|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$7,557.07
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$5,743.38 |
| Max. Negotiated Rate |
$7,557.07 |
| Rate for Payer: Aetna Medicare |
$6,287.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,557.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,557.07
|
| Rate for Payer: BCBS MAPPO |
$6,045.66
|
| Rate for Payer: BCN Medicare Advantage |
$6,045.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,045.66
|
| Rate for Payer: Mclaren Medicare |
$6,045.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,347.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,952.51
|
| Rate for Payer: PACE Medicare |
$5,743.38
|
| Rate for Payer: PACE SWMI |
$6,045.66
|
| Rate for Payer: PHP Medicare Advantage |
$6,045.66
|
| Rate for Payer: Priority Health Medicare |
$6,045.66
|
| Rate for Payer: Railroad Medicare Medicare |
$6,045.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,045.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,045.66
|
| Rate for Payer: VA VA |
$6,045.66
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$10,200.27
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$7,752.21 |
| Max. Negotiated Rate |
$10,200.27 |
| Rate for Payer: Aetna Medicare |
$8,486.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,200.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,200.27
|
| Rate for Payer: BCBS MAPPO |
$8,160.22
|
| Rate for Payer: BCN Medicare Advantage |
$8,160.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,160.22
|
| Rate for Payer: Mclaren Medicare |
$8,160.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,568.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,384.25
|
| Rate for Payer: PACE Medicare |
$7,752.21
|
| Rate for Payer: PACE SWMI |
$8,160.22
|
| Rate for Payer: PHP Medicare Advantage |
$8,160.22
|
| Rate for Payer: Priority Health Medicare |
$8,160.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8,160.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,160.22
|
| Rate for Payer: UHC Medicare Advantage |
$8,160.22
|
| Rate for Payer: VA VA |
$8,160.22
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$6,725.76
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,111.58 |
| Max. Negotiated Rate |
$6,725.76 |
| Rate for Payer: Aetna Medicare |
$5,595.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,725.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,725.76
|
| Rate for Payer: BCBS MAPPO |
$5,380.61
|
| Rate for Payer: BCN Medicare Advantage |
$5,380.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,380.61
|
| Rate for Payer: Mclaren Medicare |
$5,380.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,649.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,187.70
|
| Rate for Payer: PACE Medicare |
$5,111.58
|
| Rate for Payer: PACE SWMI |
$5,380.61
|
| Rate for Payer: PHP Medicare Advantage |
$5,380.61
|
| Rate for Payer: Priority Health Medicare |
$5,380.61
|
| Rate for Payer: Railroad Medicare Medicare |
$5,380.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,380.61
|
| Rate for Payer: UHC Medicare Advantage |
$5,380.61
|
| Rate for Payer: VA VA |
$5,380.61
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$9,913.24
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$7,534.06 |
| Max. Negotiated Rate |
$9,913.24 |
| Rate for Payer: Aetna Medicare |
$8,247.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,913.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,913.24
|
| Rate for Payer: BCBS MAPPO |
$7,930.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,930.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,930.59
|
| Rate for Payer: Mclaren Medicare |
$7,930.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,327.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,120.18
|
| Rate for Payer: PACE Medicare |
$7,534.06
|
| Rate for Payer: PACE SWMI |
$7,930.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,930.59
|
| Rate for Payer: Priority Health Medicare |
$7,930.59
|
| Rate for Payer: Railroad Medicare Medicare |
$7,930.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,930.59
|
| Rate for Payer: UHC Medicare Advantage |
$7,930.59
|
| Rate for Payer: VA VA |
$7,930.59
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$12,883.95
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$9,791.80 |
| Max. Negotiated Rate |
$12,883.95 |
| Rate for Payer: Aetna Medicare |
$10,719.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,883.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,883.95
|
| Rate for Payer: BCBS MAPPO |
$10,307.16
|
| Rate for Payer: BCN Medicare Advantage |
$10,307.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,307.16
|
| Rate for Payer: Mclaren Medicare |
$10,307.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,822.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,853.23
|
| Rate for Payer: PACE Medicare |
$9,791.80
|
| Rate for Payer: PACE SWMI |
$10,307.16
|
| Rate for Payer: PHP Medicare Advantage |
$10,307.16
|
| Rate for Payer: Priority Health Medicare |
$10,307.16
|
| Rate for Payer: Railroad Medicare Medicare |
$10,307.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,307.16
|
| Rate for Payer: UHC Medicare Advantage |
$10,307.16
|
| Rate for Payer: VA VA |
$10,307.16
|
|
|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$9,913.24
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$7,534.06 |
| Max. Negotiated Rate |
$9,913.24 |
| Rate for Payer: Aetna Medicare |
$8,247.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,913.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,913.24
|
| Rate for Payer: BCBS MAPPO |
$7,930.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,930.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,930.59
|
| Rate for Payer: Mclaren Medicare |
$7,930.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,327.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,120.18
|
| Rate for Payer: PACE Medicare |
$7,534.06
|
| Rate for Payer: PACE SWMI |
$7,930.59
|
| Rate for Payer: PHP Medicare Advantage |
$7,930.59
|
| Rate for Payer: Priority Health Medicare |
$7,930.59
|
| Rate for Payer: Railroad Medicare Medicare |
$7,930.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,930.59
|
| Rate for Payer: UHC Medicare Advantage |
$7,930.59
|
| Rate for Payer: VA VA |
$7,930.59
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$26,422.74
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$20,081.28 |
| Max. Negotiated Rate |
$26,422.74 |
| Rate for Payer: Aetna Medicare |
$21,983.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,422.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,422.74
|
| Rate for Payer: BCBS MAPPO |
$21,138.19
|
| Rate for Payer: BCN Medicare Advantage |
$21,138.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,138.19
|
| Rate for Payer: Mclaren Medicare |
$21,138.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,195.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,308.92
|
| Rate for Payer: PACE Medicare |
$20,081.28
|
| Rate for Payer: PACE SWMI |
$21,138.19
|
| Rate for Payer: PHP Medicare Advantage |
$21,138.19
|
| Rate for Payer: Priority Health Medicare |
$21,138.19
|
| Rate for Payer: Railroad Medicare Medicare |
$21,138.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,138.19
|
| Rate for Payer: UHC Medicare Advantage |
$21,138.19
|
| Rate for Payer: VA VA |
$21,138.19
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$21,158.46
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$16,080.43 |
| Max. Negotiated Rate |
$21,158.46 |
| Rate for Payer: Aetna Medicare |
$17,603.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,158.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,158.46
|
| Rate for Payer: BCBS MAPPO |
$16,926.77
|
| Rate for Payer: BCN Medicare Advantage |
$16,926.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,926.77
|
| Rate for Payer: Mclaren Medicare |
$16,926.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,773.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,465.79
|
| Rate for Payer: PACE Medicare |
$16,080.43
|
| Rate for Payer: PACE SWMI |
$16,926.77
|
| Rate for Payer: PHP Medicare Advantage |
$16,926.77
|
| Rate for Payer: Priority Health Medicare |
$16,926.77
|
| Rate for Payer: Railroad Medicare Medicare |
$16,926.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,926.77
|
| Rate for Payer: UHC Medicare Advantage |
$16,926.77
|
| Rate for Payer: VA VA |
$16,926.77
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$40,953.66
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$31,124.78 |
| Max. Negotiated Rate |
$40,953.66 |
| Rate for Payer: Aetna Medicare |
$34,073.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40,953.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40,953.66
|
| Rate for Payer: BCBS MAPPO |
$32,762.93
|
| Rate for Payer: BCN Medicare Advantage |
$32,762.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,762.93
|
| Rate for Payer: Mclaren Medicare |
$32,762.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,401.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,677.37
|
| Rate for Payer: PACE Medicare |
$31,124.78
|
| Rate for Payer: PACE SWMI |
$32,762.93
|
| Rate for Payer: PHP Medicare Advantage |
$32,762.93
|
| Rate for Payer: Priority Health Medicare |
$32,762.93
|
| Rate for Payer: Railroad Medicare Medicare |
$32,762.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$32,762.93
|
| Rate for Payer: UHC Medicare Advantage |
$32,762.93
|
| Rate for Payer: VA VA |
$32,762.93
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$15,955.81
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$12,126.42 |
| Max. Negotiated Rate |
$15,955.81 |
| Rate for Payer: Aetna Medicare |
$13,275.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,955.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,955.81
|
| Rate for Payer: BCBS MAPPO |
$12,764.65
|
| Rate for Payer: BCN Medicare Advantage |
$12,764.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,764.65
|
| Rate for Payer: Mclaren Medicare |
$12,764.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,402.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,679.35
|
| Rate for Payer: PACE Medicare |
$12,126.42
|
| Rate for Payer: PACE SWMI |
$12,764.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,764.65
|
| Rate for Payer: Priority Health Medicare |
$12,764.65
|
| Rate for Payer: Railroad Medicare Medicare |
$12,764.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,764.65
|
| Rate for Payer: UHC Medicare Advantage |
$12,764.65
|
| Rate for Payer: VA VA |
$12,764.65
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$14,803.74
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,250.84 |
| Max. Negotiated Rate |
$14,803.74 |
| Rate for Payer: Aetna Medicare |
$12,316.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,803.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,803.74
|
| Rate for Payer: BCBS MAPPO |
$11,842.99
|
| Rate for Payer: BCN Medicare Advantage |
$11,842.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,842.99
|
| Rate for Payer: Mclaren Medicare |
$11,842.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,435.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,619.44
|
| Rate for Payer: PACE Medicare |
$11,250.84
|
| Rate for Payer: PACE SWMI |
$11,842.99
|
| Rate for Payer: PHP Medicare Advantage |
$11,842.99
|
| Rate for Payer: Priority Health Medicare |
$11,842.99
|
| Rate for Payer: Railroad Medicare Medicare |
$11,842.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,842.99
|
| Rate for Payer: UHC Medicare Advantage |
$11,842.99
|
| Rate for Payer: VA VA |
$11,842.99
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$9,109.86
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$6,923.50 |
| Max. Negotiated Rate |
$9,109.86 |
| Rate for Payer: Aetna Medicare |
$7,579.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,109.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,109.86
|
| Rate for Payer: BCBS MAPPO |
$7,287.89
|
| Rate for Payer: BCN Medicare Advantage |
$7,287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,287.89
|
| Rate for Payer: Mclaren Medicare |
$7,287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,652.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,381.07
|
| Rate for Payer: PACE Medicare |
$6,923.50
|
| Rate for Payer: PACE SWMI |
$7,287.89
|
| Rate for Payer: PHP Medicare Advantage |
$7,287.89
|
| Rate for Payer: Priority Health Medicare |
$7,287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$7,287.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,287.89
|
| Rate for Payer: UHC Medicare Advantage |
$7,287.89
|
| Rate for Payer: VA VA |
$7,287.89
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$17,178.21
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$13,055.44 |
| Max. Negotiated Rate |
$17,178.21 |
| Rate for Payer: Aetna Medicare |
$14,292.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,178.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,178.21
|
| Rate for Payer: BCBS MAPPO |
$13,742.57
|
| Rate for Payer: BCN Medicare Advantage |
$13,742.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,742.57
|
| Rate for Payer: Mclaren Medicare |
$13,742.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,429.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,803.96
|
| Rate for Payer: PACE Medicare |
$13,055.44
|
| Rate for Payer: PACE SWMI |
$13,742.57
|
| Rate for Payer: PHP Medicare Advantage |
$13,742.57
|
| Rate for Payer: Priority Health Medicare |
$13,742.57
|
| Rate for Payer: Railroad Medicare Medicare |
$13,742.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,742.57
|
| Rate for Payer: UHC Medicare Advantage |
$13,742.57
|
| Rate for Payer: VA VA |
$13,742.57
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,419.09
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$7,158.51 |
| Max. Negotiated Rate |
$9,419.09 |
| Rate for Payer: Aetna Medicare |
$7,836.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,419.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,419.09
|
| Rate for Payer: BCBS MAPPO |
$7,535.27
|
| Rate for Payer: BCN Medicare Advantage |
$7,535.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,535.27
|
| Rate for Payer: Mclaren Medicare |
$7,535.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,912.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,665.56
|
| Rate for Payer: PACE Medicare |
$7,158.51
|
| Rate for Payer: PACE SWMI |
$7,535.27
|
| Rate for Payer: PHP Medicare Advantage |
$7,535.27
|
| Rate for Payer: Priority Health Medicare |
$7,535.27
|
| Rate for Payer: Railroad Medicare Medicare |
$7,535.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,535.27
|
| Rate for Payer: UHC Medicare Advantage |
$7,535.27
|
| Rate for Payer: VA VA |
$7,535.27
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$28,989.84
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$22,032.28 |
| Max. Negotiated Rate |
$28,989.84 |
| Rate for Payer: Aetna Medicare |
$24,119.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,989.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,989.84
|
| Rate for Payer: BCBS MAPPO |
$23,191.87
|
| Rate for Payer: BCN Medicare Advantage |
$23,191.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,191.87
|
| Rate for Payer: Mclaren Medicare |
$23,191.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,351.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,670.65
|
| Rate for Payer: PACE Medicare |
$22,032.28
|
| Rate for Payer: PACE SWMI |
$23,191.87
|
| Rate for Payer: PHP Medicare Advantage |
$23,191.87
|
| Rate for Payer: Priority Health Medicare |
$23,191.87
|
| Rate for Payer: Railroad Medicare Medicare |
$23,191.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,191.87
|
| Rate for Payer: UHC Medicare Advantage |
$23,191.87
|
| Rate for Payer: VA VA |
$23,191.87
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$52,613.07
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$39,985.94 |
| Max. Negotiated Rate |
$52,613.07 |
| Rate for Payer: Aetna Medicare |
$43,774.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,613.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,613.07
|
| Rate for Payer: BCBS MAPPO |
$42,090.46
|
| Rate for Payer: BCN Medicare Advantage |
$42,090.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,090.46
|
| Rate for Payer: Mclaren Medicare |
$42,090.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,194.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,404.03
|
| Rate for Payer: PACE Medicare |
$39,985.94
|
| Rate for Payer: PACE SWMI |
$42,090.46
|
| Rate for Payer: PHP Medicare Advantage |
$42,090.46
|
| Rate for Payer: Priority Health Medicare |
$42,090.46
|
| Rate for Payer: Railroad Medicare Medicare |
$42,090.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$42,090.46
|
| Rate for Payer: UHC Medicare Advantage |
$42,090.46
|
| Rate for Payer: VA VA |
$42,090.46
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,310.19
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$13,155.74 |
| Max. Negotiated Rate |
$17,310.19 |
| Rate for Payer: Aetna Medicare |
$14,402.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,310.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,310.19
|
| Rate for Payer: BCBS MAPPO |
$13,848.15
|
| Rate for Payer: BCN Medicare Advantage |
$13,848.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,848.15
|
| Rate for Payer: Mclaren Medicare |
$13,848.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,540.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,925.37
|
| Rate for Payer: PACE Medicare |
$13,155.74
|
| Rate for Payer: PACE SWMI |
$13,848.15
|
| Rate for Payer: PHP Medicare Advantage |
$13,848.15
|
| Rate for Payer: Priority Health Medicare |
$13,848.15
|
| Rate for Payer: Railroad Medicare Medicare |
$13,848.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,848.15
|
| Rate for Payer: UHC Medicare Advantage |
$13,848.15
|
| Rate for Payer: VA VA |
$13,848.15
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$18,865.88
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$14,338.07 |
| Max. Negotiated Rate |
$18,865.88 |
| Rate for Payer: Aetna Medicare |
$15,696.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,865.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,865.88
|
| Rate for Payer: BCBS MAPPO |
$15,092.70
|
| Rate for Payer: BCN Medicare Advantage |
$15,092.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,092.70
|
| Rate for Payer: Mclaren Medicare |
$15,092.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,847.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,356.60
|
| Rate for Payer: PACE Medicare |
$14,338.07
|
| Rate for Payer: PACE SWMI |
$15,092.70
|
| Rate for Payer: PHP Medicare Advantage |
$15,092.70
|
| Rate for Payer: Priority Health Medicare |
$15,092.70
|
| Rate for Payer: Railroad Medicare Medicare |
$15,092.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,092.70
|
| Rate for Payer: UHC Medicare Advantage |
$15,092.70
|
| Rate for Payer: VA VA |
$15,092.70
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$43,264.54
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$32,881.05 |
| Max. Negotiated Rate |
$43,264.54 |
| Rate for Payer: Aetna Medicare |
$35,996.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,264.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,264.54
|
| Rate for Payer: BCBS MAPPO |
$34,611.63
|
| Rate for Payer: BCN Medicare Advantage |
$34,611.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,611.63
|
| Rate for Payer: Mclaren Medicare |
$34,611.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,342.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,803.37
|
| Rate for Payer: PACE Medicare |
$32,881.05
|
| Rate for Payer: PACE SWMI |
$34,611.63
|
| Rate for Payer: PHP Medicare Advantage |
$34,611.63
|
| Rate for Payer: Priority Health Medicare |
$34,611.63
|
| Rate for Payer: Railroad Medicare Medicare |
$34,611.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,611.63
|
| Rate for Payer: UHC Medicare Advantage |
$34,611.63
|
| Rate for Payer: VA VA |
$34,611.63
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$12,330.09
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,370.87 |
| Max. Negotiated Rate |
$12,330.09 |
| Rate for Payer: Aetna Medicare |
$10,258.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,330.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,330.09
|
| Rate for Payer: BCBS MAPPO |
$9,864.07
|
| Rate for Payer: BCN Medicare Advantage |
$9,864.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,864.07
|
| Rate for Payer: Mclaren Medicare |
$9,864.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,357.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,343.68
|
| Rate for Payer: PACE Medicare |
$9,370.87
|
| Rate for Payer: PACE SWMI |
$9,864.07
|
| Rate for Payer: PHP Medicare Advantage |
$9,864.07
|
| Rate for Payer: Priority Health Medicare |
$9,864.07
|
| Rate for Payer: Railroad Medicare Medicare |
$9,864.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,864.07
|
| Rate for Payer: UHC Medicare Advantage |
$9,864.07
|
| Rate for Payer: VA VA |
$9,864.07
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$205.70
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.59 |
| Max. Negotiated Rate |
$185.13 |
| Rate for Payer: Aetna Commercial |
$174.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.71
|
| Rate for Payer: Cash Price |
$164.56
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.56
|
| Rate for Payer: Healthscope Commercial |
$185.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.84
|
| Rate for Payer: PHP Commercial |
$174.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.71
|
| Rate for Payer: Priority Health SBD |
$129.59
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$205.70
|
|
|
Service Code
|
NDC 77333086110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.28 |
| Max. Negotiated Rate |
$185.13 |
| Rate for Payer: Aetna Commercial |
$174.84
|
| Rate for Payer: Aetna Medicare |
$102.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.71
|
| Rate for Payer: BCBS Complete |
$82.28
|
| Rate for Payer: Cash Price |
$164.56
|
| Rate for Payer: Cofinity Commercial |
$143.99
|
| Rate for Payer: Cofinity Commercial |
$176.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.56
|
| Rate for Payer: Healthscope Commercial |
$185.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.84
|
| Rate for Payer: PHP Commercial |
$174.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.71
|
| Rate for Payer: Priority Health SBD |
$129.59
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
NDC 77333086125
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.85 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.34
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.75
|
| Rate for Payer: PHP Commercial |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.34
|
| Rate for Payer: Priority Health SBD |
$1.30
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$187.20
|
|
|
Service Code
|
NDC 80681016000
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$168.48 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Medicare |
$93.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.68
|
| Rate for Payer: BCBS Complete |
$74.88
|
| Rate for Payer: Cash Price |
$149.76
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$160.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.76
|
| Rate for Payer: Healthscope Commercial |
$168.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.12
|
| Rate for Payer: PHP Commercial |
$159.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.68
|
| Rate for Payer: Priority Health SBD |
$117.94
|
|
