|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$31,506.77
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$12,952.15 |
| Max. Negotiated Rate |
$31,506.77 |
| Rate for Payer: Aetna Medicare |
$14,179.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,042.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,042.30
|
| Rate for Payer: BCBS MAPPO |
$13,633.84
|
| Rate for Payer: BCBS Trust/PPO |
$31,506.77
|
| Rate for Payer: BCN Medicare Advantage |
$13,633.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,633.84
|
| Rate for Payer: Mclaren Medicare |
$13,633.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,315.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,678.92
|
| Rate for Payer: PACE Medicare |
$12,952.15
|
| Rate for Payer: PACE SWMI |
$13,633.84
|
| Rate for Payer: PHP Medicare Advantage |
$13,633.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,184.30
|
| Rate for Payer: Priority Health Medicare |
$13,633.84
|
| Rate for Payer: Priority Health Narrow Network |
$20,947.44
|
| Rate for Payer: Railroad Medicare Medicare |
$13,633.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,833.97
|
| Rate for Payer: UHC Core |
$17,079.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,633.84
|
| Rate for Payer: UHC Exchange |
$18,292.62
|
| Rate for Payer: UHC Medicare Advantage |
$14,042.86
|
| Rate for Payer: VA VA |
$13,633.84
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$13,181.99
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$5,242.24 |
| Max. Negotiated Rate |
$13,181.99 |
| Rate for Payer: Aetna Medicare |
$5,738.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,897.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,897.69
|
| Rate for Payer: BCBS MAPPO |
$5,518.15
|
| Rate for Payer: BCBS Trust/PPO |
$13,181.99
|
| Rate for Payer: BCN Medicare Advantage |
$5,518.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,518.15
|
| Rate for Payer: Mclaren Medicare |
$5,518.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,794.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,345.87
|
| Rate for Payer: PACE Medicare |
$5,242.24
|
| Rate for Payer: PACE SWMI |
$5,518.15
|
| Rate for Payer: PHP Medicare Advantage |
$5,518.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,013.37
|
| Rate for Payer: Priority Health Medicare |
$5,518.15
|
| Rate for Payer: Priority Health Narrow Network |
$8,010.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5,518.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,644.24
|
| Rate for Payer: UHC Core |
$6,531.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,518.15
|
| Rate for Payer: UHC Exchange |
$6,995.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,683.69
|
| Rate for Payer: VA VA |
$5,518.15
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.86
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.06
|
| Rate for Payer: Priority Health SBD |
$125.16
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$158.93
|
|
|
Service Code
|
NDC 3932801416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.13 |
| Max. Negotiated Rate |
$143.04 |
| Rate for Payer: Aetna Commercial |
$135.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.30
|
| Rate for Payer: Cash Price |
$127.14
|
| Rate for Payer: Cofinity Commercial |
$111.25
|
| Rate for Payer: Cofinity Commercial |
$136.68
|
| Rate for Payer: Healthscope Commercial |
$143.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.09
|
| Rate for Payer: PHP Commercial |
$135.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.25
|
| Rate for Payer: Priority Health SBD |
$100.13
|
|
|
COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAGE-LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$154.88
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$140.80
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$208,621.48
|
|
|
Service Code
|
MS-DRG 212
|
| Min. Negotiated Rate |
$74,158.02 |
| Max. Negotiated Rate |
$208,621.48 |
| Rate for Payer: Aetna Medicare |
$81,183.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$97,576.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$97,576.34
|
| Rate for Payer: BCBS MAPPO |
$78,061.07
|
| Rate for Payer: BCBS Trust/PPO |
$208,621.48
|
| Rate for Payer: BCN Medicare Advantage |
$78,061.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78,061.07
|
| Rate for Payer: Mclaren Medicare |
$78,061.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81,964.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89,770.23
|
| Rate for Payer: PACE Medicare |
$74,158.02
|
| Rate for Payer: PACE SWMI |
$78,061.07
|
| Rate for Payer: PHP Medicare Advantage |
$78,061.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154,558.68
|
| Rate for Payer: Priority Health Medicare |
$78,061.07
|
| Rate for Payer: Priority Health Narrow Network |
$123,646.94
|
| Rate for Payer: Railroad Medicare Medicare |
$78,061.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164,296.26
|
| Rate for Payer: UHC Core |
$100,813.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$78,061.07
|
| Rate for Payer: UHC Exchange |
$107,976.27
|
| Rate for Payer: UHC Medicare Advantage |
$80,402.90
|
| Rate for Payer: VA VA |
$78,061.07
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$20,325.25
|
|
|
Service Code
|
MS-DRG 089
|
| Min. Negotiated Rate |
$8,335.37 |
| Max. Negotiated Rate |
$20,325.25 |
| Rate for Payer: Aetna Medicare |
$9,125.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,967.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,967.59
|
| Rate for Payer: BCBS MAPPO |
$8,774.07
|
| Rate for Payer: BCBS Trust/PPO |
$20,325.25
|
| Rate for Payer: BCN Medicare Advantage |
$8,774.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,774.07
|
| Rate for Payer: Mclaren Medicare |
$8,774.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,212.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,090.18
|
| Rate for Payer: PACE Medicare |
$8,335.37
|
| Rate for Payer: PACE SWMI |
$8,774.07
|
| Rate for Payer: PHP Medicare Advantage |
$8,774.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,500.97
|
| Rate for Payer: Priority Health Medicare |
$8,774.07
|
| Rate for Payer: Priority Health Narrow Network |
$13,200.78
|
| Rate for Payer: Railroad Medicare Medicare |
$8,774.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,540.57
|
| Rate for Payer: UHC Core |
$10,763.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,774.07
|
| Rate for Payer: UHC Exchange |
$11,527.75
|
| Rate for Payer: UHC Medicare Advantage |
$9,037.29
|
| Rate for Payer: VA VA |
$8,774.07
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$36,559.54
|
|
|
Service Code
|
MS-DRG 088
|
| Min. Negotiated Rate |
$10,961.90 |
| Max. Negotiated Rate |
$36,559.54 |
| Rate for Payer: Aetna Medicare |
$12,000.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,423.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,423.55
|
| Rate for Payer: BCBS MAPPO |
$11,538.84
|
| Rate for Payer: BCBS Trust/PPO |
$36,559.54
|
| Rate for Payer: BCN Medicare Advantage |
$11,538.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,538.84
|
| Rate for Payer: Mclaren Medicare |
$11,538.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,115.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,269.67
|
| Rate for Payer: PACE Medicare |
$10,961.90
|
| Rate for Payer: PACE SWMI |
$11,538.84
|
| Rate for Payer: PHP Medicare Advantage |
$11,538.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,009.91
|
| Rate for Payer: Priority Health Medicare |
$11,538.84
|
| Rate for Payer: Priority Health Narrow Network |
$17,607.93
|
| Rate for Payer: Railroad Medicare Medicare |
$11,538.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,396.59
|
| Rate for Payer: UHC Core |
$14,356.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,538.84
|
| Rate for Payer: UHC Exchange |
$15,376.35
|
| Rate for Payer: UHC Medicare Advantage |
$11,885.01
|
| Rate for Payer: VA VA |
$11,538.84
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,974.77
|
|
|
Service Code
|
MS-DRG 090
|
| Min. Negotiated Rate |
$6,863.72 |
| Max. Negotiated Rate |
$18,974.77 |
| Rate for Payer: Aetna Medicare |
$7,513.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,031.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,031.21
|
| Rate for Payer: BCBS MAPPO |
$7,224.97
|
| Rate for Payer: BCBS Trust/PPO |
$18,974.77
|
| Rate for Payer: BCN Medicare Advantage |
$7,224.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,224.97
|
| Rate for Payer: Mclaren Medicare |
$7,224.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,586.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,308.72
|
| Rate for Payer: PACE Medicare |
$6,863.72
|
| Rate for Payer: PACE SWMI |
$7,224.97
|
| Rate for Payer: PHP Medicare Advantage |
$7,224.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,414.31
|
| Rate for Payer: Priority Health Medicare |
$7,224.97
|
| Rate for Payer: Priority Health Narrow Network |
$10,731.45
|
| Rate for Payer: Railroad Medicare Medicare |
$7,224.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,259.44
|
| Rate for Payer: UHC Core |
$8,749.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,224.97
|
| Rate for Payer: UHC Exchange |
$9,371.37
|
| Rate for Payer: UHC Medicare Advantage |
$7,441.72
|
| Rate for Payer: VA VA |
$7,224.97
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,659.42
|
| Rate for Payer: BCCCP Commercial |
$374.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$294.70
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.44 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.60
|
| Rate for Payer: BCCCP Commercial |
$322.14
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.78
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$253.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,376.14
|
|
|
Service Code
|
NDC 0046-1100-81
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,496.97 |
| Max. Negotiated Rate |
$2,138.53 |
| Rate for Payer: Aetna Commercial |
$2,019.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.49
|
| Rate for Payer: Cash Price |
$1,900.91
|
| Rate for Payer: Cofinity Commercial |
$1,663.30
|
| Rate for Payer: Cofinity Commercial |
$2,043.48
|
| Rate for Payer: Healthscope Commercial |
$2,138.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,019.72
|
| Rate for Payer: PHP Commercial |
$2,019.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.30
|
| Rate for Payer: Priority Health SBD |
$1,496.97
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,464.96
|
|
|
Service Code
|
NDC 0046-0872-21
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$1,318.46 |
| Rate for Payer: Aetna Commercial |
$1,245.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$952.22
|
| Rate for Payer: Cash Price |
$1,171.97
|
| Rate for Payer: Cofinity Commercial |
$1,025.47
|
| Rate for Payer: Cofinity Commercial |
$1,259.87
|
| Rate for Payer: Healthscope Commercial |
$1,318.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,245.22
|
| Rate for Payer: PHP Commercial |
$1,245.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.47
|
| Rate for Payer: Priority Health SBD |
$922.92
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,095.33
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$690.06 |
| Max. Negotiated Rate |
$985.80 |
| Rate for Payer: Aetna Commercial |
$931.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.96
|
| Rate for Payer: Cash Price |
$876.26
|
| Rate for Payer: Cofinity Commercial |
$766.73
|
| Rate for Payer: Cofinity Commercial |
$941.98
|
| Rate for Payer: Healthscope Commercial |
$985.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$931.03
|
| Rate for Payer: PHP Commercial |
$931.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$766.73
|
| Rate for Payer: Priority Health SBD |
$690.06
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$22,558.48
|
|
|
Service Code
|
MS-DRG 546
|
| Min. Negotiated Rate |
$8,673.36 |
| Max. Negotiated Rate |
$22,558.48 |
| Rate for Payer: Aetna Medicare |
$9,495.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,412.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,412.31
|
| Rate for Payer: BCBS MAPPO |
$9,129.85
|
| Rate for Payer: BCBS Trust/PPO |
$22,558.48
|
| Rate for Payer: BCN Medicare Advantage |
$9,129.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,129.85
|
| Rate for Payer: Mclaren Medicare |
$9,129.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,586.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,499.33
|
| Rate for Payer: PACE Medicare |
$8,673.36
|
| Rate for Payer: PACE SWMI |
$9,129.85
|
| Rate for Payer: PHP Medicare Advantage |
$9,129.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,209.86
|
| Rate for Payer: Priority Health Medicare |
$9,129.85
|
| Rate for Payer: Priority Health Narrow Network |
$13,767.89
|
| Rate for Payer: Railroad Medicare Medicare |
$9,129.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,294.12
|
| Rate for Payer: UHC Core |
$11,225.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,129.85
|
| Rate for Payer: UHC Exchange |
$12,022.98
|
| Rate for Payer: UHC Medicare Advantage |
$9,403.75
|
| Rate for Payer: VA VA |
$9,129.85
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$46,111.70
|
|
|
Service Code
|
MS-DRG 545
|
| Min. Negotiated Rate |
$17,525.83 |
| Max. Negotiated Rate |
$46,111.70 |
| Rate for Payer: Aetna Medicare |
$19,186.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,060.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,060.30
|
| Rate for Payer: BCBS MAPPO |
$18,448.24
|
| Rate for Payer: BCBS Trust/PPO |
$46,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$18,448.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,448.24
|
| Rate for Payer: Mclaren Medicare |
$18,448.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,370.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,215.48
|
| Rate for Payer: PACE Medicare |
$17,525.83
|
| Rate for Payer: PACE SWMI |
$18,448.24
|
| Rate for Payer: PHP Medicare Advantage |
$18,448.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,777.22
|
| Rate for Payer: Priority Health Medicare |
$18,448.24
|
| Rate for Payer: Priority Health Narrow Network |
$28,621.78
|
| Rate for Payer: Railroad Medicare Medicare |
$18,448.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,031.27
|
| Rate for Payer: UHC Core |
$23,336.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,448.24
|
| Rate for Payer: UHC Exchange |
$24,994.33
|
| Rate for Payer: UHC Medicare Advantage |
$19,001.69
|
| Rate for Payer: VA VA |
$18,448.24
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,335.77
|
|
|
Service Code
|
MS-DRG 547
|
| Min. Negotiated Rate |
$6,100.87 |
| Max. Negotiated Rate |
$18,335.77 |
| Rate for Payer: Aetna Medicare |
$6,678.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,027.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,027.46
|
| Rate for Payer: BCBS MAPPO |
$6,421.97
|
| Rate for Payer: BCBS Trust/PPO |
$18,335.77
|
| Rate for Payer: BCN Medicare Advantage |
$6,421.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,421.97
|
| Rate for Payer: Mclaren Medicare |
$6,421.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,743.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,385.27
|
| Rate for Payer: PACE Medicare |
$6,100.87
|
| Rate for Payer: PACE SWMI |
$6,421.97
|
| Rate for Payer: PHP Medicare Advantage |
$6,421.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,672.22
|
| Rate for Payer: Priority Health Medicare |
$6,421.97
|
| Rate for Payer: Priority Health Narrow Network |
$9,337.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,421.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,407.60
|
| Rate for Payer: UHC Core |
$7,613.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,421.97
|
| Rate for Payer: UHC Exchange |
$8,154.34
|
| Rate for Payer: UHC Medicare Advantage |
$6,614.63
|
| Rate for Payer: VA VA |
$6,421.97
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 30903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.84
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$75.31
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$118.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.08
|
| Rate for Payer: BCBS Complete |
$65.29
|
| Rate for Payer: BCBS MAPPO |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$100.08
|
| Rate for Payer: BCN Medicare Advantage |
$113.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.66
|
| Rate for Payer: Mclaren Medicaid |
$62.17
|
| Rate for Payer: Mclaren Medicare |
$113.66
|
| Rate for Payer: Meridian Medicaid |
$65.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.71
|
| Rate for Payer: PACE Medicare |
$107.98
|
| Rate for Payer: PACE SWMI |
$113.66
|
| Rate for Payer: PHP Medicare Advantage |
$113.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.10
|
| Rate for Payer: Priority Health Medicare |
$113.66
|
| Rate for Payer: Priority Health Narrow Network |
$280.88
|
| Rate for Payer: Railroad Medicare Medicare |
$113.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.66
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$117.07
|
| Rate for Payer: VA VA |
$113.66
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$8,819.00
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,642.45 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: BCBS Trust/PPO |
$6,348.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,806.70
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$1,642.45
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
IP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,694.64 |
| Max. Negotiated Rate |
$2,420.91 |
| Rate for Payer: Aetna Commercial |
$2,286.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.44
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Commercial |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,286.42
|
| Rate for Payer: PHP Commercial |
$2,286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,882.93
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$118,975.10
|
|
|
Service Code
|
MS-DRG 233
|
| Min. Negotiated Rate |
$53,830.64 |
| Max. Negotiated Rate |
$118,975.10 |
| Rate for Payer: Aetna Medicare |
$58,930.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,829.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,829.79
|
| Rate for Payer: BCBS MAPPO |
$56,663.83
|
| Rate for Payer: BCBS Trust/PPO |
$110,699.71
|
| Rate for Payer: BCN Medicare Advantage |
$56,663.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,663.83
|
| Rate for Payer: Mclaren Medicare |
$56,663.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59,497.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65,163.40
|
| Rate for Payer: PACE Medicare |
$53,830.64
|
| Rate for Payer: PACE SWMI |
$56,663.83
|
| Rate for Payer: PHP Medicare Advantage |
$56,663.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111,923.64
|
| Rate for Payer: Priority Health Medicare |
$56,663.83
|
| Rate for Payer: Priority Health Narrow Network |
$89,538.91
|
| Rate for Payer: Railroad Medicare Medicare |
$56,663.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118,975.10
|
| Rate for Payer: UHC Core |
$73,004.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$56,663.83
|
| Rate for Payer: UHC Exchange |
$78,190.99
|
| Rate for Payer: UHC Medicare Advantage |
$58,363.74
|
| Rate for Payer: VA VA |
$56,663.83
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$86,889.57
|
|
|
Service Code
|
MS-DRG 234
|
| Min. Negotiated Rate |
$36,030.58 |
| Max. Negotiated Rate |
$86,889.57 |
| Rate for Payer: Aetna Medicare |
$39,444.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,408.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,408.66
|
| Rate for Payer: BCBS MAPPO |
$37,926.93
|
| Rate for Payer: BCBS Trust/PPO |
$86,889.57
|
| Rate for Payer: BCN Medicare Advantage |
$37,926.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,926.93
|
| Rate for Payer: Mclaren Medicare |
$37,926.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,823.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,615.97
|
| Rate for Payer: PACE Medicare |
$36,030.58
|
| Rate for Payer: PACE SWMI |
$37,926.93
|
| Rate for Payer: PHP Medicare Advantage |
$37,926.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74,589.45
|
| Rate for Payer: Priority Health Medicare |
$37,926.93
|
| Rate for Payer: Priority Health Narrow Network |
$59,671.56
|
| Rate for Payer: Railroad Medicare Medicare |
$37,926.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79,288.77
|
| Rate for Payer: UHC Core |
$48,652.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,926.93
|
| Rate for Payer: UHC Exchange |
$52,108.95
|
| Rate for Payer: UHC Medicare Advantage |
$39,064.74
|
| Rate for Payer: VA VA |
$37,926.93
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$91,402.14
|
|
|
Service Code
|
MS-DRG 235
|
| Min. Negotiated Rate |
$40,701.40 |
| Max. Negotiated Rate |
$91,402.14 |
| Rate for Payer: Aetna Medicare |
$44,557.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,554.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,554.48
|
| Rate for Payer: BCBS MAPPO |
$42,843.58
|
| Rate for Payer: BCBS Trust/PPO |
$91,402.14
|
| Rate for Payer: BCN Medicare Advantage |
$42,843.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,843.58
|
| Rate for Payer: Mclaren Medicare |
$42,843.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44,985.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,270.12
|
| Rate for Payer: PACE Medicare |
$40,701.40
|
| Rate for Payer: PACE SWMI |
$42,843.58
|
| Rate for Payer: PHP Medicare Advantage |
$42,843.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84,386.14
|
| Rate for Payer: Priority Health Medicare |
$42,843.58
|
| Rate for Payer: Priority Health Narrow Network |
$67,508.91
|
| Rate for Payer: Railroad Medicare Medicare |
$42,843.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,702.67
|
| Rate for Payer: UHC Core |
$55,042.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$42,843.58
|
| Rate for Payer: UHC Exchange |
$58,953.02
|
| Rate for Payer: UHC Medicare Advantage |
$44,128.89
|
| Rate for Payer: VA VA |
$42,843.58
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$72,289.03
|
|
|
Service Code
|
MS-DRG 236
|
| Min. Negotiated Rate |
$28,116.79 |
| Max. Negotiated Rate |
$72,289.03 |
| Rate for Payer: Aetna Medicare |
$30,780.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,995.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,995.78
|
| Rate for Payer: BCBS MAPPO |
$29,596.62
|
| Rate for Payer: BCBS Trust/PPO |
$72,289.03
|
| Rate for Payer: BCN Medicare Advantage |
$29,596.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,596.62
|
| Rate for Payer: Mclaren Medicare |
$29,596.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,076.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,036.11
|
| Rate for Payer: PACE Medicare |
$28,116.79
|
| Rate for Payer: PACE SWMI |
$29,596.62
|
| Rate for Payer: PHP Medicare Advantage |
$29,596.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,990.90
|
| Rate for Payer: Priority Health Medicare |
$29,596.62
|
| Rate for Payer: Priority Health Narrow Network |
$46,392.72
|
| Rate for Payer: Railroad Medicare Medicare |
$29,596.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61,644.46
|
| Rate for Payer: UHC Core |
$37,825.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,596.62
|
| Rate for Payer: UHC Exchange |
$40,513.03
|
| Rate for Payer: UHC Medicare Advantage |
$30,484.52
|
| Rate for Payer: VA VA |
$29,596.62
|
|
