|
OPEN TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, INCLUDES REPAIR OF TUBEROSITY(S), WHEN PERFORMED; WITH PROXIMAL HUMERAL PROSTHETIC REPLACEMENT
|
Facility
|
OP
|
$20,727.79
|
|
|
Service Code
|
CPT 23616
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,221.03 |
| Max. Negotiated Rate |
$20,727.79 |
| Rate for Payer: Aetna Medicare |
$17,245.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,727.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,727.79
|
| Rate for Payer: BCBS Complete |
$9,524.83
|
| Rate for Payer: BCBS MAPPO |
$16,582.23
|
| Rate for Payer: BCBS Trust/PPO |
$9,853.32
|
| Rate for Payer: BCN Medicare Advantage |
$16,582.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,582.23
|
| Rate for Payer: Mclaren Medicaid |
$9,070.48
|
| Rate for Payer: Mclaren Medicare |
$16,582.23
|
| Rate for Payer: Meridian Medicaid |
$9,524.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,411.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,069.56
|
| Rate for Payer: PACE Medicare |
$15,753.12
|
| Rate for Payer: PACE SWMI |
$16,582.23
|
| Rate for Payer: PHP Medicare Advantage |
$16,582.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,070.48
|
| Rate for Payer: Priority Health Medicare |
$16,582.23
|
| Rate for Payer: Railroad Medicare Medicare |
$16,582.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,343.13
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,582.23
|
| Rate for Payer: UHC Exchange |
$1,221.03
|
| Rate for Payer: UHC Medicare Advantage |
$17,079.70
|
| Rate for Payer: VA VA |
$16,582.23
|
|
|
OPEN TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES, WITH INTERNAL FIXATION, WHEN PERFORMED; OF RADIUS AND ULNA
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 25575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$899.81 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,865.49
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$989.79
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$899.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
OPEN TREATMENT OF RADIAL HEAD OR NECK FRACTURE, INCLUDES INTERNAL FIXATION OR RADIAL HEAD EXCISION, WHEN PERFORMED; WITH RADIAL HEAD PROSTHETIC REPLACEMENT
|
Facility
|
OP
|
$39,125.19
|
|
|
Service Code
|
CPT 24666
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$729.87 |
| Max. Negotiated Rate |
$39,125.19 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,401.09
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,125.19
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$31,300.15
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$802.86
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$729.87
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
OPEN TREATMENT OF RADIAL SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 25515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.93 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.02
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$670.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
OPEN TREATMENT OF SCAPULAR FRACTURE (BODY, GLENOID OR ACROMION) INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 23585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$965.95 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,064.83
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.54
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$965.95
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 23680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$913.56 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,321.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,004.92
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$913.56
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$6,837.00
|
|
|
Service Code
|
CPT 27535
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$885.40 |
| Max. Negotiated Rate |
$6,837.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,750.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$973.94
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Exchange |
$885.40
|
|
|
OPEN TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$19,502.65
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$867.07 |
| Max. Negotiated Rate |
$19,502.65 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,517.65
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,502.65
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Priority Health Narrow Network |
$15,602.12
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$953.78
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$867.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
OPEN TREATMENT OF ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,834.21
|
|
|
Service Code
|
CPT 24685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.90 |
| Max. Negotiated Rate |
$19,834.21 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,655.42
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,834.21
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Priority Health Narrow Network |
$15,867.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.29
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$653.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 25652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.51
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$624.10
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$39,998.32
|
|
|
Service Code
|
MS-DRG 113
|
| Min. Negotiated Rate |
$17,622.30 |
| Max. Negotiated Rate |
$39,998.32 |
| Rate for Payer: Aetna Medicare |
$19,291.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,187.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,187.24
|
| Rate for Payer: BCBS MAPPO |
$18,549.79
|
| Rate for Payer: BCBS Trust/PPO |
$39,998.32
|
| Rate for Payer: BCN Medicare Advantage |
$18,549.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,549.79
|
| Rate for Payer: Mclaren Medicare |
$18,549.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,477.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,332.26
|
| Rate for Payer: PACE Medicare |
$17,622.30
|
| Rate for Payer: PACE SWMI |
$18,549.79
|
| Rate for Payer: PHP Medicare Advantage |
$18,549.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,979.55
|
| Rate for Payer: Priority Health Medicare |
$18,549.79
|
| Rate for Payer: Priority Health Narrow Network |
$28,783.64
|
| Rate for Payer: Railroad Medicare Medicare |
$18,549.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,246.35
|
| Rate for Payer: UHC Core |
$23,468.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,549.79
|
| Rate for Payer: UHC Exchange |
$25,135.68
|
| Rate for Payer: UHC Medicare Advantage |
$19,106.28
|
| Rate for Payer: VA VA |
$18,549.79
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,418.87
|
|
|
Service Code
|
MS-DRG 114
|
| Min. Negotiated Rate |
$8,895.70 |
| Max. Negotiated Rate |
$26,418.87 |
| Rate for Payer: Aetna Medicare |
$9,738.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,704.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,704.86
|
| Rate for Payer: BCBS MAPPO |
$9,363.89
|
| Rate for Payer: BCBS Trust/PPO |
$26,418.87
|
| Rate for Payer: BCN Medicare Advantage |
$9,363.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,363.89
|
| Rate for Payer: Mclaren Medicare |
$9,363.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,832.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,768.47
|
| Rate for Payer: PACE Medicare |
$8,895.70
|
| Rate for Payer: PACE SWMI |
$9,363.89
|
| Rate for Payer: PHP Medicare Advantage |
$9,363.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,676.23
|
| Rate for Payer: Priority Health Medicare |
$9,363.89
|
| Rate for Payer: Priority Health Narrow Network |
$14,140.98
|
| Rate for Payer: Railroad Medicare Medicare |
$9,363.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,789.88
|
| Rate for Payer: UHC Core |
$11,529.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,363.89
|
| Rate for Payer: UHC Exchange |
$12,348.80
|
| Rate for Payer: UHC Medicare Advantage |
$9,644.81
|
| Rate for Payer: VA VA |
$9,363.89
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$10,620.61
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$500.99 |
| Max. Negotiated Rate |
$10,620.61 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.61
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.09
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$500.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$323.84 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.22
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$323.84
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$10,620.61
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.06 |
| Max. Negotiated Rate |
$10,620.61 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,062.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.61
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.37
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$423.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$26,799.75
|
|
|
Service Code
|
MS-DRG 884
|
| Min. Negotiated Rate |
$12,488.27 |
| Max. Negotiated Rate |
$26,799.75 |
| Rate for Payer: Aetna Medicare |
$13,671.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,431.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,431.94
|
| Rate for Payer: BCBS MAPPO |
$13,145.55
|
| Rate for Payer: BCBS Trust/PPO |
$18,779.34
|
| Rate for Payer: BCN Medicare Advantage |
$13,145.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,145.55
|
| Rate for Payer: Mclaren Medicare |
$13,145.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,802.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,117.38
|
| Rate for Payer: PACE Medicare |
$12,488.27
|
| Rate for Payer: PACE SWMI |
$13,145.55
|
| Rate for Payer: PHP Medicare Advantage |
$13,145.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,211.37
|
| Rate for Payer: Priority Health Medicare |
$13,145.55
|
| Rate for Payer: Priority Health Narrow Network |
$20,169.10
|
| Rate for Payer: Railroad Medicare Medicare |
$13,145.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,799.75
|
| Rate for Payer: UHC Core |
$16,444.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,145.55
|
| Rate for Payer: UHC Exchange |
$17,612.92
|
| Rate for Payer: UHC Medicare Advantage |
$13,539.92
|
| Rate for Payer: VA VA |
$13,145.55
|
|
|
ORITAVANCIN 400 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,447.63
|
|
|
Service Code
|
HCPCS J2407
|
| Hospital Charge Code |
172319
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,172.01 |
| Max. Negotiated Rate |
$3,102.87 |
| Rate for Payer: Aetna Commercial |
$2,930.49
|
| Rate for Payer: Aetna Commercial |
$8,791.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,722.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,240.96
|
| Rate for Payer: Cash Price |
$8,274.30
|
| Rate for Payer: Cash Price |
$2,758.10
|
| Rate for Payer: Cofinity Commercial |
$2,964.96
|
| Rate for Payer: Cofinity Commercial |
$2,413.34
|
| Rate for Payer: Cofinity Commercial |
$7,240.02
|
| Rate for Payer: Cofinity Commercial |
$8,894.88
|
| Rate for Payer: Healthscope Commercial |
$9,308.59
|
| Rate for Payer: Healthscope Commercial |
$3,102.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8,791.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,930.49
|
| Rate for Payer: PHP Commercial |
$8,791.45
|
| Rate for Payer: PHP Commercial |
$2,930.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,413.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,240.02
|
| Rate for Payer: Priority Health SBD |
$6,516.01
|
| Rate for Payer: Priority Health SBD |
$2,172.01
|
|
|
ORPHENADRINE CITRATE 30 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$49.67
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
5886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$44.70 |
| Rate for Payer: Aetna Commercial |
$42.22
|
| Rate for Payer: Aetna Commercial |
$36.71
|
| Rate for Payer: Aetna Commercial |
$51.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.01
|
| Rate for Payer: Cash Price |
$39.74
|
| Rate for Payer: Cash Price |
$48.02
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Cofinity Commercial |
$34.77
|
| Rate for Payer: Cofinity Commercial |
$37.14
|
| Rate for Payer: Cofinity Commercial |
$51.62
|
| Rate for Payer: Cofinity Commercial |
$30.23
|
| Rate for Payer: Cofinity Commercial |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$42.01
|
| Rate for Payer: Healthscope Commercial |
$54.02
|
| Rate for Payer: Healthscope Commercial |
$44.70
|
| Rate for Payer: Healthscope Commercial |
$38.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.02
|
| Rate for Payer: PHP Commercial |
$51.02
|
| Rate for Payer: PHP Commercial |
$36.71
|
| Rate for Payer: PHP Commercial |
$42.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.01
|
| Rate for Payer: Priority Health SBD |
$27.21
|
| Rate for Payer: Priority Health SBD |
$37.81
|
| Rate for Payer: Priority Health SBD |
$31.29
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$439.68
|
|
|
Service Code
|
NDC 0115-2011-01
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Commercial |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.73
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.78
|
| Rate for Payer: Priority Health SBD |
$277.00
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
NDC 0185-0022-01
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Aetna Commercial |
$354.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.44
|
| Rate for Payer: Cash Price |
$334.08
|
| Rate for Payer: Cofinity Commercial |
$359.14
|
| Rate for Payer: Cofinity Commercial |
$292.32
|
| Rate for Payer: Healthscope Commercial |
$375.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.96
|
| Rate for Payer: PHP Commercial |
$354.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.32
|
| Rate for Payer: Priority Health SBD |
$263.09
|
|
|
ORPHENADRINE CITRATE ER 100 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 43386-480-24
|
| Hospital Charge Code |
27146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health SBD |
$171.77
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$27,591.48
|
|
|
Service Code
|
MS-DRG 620
|
| Min. Negotiated Rate |
$11,566.72 |
| Max. Negotiated Rate |
$27,591.48 |
| Rate for Payer: Aetna Medicare |
$12,662.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,219.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,219.36
|
| Rate for Payer: BCBS MAPPO |
$12,175.49
|
| Rate for Payer: BCBS Trust/PPO |
$27,591.48
|
| Rate for Payer: BCN Medicare Advantage |
$12,175.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,175.49
|
| Rate for Payer: Mclaren Medicare |
$12,175.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,784.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,001.81
|
| Rate for Payer: PACE Medicare |
$11,566.72
|
| Rate for Payer: PACE SWMI |
$12,175.49
|
| Rate for Payer: PHP Medicare Advantage |
$12,175.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,278.44
|
| Rate for Payer: Priority Health Medicare |
$12,175.49
|
| Rate for Payer: Priority Health Narrow Network |
$18,622.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,175.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,745.04
|
| Rate for Payer: UHC Core |
$15,183.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,175.49
|
| Rate for Payer: UHC Exchange |
$16,262.56
|
| Rate for Payer: UHC Medicare Advantage |
$12,540.75
|
| Rate for Payer: VA VA |
$12,175.49
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$39,484.98
|
|
|
Service Code
|
MS-DRG 619
|
| Min. Negotiated Rate |
$18,273.63 |
| Max. Negotiated Rate |
$39,484.98 |
| Rate for Payer: Aetna Medicare |
$20,004.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,044.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,044.25
|
| Rate for Payer: BCBS MAPPO |
$19,235.40
|
| Rate for Payer: BCBS Trust/PPO |
$38,235.01
|
| Rate for Payer: BCN Medicare Advantage |
$19,235.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,235.40
|
| Rate for Payer: Mclaren Medicare |
$19,235.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,197.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,120.71
|
| Rate for Payer: PACE Medicare |
$18,273.63
|
| Rate for Payer: PACE SWMI |
$19,235.40
|
| Rate for Payer: PHP Medicare Advantage |
$19,235.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,144.77
|
| Rate for Payer: Priority Health Medicare |
$19,235.40
|
| Rate for Payer: Priority Health Narrow Network |
$29,715.82
|
| Rate for Payer: Railroad Medicare Medicare |
$19,235.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,484.98
|
| Rate for Payer: UHC Core |
$24,228.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,235.40
|
| Rate for Payer: UHC Exchange |
$25,949.71
|
| Rate for Payer: UHC Medicare Advantage |
$19,812.46
|
| Rate for Payer: VA VA |
$19,235.40
|
|
|
O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC
|
Facility
|
IP
|
$25,103.53
|
|
|
Service Code
|
MS-DRG 621
|
| Min. Negotiated Rate |
$10,849.01 |
| Max. Negotiated Rate |
$25,103.53 |
| Rate for Payer: Aetna Medicare |
$11,876.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,275.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,275.01
|
| Rate for Payer: BCBS MAPPO |
$11,420.01
|
| Rate for Payer: BCBS Trust/PPO |
$25,103.53
|
| Rate for Payer: BCN Medicare Advantage |
$11,420.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,420.01
|
| Rate for Payer: Mclaren Medicare |
$11,420.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,991.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,133.01
|
| Rate for Payer: PACE Medicare |
$10,849.01
|
| Rate for Payer: PACE SWMI |
$11,420.01
|
| Rate for Payer: PHP Medicare Advantage |
$11,420.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,773.13
|
| Rate for Payer: Priority Health Medicare |
$11,420.01
|
| Rate for Payer: Priority Health Narrow Network |
$17,418.50
|
| Rate for Payer: Railroad Medicare Medicare |
$11,420.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,144.89
|
| Rate for Payer: UHC Core |
$14,201.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,420.01
|
| Rate for Payer: UHC Exchange |
$15,210.93
|
| Rate for Payer: UHC Medicare Advantage |
$11,762.61
|
| Rate for Payer: VA VA |
$11,420.01
|
|
|
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC
|
Facility
|
IP
|
$36,118.16
|
|
|
Service Code
|
MS-DRG 940
|
| Min. Negotiated Rate |
$15,291.32 |
| Max. Negotiated Rate |
$36,118.16 |
| Rate for Payer: Aetna Medicare |
$16,739.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,120.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,120.16
|
| Rate for Payer: BCBS MAPPO |
$16,096.13
|
| Rate for Payer: BCBS Trust/PPO |
$36,118.16
|
| Rate for Payer: BCN Medicare Advantage |
$16,096.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,096.13
|
| Rate for Payer: Mclaren Medicare |
$16,096.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,900.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,510.55
|
| Rate for Payer: PACE Medicare |
$15,291.32
|
| Rate for Payer: PACE SWMI |
$16,096.13
|
| Rate for Payer: PHP Medicare Advantage |
$16,096.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,090.54
|
| Rate for Payer: Priority Health Medicare |
$16,096.13
|
| Rate for Payer: Priority Health Narrow Network |
$24,872.43
|
| Rate for Payer: Railroad Medicare Medicare |
$16,096.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,049.32
|
| Rate for Payer: UHC Core |
$20,279.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,096.13
|
| Rate for Payer: UHC Exchange |
$21,720.17
|
| Rate for Payer: UHC Medicare Advantage |
$16,579.01
|
| Rate for Payer: VA VA |
$16,096.13
|
|
