|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$49.57
|
|
|
Service Code
|
NDC 63323032101
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$44.61 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.22
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Cofinity Advantage |
$34.70
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.66
|
| Rate for Payer: Healthscope Commercial |
$44.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.18
|
| Rate for Payer: PHP Commercial |
$42.13
|
| Rate for Payer: Priority Health SBD |
$31.23
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$49.57
|
|
|
Service Code
|
NDC 63323032101
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$44.61 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.22
|
| Rate for Payer: BCBS Complete |
$19.83
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Cofinity Advantage |
$34.70
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.66
|
| Rate for Payer: Healthscope Commercial |
$44.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.18
|
| Rate for Payer: PHP Commercial |
$42.13
|
| Rate for Payer: Priority Health SBD |
$31.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.22
|
| Rate for Payer: UHC Core |
$25.83
|
| Rate for Payer: UHC Exchange |
$19.48
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$23.40
|
|
|
Service Code
|
NDC 55150023410
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.21
|
| Rate for Payer: UHC Core |
$12.19
|
| Rate for Payer: UHC Exchange |
$9.20
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
OP
|
$49.57
|
|
|
Service Code
|
NDC 63323032110
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$44.61 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna Medicare |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.22
|
| Rate for Payer: BCBS Complete |
$19.83
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Cofinity Advantage |
$34.70
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.66
|
| Rate for Payer: Healthscope Commercial |
$44.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.18
|
| Rate for Payer: PHP Commercial |
$42.13
|
| Rate for Payer: Priority Health SBD |
$31.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.22
|
| Rate for Payer: UHC Core |
$25.83
|
| Rate for Payer: UHC Exchange |
$19.48
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$49.57
|
|
|
Service Code
|
NDC 63323032110
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.23 |
| Max. Negotiated Rate |
$44.61 |
| Rate for Payer: Aetna Commercial |
$42.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.22
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Cofinity Advantage |
$34.70
|
| Rate for Payer: Cofinity Commercial |
$42.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.66
|
| Rate for Payer: Healthscope Commercial |
$44.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.18
|
| Rate for Payer: PHP Commercial |
$42.13
|
| Rate for Payer: Priority Health SBD |
$31.23
|
|
|
POLYMYXIN B SULFATE 500,000 UNIT SOLUTION FOR INJECTION
|
Facility
|
IP
|
$23.40
|
|
|
Service Code
|
NDC 55150023410
|
| Hospital Charge Code |
6393
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$21.06 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: Priority Health SBD |
$14.74
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
NDC 00536132594
|
| Hospital Charge Code |
27994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.85 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna Medicare |
$29.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Advantage |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.60
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health SBD |
$36.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.79
|
| Rate for Payer: UHC Core |
$30.29
|
| Rate for Payer: UHC Exchange |
$22.85
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS
|
Facility
|
OP
|
$92.34
|
|
|
Service Code
|
NDC 17478006012
|
| Hospital Charge Code |
27994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.29 |
| Max. Negotiated Rate |
$83.11 |
| Rate for Payer: Aetna Commercial |
$78.49
|
| Rate for Payer: Aetna Medicare |
$46.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.02
|
| Rate for Payer: BCBS Complete |
$36.94
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cofinity Advantage |
$64.64
|
| Rate for Payer: Cofinity Commercial |
$79.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.87
|
| Rate for Payer: Healthscope Commercial |
$83.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.25
|
| Rate for Payer: PHP Commercial |
$78.49
|
| Rate for Payer: Priority Health SBD |
$58.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.02
|
| Rate for Payer: UHC Core |
$48.11
|
| Rate for Payer: UHC Exchange |
$36.29
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
NDC 00536132594
|
| Hospital Charge Code |
27994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.63 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Advantage |
$40.70
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.60
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health SBD |
$36.63
|
|
|
POLYVINYL ALCOHOL 1.4 % EYE DROPS
|
Facility
|
IP
|
$92.34
|
|
|
Service Code
|
NDC 17478006012
|
| Hospital Charge Code |
27994
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.17 |
| Max. Negotiated Rate |
$83.11 |
| Rate for Payer: Aetna Commercial |
$78.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.02
|
| Rate for Payer: Cash Price |
$73.87
|
| Rate for Payer: Cofinity Advantage |
$64.64
|
| Rate for Payer: Cofinity Commercial |
$79.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.87
|
| Rate for Payer: Healthscope Commercial |
$83.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.25
|
| Rate for Payer: PHP Commercial |
$78.49
|
| Rate for Payer: Priority Health SBD |
$58.17
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,337.77
|
|
|
Service Code
|
NDC 43598047060
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,102.80 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Advantage |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,503.33
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,548.45
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$975.52 |
| Max. Negotiated Rate |
$1,393.61 |
| Rate for Payer: Aetna Commercial |
$1,316.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.49
|
| Rate for Payer: Cash Price |
$1,238.76
|
| Rate for Payer: Cofinity Advantage |
$1,083.91
|
| Rate for Payer: Cofinity Commercial |
$1,331.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.76
|
| Rate for Payer: Healthscope Commercial |
$1,393.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.34
|
| Rate for Payer: PHP Commercial |
$1,316.18
|
| Rate for Payer: Priority Health SBD |
$975.52
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,548.45
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$608.54 |
| Max. Negotiated Rate |
$1,393.61 |
| Rate for Payer: Aetna Commercial |
$1,316.18
|
| Rate for Payer: Aetna Medicare |
$774.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.49
|
| Rate for Payer: BCBS Complete |
$619.38
|
| Rate for Payer: Cash Price |
$1,238.76
|
| Rate for Payer: Cofinity Advantage |
$1,083.91
|
| Rate for Payer: Cofinity Commercial |
$1,331.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,238.76
|
| Rate for Payer: Healthscope Commercial |
$1,393.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,316.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.34
|
| Rate for Payer: PHP Commercial |
$1,316.18
|
| Rate for Payer: Priority Health SBD |
$975.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.49
|
| Rate for Payer: UHC Core |
$806.74
|
| Rate for Payer: UHC Exchange |
$608.54
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,337.77
|
|
|
Service Code
|
NDC 43598047060
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,311.74 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna Medicare |
$1,668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: BCBS Complete |
$1,335.11
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Advantage |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,670.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,503.33
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,169.55
|
| Rate for Payer: UHC Core |
$1,738.98
|
| Rate for Payer: UHC Exchange |
$1,311.74
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,444.01
|
| Rate for Payer: BCN Commercial |
$3,444.01
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,067.50
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,067.50 |
| Max. Negotiated Rate |
$2,067.50 |
| Rate for Payer: BCBS Trust/PPO |
$2,067.50
|
| Rate for Payer: BCN Commercial |
$2,067.50
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$29,726.31
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$13,939.33 |
| Max. Negotiated Rate |
$29,726.31 |
| Rate for Payer: Aetna Medicare |
$15,259.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,341.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,341.22
|
| Rate for Payer: BCBS MAPPO |
$14,672.98
|
| Rate for Payer: BCBS Trust/PPO |
$21,790.51
|
| Rate for Payer: BCN Commercial |
$21,790.51
|
| Rate for Payer: BCN Medicare Advantage |
$14,672.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,672.98
|
| Rate for Payer: Mclaren Medicare |
$14,672.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,406.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,873.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,140.28
|
| Rate for Payer: Nomi Health Commercial |
$23,525.73
|
| Rate for Payer: PACE Medicare |
$13,939.33
|
| Rate for Payer: PACE SWMI |
$14,672.98
|
| Rate for Payer: PHP Medicare Advantage |
$14,672.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,401.95
|
| Rate for Payer: Priority Health Medicare |
$14,672.98
|
| Rate for Payer: Priority Health Tiered Network |
$23,521.55
|
| Rate for Payer: Railroad Medicare Medicare |
$14,672.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,726.31
|
| Rate for Payer: UHC Core |
$24,869.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,672.98
|
| Rate for Payer: UHC Exchange |
$20,310.55
|
| Rate for Payer: VA VA |
$14,672.98
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$16,265.77
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$7,876.45 |
| Max. Negotiated Rate |
$16,265.77 |
| Rate for Payer: Aetna Medicare |
$8,622.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,363.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,363.75
|
| Rate for Payer: BCBS MAPPO |
$8,291.00
|
| Rate for Payer: BCBS Trust/PPO |
$15,006.87
|
| Rate for Payer: BCN Commercial |
$15,006.87
|
| Rate for Payer: BCN Medicare Advantage |
$8,291.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,291.00
|
| Rate for Payer: Mclaren Medicare |
$8,291.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,705.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,534.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,120.10
|
| Rate for Payer: Nomi Health Commercial |
$12,872.91
|
| Rate for Payer: PACE Medicare |
$7,876.45
|
| Rate for Payer: PACE SWMI |
$8,291.00
|
| Rate for Payer: PHP Medicare Advantage |
$8,291.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,088.28
|
| Rate for Payer: Priority Health Medicare |
$8,291.00
|
| Rate for Payer: Priority Health Tiered Network |
$12,870.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8,291.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,265.77
|
| Rate for Payer: UHC Core |
$13,608.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,291.00
|
| Rate for Payer: UHC Exchange |
$11,113.61
|
| Rate for Payer: VA VA |
$8,291.00
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$34,906.45
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$16,272.56 |
| Max. Negotiated Rate |
$34,906.45 |
| Rate for Payer: Aetna Medicare |
$17,814.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,411.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,411.26
|
| Rate for Payer: BCBS MAPPO |
$17,129.01
|
| Rate for Payer: BCBS Trust/PPO |
$30,856.43
|
| Rate for Payer: BCN Commercial |
$30,856.43
|
| Rate for Payer: BCN Medicare Advantage |
$17,129.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,129.01
|
| Rate for Payer: Mclaren Medicare |
$17,129.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,985.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,698.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,841.91
|
| Rate for Payer: Nomi Health Commercial |
$27,625.35
|
| Rate for Payer: PACE Medicare |
$16,272.56
|
| Rate for Payer: PACE SWMI |
$17,129.01
|
| Rate for Payer: PHP Medicare Advantage |
$17,129.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,525.56
|
| Rate for Payer: Priority Health Medicare |
$17,129.01
|
| Rate for Payer: Priority Health Tiered Network |
$27,620.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17,129.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,906.45
|
| Rate for Payer: UHC Core |
$29,203.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,129.01
|
| Rate for Payer: UHC Exchange |
$23,849.89
|
| Rate for Payer: VA VA |
$17,129.01
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$76,094.73
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$33,945.78 |
| Max. Negotiated Rate |
$76,094.73 |
| Rate for Payer: Aetna Medicare |
$37,161.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,665.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,665.50
|
| Rate for Payer: BCBS MAPPO |
$35,732.40
|
| Rate for Payer: BCBS Trust/PPO |
$76,094.73
|
| Rate for Payer: BCN Commercial |
$76,094.73
|
| Rate for Payer: BCN Medicare Advantage |
$35,732.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,732.40
|
| Rate for Payer: Mclaren Medicare |
$35,732.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,519.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,092.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,305.64
|
| Rate for Payer: Nomi Health Commercial |
$58,678.23
|
| Rate for Payer: PACE Medicare |
$33,945.78
|
| Rate for Payer: PACE SWMI |
$35,732.40
|
| Rate for Payer: PHP Medicare Advantage |
$35,732.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,334.78
|
| Rate for Payer: Priority Health Medicare |
$35,732.40
|
| Rate for Payer: Priority Health Tiered Network |
$58,667.81
|
| Rate for Payer: Railroad Medicare Medicare |
$35,732.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,143.81
|
| Rate for Payer: UHC Core |
$62,030.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,732.40
|
| Rate for Payer: UHC Exchange |
$50,658.87
|
| Rate for Payer: VA VA |
$35,732.40
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$22,704.27
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$10,776.47 |
| Max. Negotiated Rate |
$22,704.27 |
| Rate for Payer: Aetna Medicare |
$11,797.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,179.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,179.56
|
| Rate for Payer: BCBS MAPPO |
$11,343.65
|
| Rate for Payer: BCBS Trust/PPO |
$21,495.57
|
| Rate for Payer: BCN Commercial |
$21,495.57
|
| Rate for Payer: BCN Medicare Advantage |
$11,343.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,343.65
|
| Rate for Payer: Mclaren Medicare |
$11,343.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,910.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,045.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,478.01
|
| Rate for Payer: Nomi Health Commercial |
$17,968.41
|
| Rate for Payer: PACE Medicare |
$10,776.47
|
| Rate for Payer: PACE SWMI |
$11,343.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,343.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,456.53
|
| Rate for Payer: Priority Health Medicare |
$11,343.65
|
| Rate for Payer: Priority Health Tiered Network |
$17,965.22
|
| Rate for Payer: Railroad Medicare Medicare |
$11,343.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,704.27
|
| Rate for Payer: UHC Core |
$18,994.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,343.65
|
| Rate for Payer: UHC Exchange |
$15,512.73
|
| Rate for Payer: VA VA |
$11,343.65
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$8,234.31
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$7,842.20 |
| Max. Negotiated Rate |
$8,234.31 |
| Rate for Payer: BCBS Complete |
$8,234.31
|
| Rate for Payer: Mclaren Medicaid |
$7,842.20
|
| Rate for Payer: Meridian Medicaid |
$8,234.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,842.20
|
| Rate for Payer: UHC Medicaid |
$7,842.20
|
| Rate for Payer: UHCCP Medicaid |
$7,842.20
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$25,482.61
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$24,269.15 |
| Max. Negotiated Rate |
$25,482.61 |
| Rate for Payer: BCBS Complete |
$25,482.61
|
| Rate for Payer: Mclaren Medicaid |
$24,269.15
|
| Rate for Payer: Meridian Medicaid |
$25,482.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,269.15
|
| Rate for Payer: UHC Medicaid |
$24,269.15
|
| Rate for Payer: UHCCP Medicaid |
$24,269.15
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$10,586.56
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$10,082.44 |
| Max. Negotiated Rate |
$10,586.56 |
| Rate for Payer: BCBS Complete |
$10,586.56
|
| Rate for Payer: Mclaren Medicaid |
$10,082.44
|
| Rate for Payer: Meridian Medicaid |
$10,586.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,082.44
|
| Rate for Payer: UHC Medicaid |
$10,082.44
|
| Rate for Payer: UHCCP Medicaid |
$10,082.44
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$13,385.98
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$12,748.55 |
| Max. Negotiated Rate |
$13,385.98 |
| Rate for Payer: BCBS Complete |
$13,385.98
|
| Rate for Payer: Mclaren Medicaid |
$12,748.55
|
| Rate for Payer: Meridian Medicaid |
$13,385.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,748.55
|
| Rate for Payer: UHC Medicaid |
$12,748.55
|
| Rate for Payer: UHCCP Medicaid |
$12,748.55
|
|
