27200097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,129.01 |
| Max. Negotiated Rate |
$1,612.87 |
| Rate for Payer: Aetna Commercial |
$1,523.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.85
|
| Rate for Payer: Cash Price |
$1,433.66
|
| Rate for Payer: Cofinity Advantage |
$1,254.46
|
| Rate for Payer: Cofinity Commercial |
$1,541.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,433.66
|
| Rate for Payer: Healthscope Commercial |
$1,612.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,523.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.06
|
| Rate for Payer: PHP Commercial |
$1,523.27
|
| Rate for Payer: Priority Health SBD |
$1,129.01
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
IP
|
$659.22
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.31 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Aetna Commercial |
$560.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.49
|
| Rate for Payer: Cash Price |
$527.38
|
| Rate for Payer: Cofinity Advantage |
$461.45
|
| Rate for Payer: Cofinity Commercial |
$566.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.38
|
| Rate for Payer: Healthscope Commercial |
$593.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.42
|
| Rate for Payer: PHP Commercial |
$560.34
|
| Rate for Payer: Priority Health SBD |
$415.31
|
|
|
HC Z VACUUM BIOPSY DEVICE
|
Facility
|
OP
|
$659.22
|
|
| Hospital Charge Code |
27200129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$259.07 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Aetna Commercial |
$560.34
|
| Rate for Payer: Aetna Medicare |
$329.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.49
|
| Rate for Payer: BCBS Complete |
$263.69
|
| Rate for Payer: Cash Price |
$527.38
|
| Rate for Payer: Cofinity Advantage |
$461.45
|
| Rate for Payer: Cofinity Commercial |
$566.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$527.38
|
| Rate for Payer: Healthscope Commercial |
$593.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$527.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$560.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.42
|
| Rate for Payer: PHP Commercial |
$560.34
|
| Rate for Payer: Priority Health SBD |
$415.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$428.49
|
| Rate for Payer: UHC Core |
$343.45
|
| Rate for Payer: UHC Exchange |
$259.07
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
OP
|
$1,041.32
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.24 |
| Max. Negotiated Rate |
$937.19 |
| Rate for Payer: Aetna Commercial |
$885.12
|
| Rate for Payer: Aetna Medicare |
$520.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.86
|
| Rate for Payer: BCBS Complete |
$416.53
|
| Rate for Payer: Cash Price |
$833.06
|
| Rate for Payer: Cofinity Advantage |
$728.92
|
| Rate for Payer: Cofinity Commercial |
$895.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.06
|
| Rate for Payer: Healthscope Commercial |
$937.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$833.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.99
|
| Rate for Payer: PHP Commercial |
$885.12
|
| Rate for Payer: Priority Health SBD |
$656.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.86
|
| Rate for Payer: UHC Core |
$542.53
|
| Rate for Payer: UHC Exchange |
$409.24
|
|
|
HC Z VASCULAR CLOSURE
|
Facility
|
IP
|
$1,041.32
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
27200098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$656.03 |
| Max. Negotiated Rate |
$937.19 |
| Rate for Payer: Aetna Commercial |
$885.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$676.86
|
| Rate for Payer: Cash Price |
$833.06
|
| Rate for Payer: Cofinity Advantage |
$728.92
|
| Rate for Payer: Cofinity Commercial |
$895.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$833.06
|
| Rate for Payer: Healthscope Commercial |
$937.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$780.99
|
| Rate for Payer: PHP Commercial |
$885.12
|
| Rate for Payer: Priority Health SBD |
$656.03
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
IP
|
$5,988.76
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,772.92 |
| Max. Negotiated Rate |
$5,389.88 |
| Rate for Payer: Aetna Commercial |
$5,090.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,892.69
|
| Rate for Payer: Cash Price |
$4,791.01
|
| Rate for Payer: Cofinity Advantage |
$4,192.13
|
| Rate for Payer: Cofinity Commercial |
$5,150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,791.01
|
| Rate for Payer: Healthscope Commercial |
$5,389.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,090.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.57
|
| Rate for Payer: PHP Commercial |
$5,090.45
|
| Rate for Payer: Priority Health SBD |
$3,772.92
|
|
|
HC Z VENA CAVA FILTER
|
Facility
|
OP
|
$5,988.76
|
|
|
Service Code
|
HCPCS C1880
|
| Hospital Charge Code |
27800042
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,353.58 |
| Max. Negotiated Rate |
$5,389.88 |
| Rate for Payer: Aetna Commercial |
$5,090.45
|
| Rate for Payer: Aetna Medicare |
$2,994.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,892.69
|
| Rate for Payer: BCBS Complete |
$2,395.50
|
| Rate for Payer: Cash Price |
$4,791.01
|
| Rate for Payer: Cofinity Advantage |
$4,192.13
|
| Rate for Payer: Cofinity Commercial |
$5,150.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,791.01
|
| Rate for Payer: Healthscope Commercial |
$5,389.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,791.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,090.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,491.57
|
| Rate for Payer: PHP Commercial |
$5,090.45
|
| Rate for Payer: Priority Health SBD |
$3,772.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,892.69
|
| Rate for Payer: UHC Core |
$3,120.14
|
| Rate for Payer: UHC Exchange |
$2,353.58
|
|
|
HEADACHES WITH MCC
|
Facility
|
IP
|
$19,730.60
|
|
|
Service Code
|
MSDRG 102
|
| Min. Negotiated Rate |
$8,779.50 |
| Max. Negotiated Rate |
$19,730.60 |
| Rate for Payer: Aetna Medicare |
$9,611.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,551.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,551.98
|
| Rate for Payer: BCBS MAPPO |
$9,241.58
|
| Rate for Payer: BCBS Trust/PPO |
$19,730.60
|
| Rate for Payer: BCN Commercial |
$19,730.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,241.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,241.58
|
| Rate for Payer: Mclaren Medicare |
$9,241.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,703.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,627.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,165.74
|
| Rate for Payer: Nomi Health Commercial |
$14,459.61
|
| Rate for Payer: PACE Medicare |
$8,779.50
|
| Rate for Payer: PACE SWMI |
$9,241.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,241.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,071.31
|
| Rate for Payer: Priority Health Medicare |
$9,241.58
|
| Rate for Payer: Priority Health Tiered Network |
$14,457.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9,241.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,270.67
|
| Rate for Payer: UHC Core |
$15,285.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,241.58
|
| Rate for Payer: UHC Exchange |
$12,483.46
|
| Rate for Payer: VA VA |
$9,241.58
|
|
|
HEADACHES WITHOUT MCC
|
Facility
|
IP
|
$18,059.27
|
|
|
Service Code
|
MSDRG 103
|
| Min. Negotiated Rate |
$6,690.00 |
| Max. Negotiated Rate |
$18,059.27 |
| Rate for Payer: Aetna Medicare |
$7,323.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,802.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,802.64
|
| Rate for Payer: BCBS MAPPO |
$7,042.11
|
| Rate for Payer: BCBS Trust/PPO |
$18,059.27
|
| Rate for Payer: BCN Commercial |
$18,059.27
|
| Rate for Payer: BCN Medicare Advantage |
$7,042.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,042.11
|
| Rate for Payer: Mclaren Medicare |
$7,042.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,394.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,098.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,746.32
|
| Rate for Payer: Nomi Health Commercial |
$10,788.27
|
| Rate for Payer: PACE Medicare |
$6,690.00
|
| Rate for Payer: PACE SWMI |
$7,042.11
|
| Rate for Payer: PHP Medicare Advantage |
$7,042.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,482.95
|
| Rate for Payer: Priority Health Medicare |
$7,042.11
|
| Rate for Payer: Priority Health Tiered Network |
$10,786.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7,042.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,631.69
|
| Rate for Payer: UHC Core |
$11,404.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,042.11
|
| Rate for Payer: UHC Exchange |
$9,313.87
|
| Rate for Payer: VA VA |
$7,042.11
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$12,399.91
|
|
|
Service Code
|
APR-DRG 0604
|
| Min. Negotiated Rate |
$11,809.43 |
| Max. Negotiated Rate |
$12,399.91 |
| Rate for Payer: BCBS Complete |
$12,399.91
|
| Rate for Payer: Mclaren Medicaid |
$11,809.43
|
| Rate for Payer: Meridian Medicaid |
$12,399.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,809.43
|
| Rate for Payer: UHC Medicaid |
$11,809.43
|
| Rate for Payer: UHCCP Medicaid |
$11,809.43
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$5,139.63
|
|
|
Service Code
|
APR-DRG 0602
|
| Min. Negotiated Rate |
$4,894.89 |
| Max. Negotiated Rate |
$5,139.63 |
| Rate for Payer: BCBS Complete |
$5,139.63
|
| Rate for Payer: Mclaren Medicaid |
$4,894.89
|
| Rate for Payer: Meridian Medicaid |
$5,139.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,894.89
|
| Rate for Payer: UHC Medicaid |
$4,894.89
|
| Rate for Payer: UHCCP Medicaid |
$4,894.89
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$7,322.76
|
|
|
Service Code
|
APR-DRG 0603
|
| Min. Negotiated Rate |
$6,974.06 |
| Max. Negotiated Rate |
$7,322.76 |
| Rate for Payer: BCBS Complete |
$7,322.76
|
| Rate for Payer: Mclaren Medicaid |
$6,974.06
|
| Rate for Payer: Meridian Medicaid |
$7,322.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,974.06
|
| Rate for Payer: UHC Medicaid |
$6,974.06
|
| Rate for Payer: UHCCP Medicaid |
$6,974.06
|
|
|
HEAD TRAUMA WITH COMA < 1 HOUR
|
Facility
|
IP
|
$3,600.90
|
|
|
Service Code
|
APR-DRG 0601
|
| Min. Negotiated Rate |
$3,429.43 |
| Max. Negotiated Rate |
$3,600.90 |
| Rate for Payer: BCBS Complete |
$3,600.90
|
| Rate for Payer: Mclaren Medicaid |
$3,429.43
|
| Rate for Payer: Meridian Medicaid |
$3,600.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,429.43
|
| Rate for Payer: UHC Medicaid |
$3,429.43
|
| Rate for Payer: UHCCP Medicaid |
$3,429.43
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$6,468.54
|
|
|
Service Code
|
APR-DRG 0552
|
| Min. Negotiated Rate |
$6,160.52 |
| Max. Negotiated Rate |
$6,468.54 |
| Rate for Payer: BCBS Complete |
$6,468.54
|
| Rate for Payer: Mclaren Medicaid |
$6,160.52
|
| Rate for Payer: Meridian Medicaid |
$6,468.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,160.52
|
| Rate for Payer: UHC Medicaid |
$6,160.52
|
| Rate for Payer: UHCCP Medicaid |
$6,160.52
|
|
|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$14,706.86
|
|
|
Service Code
|
APR-DRG 0554
|
| Min. Negotiated Rate |
$14,006.54 |
| Max. Negotiated Rate |
$14,706.86 |
| Rate for Payer: BCBS Complete |
$14,706.86
|
| Rate for Payer: Mclaren Medicaid |
$14,006.54
|
| Rate for Payer: Meridian Medicaid |
$14,706.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,006.54
|
| Rate for Payer: UHC Medicaid |
$14,006.54
|
| Rate for Payer: UHCCP Medicaid |
$14,006.54
|
|
