|
ACUTE KIDNEY INJURY
|
Facility
|
IP
|
$3,052.82
|
|
|
Service Code
|
APR-DRG 4691
|
| Min. Negotiated Rate |
$2,907.45 |
| Max. Negotiated Rate |
$3,052.82 |
| Rate for Payer: BCBS Complete |
$3,052.82
|
| Rate for Payer: Mclaren Medicaid |
$2,907.45
|
| Rate for Payer: Meridian Medicaid |
$3,052.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,907.45
|
| Rate for Payer: UHC Medicaid |
$2,907.45
|
| Rate for Payer: UHCCP Medicaid |
$2,907.45
|
|
|
ACUTE KIDNEY INJURY
|
Facility
|
IP
|
$4,190.25
|
|
|
Service Code
|
APR-DRG 4692
|
| Min. Negotiated Rate |
$3,990.71 |
| Max. Negotiated Rate |
$4,190.25 |
| Rate for Payer: BCBS Complete |
$4,190.25
|
| Rate for Payer: Mclaren Medicaid |
$3,990.71
|
| Rate for Payer: Meridian Medicaid |
$4,190.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,990.71
|
| Rate for Payer: UHC Medicaid |
$3,990.71
|
| Rate for Payer: UHCCP Medicaid |
$3,990.71
|
|
|
ACUTE KIDNEY INJURY
|
Facility
|
IP
|
$15,155.19
|
|
|
Service Code
|
APR-DRG 4694
|
| Min. Negotiated Rate |
$14,433.51 |
| Max. Negotiated Rate |
$15,155.19 |
| Rate for Payer: BCBS Complete |
$15,155.19
|
| Rate for Payer: Mclaren Medicaid |
$14,433.51
|
| Rate for Payer: Meridian Medicaid |
$15,155.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,433.51
|
| Rate for Payer: UHC Medicaid |
$14,433.51
|
| Rate for Payer: UHCCP Medicaid |
$14,433.51
|
|
|
ACUTE KIDNEY INJURY
|
Facility
|
IP
|
$7,596.80
|
|
|
Service Code
|
APR-DRG 4693
|
| Min. Negotiated Rate |
$7,235.05 |
| Max. Negotiated Rate |
$7,596.80 |
| Rate for Payer: BCBS Complete |
$7,596.80
|
| Rate for Payer: Mclaren Medicaid |
$7,235.05
|
| Rate for Payer: Meridian Medicaid |
$7,596.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,235.05
|
| Rate for Payer: UHC Medicaid |
$7,235.05
|
| Rate for Payer: UHCCP Medicaid |
$7,235.05
|
|
|
ACUTE LEUKEMIA
|
Facility
|
IP
|
$27,999.97
|
|
|
Service Code
|
APR-DRG 6903
|
| Min. Negotiated Rate |
$26,666.64 |
| Max. Negotiated Rate |
$27,999.97 |
| Rate for Payer: BCBS Complete |
$27,999.97
|
| Rate for Payer: Mclaren Medicaid |
$26,666.64
|
| Rate for Payer: Meridian Medicaid |
$27,999.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,666.64
|
| Rate for Payer: UHC Medicaid |
$26,666.64
|
| Rate for Payer: UHCCP Medicaid |
$26,666.64
|
|
|
ACUTE LEUKEMIA
|
Facility
|
IP
|
$40,439.44
|
|
|
Service Code
|
APR-DRG 6904
|
| Min. Negotiated Rate |
$38,513.75 |
| Max. Negotiated Rate |
$40,439.44 |
| Rate for Payer: BCBS Complete |
$40,439.44
|
| Rate for Payer: Mclaren Medicaid |
$38,513.75
|
| Rate for Payer: Meridian Medicaid |
$40,439.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$38,513.75
|
| Rate for Payer: UHC Medicaid |
$38,513.75
|
| Rate for Payer: UHCCP Medicaid |
$38,513.75
|
|
|
ACUTE LEUKEMIA
|
Facility
|
IP
|
$16,253.06
|
|
|
Service Code
|
APR-DRG 6902
|
| Min. Negotiated Rate |
$15,479.10 |
| Max. Negotiated Rate |
$16,253.06 |
| Rate for Payer: BCBS Complete |
$16,253.06
|
| Rate for Payer: Mclaren Medicaid |
$15,479.10
|
| Rate for Payer: Meridian Medicaid |
$16,253.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,479.10
|
| Rate for Payer: UHC Medicaid |
$15,479.10
|
| Rate for Payer: UHCCP Medicaid |
$15,479.10
|
|
|
ACUTE LEUKEMIA
|
Facility
|
IP
|
$10,487.38
|
|
|
Service Code
|
APR-DRG 6901
|
| Min. Negotiated Rate |
$9,987.98 |
| Max. Negotiated Rate |
$10,487.38 |
| Rate for Payer: BCBS Complete |
$10,487.38
|
| Rate for Payer: Mclaren Medicaid |
$9,987.98
|
| Rate for Payer: Meridian Medicaid |
$10,487.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,987.98
|
| Rate for Payer: UHC Medicaid |
$9,987.98
|
| Rate for Payer: UHCCP Medicaid |
$9,987.98
|
|
|
ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$83,344.18
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$15,863.60 |
| Max. Negotiated Rate |
$83,344.18 |
| Rate for Payer: Aetna Medicare |
$17,366.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,873.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,873.16
|
| Rate for Payer: BCBS MAPPO |
$16,698.53
|
| Rate for Payer: BCBS Trust/PPO |
$83,344.18
|
| Rate for Payer: BCN Commercial |
$83,344.18
|
| Rate for Payer: BCN Medicare Advantage |
$16,698.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,698.53
|
| Rate for Payer: Mclaren Medicare |
$16,698.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,533.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,203.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,368.38
|
| Rate for Payer: Nomi Health Commercial |
$26,906.82
|
| Rate for Payer: PACE Medicare |
$15,863.60
|
| Rate for Payer: PACE SWMI |
$16,698.53
|
| Rate for Payer: PHP Medicare Advantage |
$16,698.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,627.56
|
| Rate for Payer: Priority Health Medicare |
$16,698.53
|
| Rate for Payer: Priority Health Tiered Network |
$26,902.04
|
| Rate for Payer: Railroad Medicare Medicare |
$16,698.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,998.54
|
| Rate for Payer: UHC Core |
$28,444.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,698.53
|
| Rate for Payer: UHC Exchange |
$23,229.55
|
| Rate for Payer: VA VA |
$16,698.53
|
|
|
ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$172,729.97
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$40,855.90 |
| Max. Negotiated Rate |
$172,729.97 |
| Rate for Payer: Aetna Medicare |
$44,726.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,757.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,757.76
|
| Rate for Payer: BCBS MAPPO |
$43,006.21
|
| Rate for Payer: BCBS Trust/PPO |
$172,729.97
|
| Rate for Payer: BCN Commercial |
$172,729.97
|
| Rate for Payer: BCN Medicare Advantage |
$43,006.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43,006.21
|
| Rate for Payer: Mclaren Medicare |
$43,006.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45,156.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,457.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$47,306.83
|
| Rate for Payer: Nomi Health Commercial |
$70,819.71
|
| Rate for Payer: PACE Medicare |
$40,855.90
|
| Rate for Payer: PACE SWMI |
$43,006.21
|
| Rate for Payer: PHP Medicare Advantage |
$43,006.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88,508.94
|
| Rate for Payer: Priority Health Medicare |
$43,006.21
|
| Rate for Payer: Priority Health Tiered Network |
$70,807.14
|
| Rate for Payer: Railroad Medicare Medicare |
$43,006.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,485.37
|
| Rate for Payer: UHC Core |
$74,865.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43,006.21
|
| Rate for Payer: UHC Exchange |
$61,141.02
|
| Rate for Payer: VA VA |
$43,006.21
|
|
|
ACUTE LEUKEMIA WITH OTHER PROCEDURES
|
Facility
|
IP
|
$151,630.00
|
|
|
Service Code
|
MSDRG 850
|
| Min. Negotiated Rate |
$64,126.51 |
| Max. Negotiated Rate |
$151,630.00 |
| Rate for Payer: Aetna Medicare |
$70,201.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84,376.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84,376.99
|
| Rate for Payer: BCBS MAPPO |
$67,501.59
|
| Rate for Payer: BCBS Trust/PPO |
$151,630.00
|
| Rate for Payer: BCN Commercial |
$151,630.00
|
| Rate for Payer: BCN Medicare Advantage |
$67,501.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67,501.59
|
| Rate for Payer: Mclaren Medicare |
$67,501.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70,876.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77,626.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$74,251.75
|
| Rate for Payer: Nomi Health Commercial |
$111,707.55
|
| Rate for Payer: PACE Medicare |
$64,126.51
|
| Rate for Payer: PACE SWMI |
$67,501.59
|
| Rate for Payer: PHP Medicare Advantage |
$67,501.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139,609.67
|
| Rate for Payer: Priority Health Medicare |
$67,501.59
|
| Rate for Payer: Priority Health Tiered Network |
$111,687.72
|
| Rate for Payer: Railroad Medicare Medicare |
$67,501.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141,149.85
|
| Rate for Payer: UHC Core |
$118,089.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67,501.59
|
| Rate for Payer: UHC Exchange |
$96,440.85
|
| Rate for Payer: VA VA |
$67,501.59
|
|
|
ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$23,873.82
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$9,503.39 |
| Max. Negotiated Rate |
$23,873.82 |
| Rate for Payer: Aetna Medicare |
$10,403.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,504.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,504.46
|
| Rate for Payer: BCBS MAPPO |
$10,003.57
|
| Rate for Payer: BCBS Trust/PPO |
$23,873.82
|
| Rate for Payer: BCN Commercial |
$23,873.82
|
| Rate for Payer: BCN Medicare Advantage |
$10,003.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,003.57
|
| Rate for Payer: Mclaren Medicare |
$10,003.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,503.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,504.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,003.93
|
| Rate for Payer: Nomi Health Commercial |
$15,731.55
|
| Rate for Payer: PACE Medicare |
$9,503.39
|
| Rate for Payer: PACE SWMI |
$10,003.57
|
| Rate for Payer: PHP Medicare Advantage |
$10,003.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,660.95
|
| Rate for Payer: Priority Health Medicare |
$10,003.57
|
| Rate for Payer: Priority Health Tiered Network |
$15,728.76
|
| Rate for Payer: Railroad Medicare Medicare |
$10,003.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,877.85
|
| Rate for Payer: UHC Core |
$16,630.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,003.57
|
| Rate for Payer: UHC Exchange |
$13,581.57
|
| Rate for Payer: VA VA |
$10,003.57
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$18,961.79
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$9,090.79 |
| Max. Negotiated Rate |
$18,961.79 |
| Rate for Payer: Aetna Medicare |
$9,952.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,961.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,961.56
|
| Rate for Payer: BCBS MAPPO |
$9,569.25
|
| Rate for Payer: BCBS Trust/PPO |
$10,786.41
|
| Rate for Payer: BCN Commercial |
$10,786.41
|
| Rate for Payer: BCN Medicare Advantage |
$9,569.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,569.25
|
| Rate for Payer: Mclaren Medicare |
$9,569.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,047.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,004.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,526.17
|
| Rate for Payer: Nomi Health Commercial |
$15,006.57
|
| Rate for Payer: PACE Medicare |
$9,090.79
|
| Rate for Payer: PACE SWMI |
$9,569.25
|
| Rate for Payer: PHP Medicare Advantage |
$9,569.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,754.89
|
| Rate for Payer: Priority Health Medicare |
$9,569.25
|
| Rate for Payer: Priority Health Tiered Network |
$15,003.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9,569.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,961.79
|
| Rate for Payer: UHC Core |
$15,863.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,569.25
|
| Rate for Payer: UHC Exchange |
$12,955.67
|
| Rate for Payer: VA VA |
$9,569.25
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,808.54
|
|
|
Service Code
|
MSDRG 122
|
| Min. Negotiated Rate |
$6,319.26 |
| Max. Negotiated Rate |
$12,808.54 |
| Rate for Payer: Aetna Medicare |
$6,917.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,314.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,314.81
|
| Rate for Payer: BCBS MAPPO |
$6,651.85
|
| Rate for Payer: BCBS Trust/PPO |
$9,569.19
|
| Rate for Payer: BCN Commercial |
$9,569.19
|
| Rate for Payer: BCN Medicare Advantage |
$6,651.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,651.85
|
| Rate for Payer: Mclaren Medicare |
$6,651.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,984.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,649.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,317.03
|
| Rate for Payer: Nomi Health Commercial |
$10,136.82
|
| Rate for Payer: PACE Medicare |
$6,319.26
|
| Rate for Payer: PACE SWMI |
$6,651.85
|
| Rate for Payer: PHP Medicare Advantage |
$6,651.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,668.78
|
| Rate for Payer: Priority Health Medicare |
$6,651.85
|
| Rate for Payer: Priority Health Tiered Network |
$10,135.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6,651.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,808.54
|
| Rate for Payer: UHC Core |
$10,715.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,651.85
|
| Rate for Payer: UHC Exchange |
$8,751.45
|
| Rate for Payer: VA VA |
$6,651.85
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
|
IP
|
$13,738.56
|
|
|
Service Code
|
APR-DRG 1904
|
| Min. Negotiated Rate |
$13,084.34 |
| Max. Negotiated Rate |
$13,738.56 |
| Rate for Payer: BCBS Complete |
$13,738.56
|
| Rate for Payer: Mclaren Medicaid |
$13,084.34
|
| Rate for Payer: Meridian Medicaid |
$13,738.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,084.34
|
| Rate for Payer: UHC Medicaid |
$13,084.34
|
| Rate for Payer: UHCCP Medicaid |
$13,084.34
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
|
IP
|
$3,145.12
|
|
|
Service Code
|
APR-DRG 1901
|
| Min. Negotiated Rate |
$2,995.36 |
| Max. Negotiated Rate |
$3,145.12 |
| Rate for Payer: BCBS Complete |
$3,145.12
|
| Rate for Payer: Mclaren Medicaid |
$2,995.36
|
| Rate for Payer: Meridian Medicaid |
$3,145.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,995.36
|
| Rate for Payer: UHC Medicaid |
$2,995.36
|
| Rate for Payer: UHCCP Medicaid |
$2,995.36
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
|
IP
|
$4,938.98
|
|
|
Service Code
|
APR-DRG 1902
|
| Min. Negotiated Rate |
$4,703.79 |
| Max. Negotiated Rate |
$4,938.98 |
| Rate for Payer: BCBS Complete |
$4,938.98
|
| Rate for Payer: Mclaren Medicaid |
$4,703.79
|
| Rate for Payer: Meridian Medicaid |
$4,938.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,703.79
|
| Rate for Payer: UHC Medicaid |
$4,703.79
|
| Rate for Payer: UHCCP Medicaid |
$4,703.79
|
|
|
ACUTE MYOCARDIAL INFARCTION
|
Facility
|
IP
|
$6,660.60
|
|
|
Service Code
|
APR-DRG 1903
|
| Min. Negotiated Rate |
$6,343.43 |
| Max. Negotiated Rate |
$6,660.60 |
| Rate for Payer: BCBS Complete |
$6,660.60
|
| Rate for Payer: Mclaren Medicaid |
$6,343.43
|
| Rate for Payer: Meridian Medicaid |
$6,660.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,343.43
|
| Rate for Payer: UHC Medicaid |
$6,343.43
|
| Rate for Payer: UHCCP Medicaid |
$6,343.43
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$18,433.80
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$7,297.89 |
| Max. Negotiated Rate |
$18,433.80 |
| Rate for Payer: Aetna Medicare |
$7,989.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,602.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,602.49
|
| Rate for Payer: BCBS MAPPO |
$7,681.99
|
| Rate for Payer: BCBS Trust/PPO |
$18,433.80
|
| Rate for Payer: BCN Commercial |
$18,433.80
|
| Rate for Payer: BCN Medicare Advantage |
$7,681.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,681.99
|
| Rate for Payer: Mclaren Medicare |
$7,681.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,066.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,834.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,450.19
|
| Rate for Payer: Nomi Health Commercial |
$11,856.39
|
| Rate for Payer: PACE Medicare |
$7,297.89
|
| Rate for Payer: PACE SWMI |
$7,681.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,681.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,817.86
|
| Rate for Payer: Priority Health Medicare |
$7,681.99
|
| Rate for Payer: Priority Health Tiered Network |
$11,854.29
|
| Rate for Payer: Railroad Medicare Medicare |
$7,681.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,981.33
|
| Rate for Payer: UHC Core |
$12,533.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,681.99
|
| Rate for Payer: UHC Exchange |
$10,236.02
|
| Rate for Payer: VA VA |
$7,681.99
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$26,504.88
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$12,327.05 |
| Max. Negotiated Rate |
$26,504.88 |
| Rate for Payer: Aetna Medicare |
$13,494.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,219.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,219.80
|
| Rate for Payer: BCBS MAPPO |
$12,975.84
|
| Rate for Payer: BCBS Trust/PPO |
$26,504.88
|
| Rate for Payer: BCN Commercial |
$26,504.88
|
| Rate for Payer: BCN Medicare Advantage |
$12,975.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,975.84
|
| Rate for Payer: Mclaren Medicare |
$12,975.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,624.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,922.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,273.42
|
| Rate for Payer: Nomi Health Commercial |
$20,692.89
|
| Rate for Payer: PACE Medicare |
$12,327.05
|
| Rate for Payer: PACE SWMI |
$12,975.84
|
| Rate for Payer: PHP Medicare Advantage |
$12,975.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,861.52
|
| Rate for Payer: Priority Health Medicare |
$12,975.84
|
| Rate for Payer: Priority Health Tiered Network |
$20,689.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,975.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,146.83
|
| Rate for Payer: UHC Core |
$21,875.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,975.84
|
| Rate for Payer: UHC Exchange |
$17,864.86
|
| Rate for Payer: VA VA |
$12,975.84
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$15,994.69
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$5,858.93 |
| Max. Negotiated Rate |
$15,994.69 |
| Rate for Payer: Aetna Medicare |
$6,413.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,709.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,709.11
|
| Rate for Payer: BCBS MAPPO |
$6,167.29
|
| Rate for Payer: BCBS Trust/PPO |
$15,994.69
|
| Rate for Payer: BCN Commercial |
$15,994.69
|
| Rate for Payer: BCN Medicare Advantage |
$6,167.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,167.29
|
| Rate for Payer: Mclaren Medicare |
$6,167.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,475.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,092.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,784.02
|
| Rate for Payer: Nomi Health Commercial |
$9,327.99
|
| Rate for Payer: PACE Medicare |
$5,858.93
|
| Rate for Payer: PACE SWMI |
$6,167.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,167.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,657.92
|
| Rate for Payer: Priority Health Medicare |
$6,167.29
|
| Rate for Payer: Priority Health Tiered Network |
$9,326.33
|
| Rate for Payer: Railroad Medicare Medicare |
$6,167.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,786.53
|
| Rate for Payer: UHC Core |
$9,860.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,167.29
|
| Rate for Payer: UHC Exchange |
$8,053.16
|
| Rate for Payer: VA VA |
$6,167.29
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$15,336.92
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$5,632.06 |
| Max. Negotiated Rate |
$15,336.92 |
| Rate for Payer: Aetna Medicare |
$6,165.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,410.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,410.60
|
| Rate for Payer: BCBS MAPPO |
$5,928.48
|
| Rate for Payer: BCBS Trust/PPO |
$15,336.92
|
| Rate for Payer: BCN Commercial |
$15,336.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,928.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,928.48
|
| Rate for Payer: Mclaren Medicare |
$5,928.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,224.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,817.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,521.33
|
| Rate for Payer: Nomi Health Commercial |
$8,929.38
|
| Rate for Payer: PACE Medicare |
$5,632.06
|
| Rate for Payer: PACE SWMI |
$5,928.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,928.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,159.75
|
| Rate for Payer: Priority Health Medicare |
$5,928.48
|
| Rate for Payer: Priority Health Tiered Network |
$8,927.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5,928.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,282.86
|
| Rate for Payer: UHC Core |
$9,439.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,928.48
|
| Rate for Payer: UHC Exchange |
$7,709.03
|
| Rate for Payer: VA VA |
$5,928.48
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$40,580.11
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$15,092.72 |
| Max. Negotiated Rate |
$40,580.11 |
| Rate for Payer: Aetna Medicare |
$16,522.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,858.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,858.84
|
| Rate for Payer: BCBS MAPPO |
$15,887.07
|
| Rate for Payer: BCBS Trust/PPO |
$40,580.11
|
| Rate for Payer: BCN Commercial |
$40,580.11
|
| Rate for Payer: BCN Medicare Advantage |
$15,887.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,887.07
|
| Rate for Payer: Mclaren Medicare |
$15,887.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,681.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,270.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,475.78
|
| Rate for Payer: Nomi Health Commercial |
$25,552.32
|
| Rate for Payer: PACE Medicare |
$15,092.72
|
| Rate for Payer: PACE SWMI |
$15,887.07
|
| Rate for Payer: PHP Medicare Advantage |
$15,887.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,934.73
|
| Rate for Payer: Priority Health Medicare |
$15,887.07
|
| Rate for Payer: Priority Health Tiered Network |
$25,547.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15,887.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,287.04
|
| Rate for Payer: UHC Core |
$27,012.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,887.07
|
| Rate for Payer: UHC Exchange |
$22,060.17
|
| Rate for Payer: VA VA |
$15,887.07
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$10,130.98
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$4,947.06 |
| Max. Negotiated Rate |
$10,130.98 |
| Rate for Payer: Aetna Medicare |
$5,415.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,509.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,509.29
|
| Rate for Payer: BCBS MAPPO |
$5,207.43
|
| Rate for Payer: BCBS Trust/PPO |
$10,130.98
|
| Rate for Payer: BCN Commercial |
$10,130.98
|
| Rate for Payer: BCN Medicare Advantage |
$5,207.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,207.43
|
| Rate for Payer: Mclaren Medicare |
$5,207.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,467.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,988.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,728.17
|
| Rate for Payer: Nomi Health Commercial |
$7,725.81
|
| Rate for Payer: PACE Medicare |
$4,947.06
|
| Rate for Payer: PACE SWMI |
$5,207.43
|
| Rate for Payer: PHP Medicare Advantage |
$5,207.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,655.55
|
| Rate for Payer: Priority Health Medicare |
$5,207.43
|
| Rate for Payer: Priority Health Tiered Network |
$7,724.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5,207.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,762.07
|
| Rate for Payer: UHC Core |
$8,167.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,207.43
|
| Rate for Payer: UHC Exchange |
$6,669.95
|
| Rate for Payer: VA VA |
$5,207.43
|
|
|
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,911.87
|
|
|
Service Code
|
NDC 70954018810
|
| Hospital Charge Code |
8970
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,204.48 |
| Max. Negotiated Rate |
$1,720.68 |
| Rate for Payer: Aetna Commercial |
$1,625.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,242.72
|
| Rate for Payer: Cash Price |
$1,529.50
|
| Rate for Payer: Cofinity Advantage |
$1,338.31
|
| Rate for Payer: Cofinity Commercial |
$1,644.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,529.50
|
| Rate for Payer: Healthscope Commercial |
$1,720.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,625.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,433.90
|
| Rate for Payer: PHP Commercial |
$1,625.09
|
| Rate for Payer: Priority Health SBD |
$1,204.48
|
|
