|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC
|
Facility
|
IP
|
$36,526.60
|
|
|
Service Code
|
MS-DRG 511
|
| Min. Negotiated Rate |
$14,109.08 |
| Max. Negotiated Rate |
$36,526.60 |
| Rate for Payer: Aetna Medicare |
$15,445.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,564.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,564.58
|
| Rate for Payer: BCBS MAPPO |
$14,851.66
|
| Rate for Payer: BCBS Trust/PPO |
$36,526.60
|
| Rate for Payer: BCN Medicare Advantage |
$14,851.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,851.66
|
| Rate for Payer: Mclaren Medicare |
$14,851.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,594.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,079.41
|
| Rate for Payer: PACE Medicare |
$14,109.08
|
| Rate for Payer: PACE SWMI |
$14,851.66
|
| Rate for Payer: PHP Medicare Advantage |
$14,851.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,610.87
|
| Rate for Payer: Priority Health Medicare |
$14,851.66
|
| Rate for Payer: Priority Health Narrow Network |
$22,888.70
|
| Rate for Payer: Railroad Medicare Medicare |
$14,851.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,413.43
|
| Rate for Payer: UHC Core |
$18,661.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,851.66
|
| Rate for Payer: UHC Exchange |
$19,987.85
|
| Rate for Payer: UHC Medicare Advantage |
$15,297.21
|
| Rate for Payer: VA VA |
$14,851.66
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC
|
Facility
|
IP
|
$41,500.03
|
|
|
Service Code
|
MS-DRG 510
|
| Min. Negotiated Rate |
$19,081.63 |
| Max. Negotiated Rate |
$41,500.03 |
| Rate for Payer: Aetna Medicare |
$20,889.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,107.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,107.41
|
| Rate for Payer: BCBS MAPPO |
$20,085.93
|
| Rate for Payer: BCBS Trust/PPO |
$40,327.70
|
| Rate for Payer: BCN Medicare Advantage |
$20,085.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,085.93
|
| Rate for Payer: Mclaren Medicare |
$20,085.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,090.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,098.82
|
| Rate for Payer: PACE Medicare |
$19,081.63
|
| Rate for Payer: PACE SWMI |
$20,085.93
|
| Rate for Payer: PHP Medicare Advantage |
$20,085.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,040.39
|
| Rate for Payer: Priority Health Medicare |
$20,085.93
|
| Rate for Payer: Priority Health Narrow Network |
$31,232.31
|
| Rate for Payer: Railroad Medicare Medicare |
$20,085.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,500.03
|
| Rate for Payer: UHC Core |
$25,464.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,085.93
|
| Rate for Payer: UHC Exchange |
$27,274.02
|
| Rate for Payer: UHC Medicare Advantage |
$20,688.51
|
| Rate for Payer: VA VA |
$20,085.93
|
|
|
SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,561.21
|
|
|
Service Code
|
MS-DRG 512
|
| Min. Negotiated Rate |
$11,509.24 |
| Max. Negotiated Rate |
$29,561.21 |
| Rate for Payer: Aetna Medicare |
$12,599.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,143.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,143.74
|
| Rate for Payer: BCBS MAPPO |
$12,114.99
|
| Rate for Payer: BCBS Trust/PPO |
$29,561.21
|
| Rate for Payer: BCN Medicare Advantage |
$12,114.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,114.99
|
| Rate for Payer: Mclaren Medicare |
$12,114.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,720.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,932.24
|
| Rate for Payer: PACE Medicare |
$11,509.24
|
| Rate for Payer: PACE SWMI |
$12,114.99
|
| Rate for Payer: PHP Medicare Advantage |
$12,114.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,157.90
|
| Rate for Payer: Priority Health Medicare |
$12,114.99
|
| Rate for Payer: Priority Health Narrow Network |
$18,526.32
|
| Rate for Payer: Railroad Medicare Medicare |
$12,114.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,616.91
|
| Rate for Payer: UHC Core |
$15,105.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,114.99
|
| Rate for Payer: UHC Exchange |
$16,178.35
|
| Rate for Payer: UHC Medicare Advantage |
$12,478.44
|
| Rate for Payer: VA VA |
$12,114.99
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,470.91
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$2,470.91 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$519.48
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,470.91
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.73
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$3,228.76
|
|
|
Service Code
|
CPT 45346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$3,228.76 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$480.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,228.76
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,583.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.73
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$155.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$2,470.91
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$2,470.91 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$648.77
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,470.91
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,976.73
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.44
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$70.40
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$3,228.76
|
|
|
Service Code
|
CPT 45334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$113.95 |
| Max. Negotiated Rate |
$3,228.76 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$411.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,228.76
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,583.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.34
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$113.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$3,228.76
|
|
|
Service Code
|
CPT 45332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$3,228.76 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$411.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,228.76
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,583.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.74
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$102.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,228.76
|
|
|
Service Code
|
CPT 45338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.57 |
| Max. Negotiated Rate |
$3,228.76 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$826.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,228.76
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,583.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.23
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$116.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$27,635.40
|
|
|
Service Code
|
MS-DRG 555
|
| Min. Negotiated Rate |
$10,039.63 |
| Max. Negotiated Rate |
$27,635.40 |
| Rate for Payer: Aetna Medicare |
$10,990.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,210.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,210.04
|
| Rate for Payer: BCBS MAPPO |
$10,568.03
|
| Rate for Payer: BCBS Trust/PPO |
$27,635.40
|
| Rate for Payer: BCN Medicare Advantage |
$10,568.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,568.03
|
| Rate for Payer: Mclaren Medicare |
$10,568.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,096.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,153.23
|
| Rate for Payer: PACE Medicare |
$10,039.63
|
| Rate for Payer: PACE SWMI |
$10,568.03
|
| Rate for Payer: PHP Medicare Advantage |
$10,568.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,075.54
|
| Rate for Payer: Priority Health Medicare |
$10,568.03
|
| Rate for Payer: Priority Health Narrow Network |
$16,060.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10,568.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,340.35
|
| Rate for Payer: UHC Core |
$13,094.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,568.03
|
| Rate for Payer: UHC Exchange |
$14,024.98
|
| Rate for Payer: UHC Medicare Advantage |
$10,885.07
|
| Rate for Payer: VA VA |
$10,568.03
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$15,577.71
|
|
|
Service Code
|
MS-DRG 556
|
| Min. Negotiated Rate |
$6,108.39 |
| Max. Negotiated Rate |
$15,577.71 |
| Rate for Payer: Aetna Medicare |
$6,687.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,037.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,037.35
|
| Rate for Payer: BCBS MAPPO |
$6,429.88
|
| Rate for Payer: BCBS Trust/PPO |
$15,577.71
|
| Rate for Payer: BCN Medicare Advantage |
$6,429.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,429.88
|
| Rate for Payer: Mclaren Medicare |
$6,429.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,751.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,394.36
|
| Rate for Payer: PACE Medicare |
$6,108.39
|
| Rate for Payer: PACE SWMI |
$6,429.88
|
| Rate for Payer: PHP Medicare Advantage |
$6,429.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,830.07
|
| Rate for Payer: Priority Health Medicare |
$6,429.88
|
| Rate for Payer: Priority Health Narrow Network |
$9,464.06
|
| Rate for Payer: Railroad Medicare Medicare |
$6,429.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,575.40
|
| Rate for Payer: UHC Core |
$7,716.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,429.88
|
| Rate for Payer: UHC Exchange |
$8,264.61
|
| Rate for Payer: UHC Medicare Advantage |
$6,622.78
|
| Rate for Payer: VA VA |
$6,429.88
|
|
|
SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$20,997.20
|
|
|
Service Code
|
MS-DRG 947
|
| Min. Negotiated Rate |
$9,031.17 |
| Max. Negotiated Rate |
$20,997.20 |
| Rate for Payer: Aetna Medicare |
$9,886.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,883.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,883.11
|
| Rate for Payer: BCBS MAPPO |
$9,506.49
|
| Rate for Payer: BCBS Trust/PPO |
$20,997.20
|
| Rate for Payer: BCN Medicare Advantage |
$9,506.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,506.49
|
| Rate for Payer: Mclaren Medicare |
$9,506.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,981.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,932.46
|
| Rate for Payer: PACE Medicare |
$9,031.17
|
| Rate for Payer: PACE SWMI |
$9,506.49
|
| Rate for Payer: PHP Medicare Advantage |
$9,506.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,960.36
|
| Rate for Payer: Priority Health Medicare |
$9,506.49
|
| Rate for Payer: Priority Health Narrow Network |
$14,368.29
|
| Rate for Payer: Railroad Medicare Medicare |
$9,506.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,091.91
|
| Rate for Payer: UHC Core |
$11,714.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,506.49
|
| Rate for Payer: UHC Exchange |
$12,547.29
|
| Rate for Payer: UHC Medicare Advantage |
$9,791.68
|
| Rate for Payer: VA VA |
$9,506.49
|
|
|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$16,412.16
|
|
|
Service Code
|
MS-DRG 948
|
| Min. Negotiated Rate |
$5,948.31 |
| Max. Negotiated Rate |
$16,412.16 |
| Rate for Payer: Aetna Medicare |
$6,511.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,826.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,826.72
|
| Rate for Payer: BCBS MAPPO |
$6,261.38
|
| Rate for Payer: BCBS Trust/PPO |
$16,412.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,261.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,261.38
|
| Rate for Payer: Mclaren Medicare |
$6,261.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,574.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,200.59
|
| Rate for Payer: PACE Medicare |
$5,948.31
|
| Rate for Payer: PACE SWMI |
$6,261.38
|
| Rate for Payer: PHP Medicare Advantage |
$6,261.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,494.29
|
| Rate for Payer: Priority Health Medicare |
$6,261.38
|
| Rate for Payer: Priority Health Narrow Network |
$9,195.43
|
| Rate for Payer: Railroad Medicare Medicare |
$6,261.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,218.45
|
| Rate for Payer: UHC Core |
$7,497.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,261.38
|
| Rate for Payer: UHC Exchange |
$8,030.03
|
| Rate for Payer: UHC Medicare Advantage |
$6,449.22
|
| Rate for Payer: VA VA |
$6,261.38
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$126.96
|
|
|
Service Code
|
NDC 50268-717-15
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.98 |
| Max. Negotiated Rate |
$114.26 |
| Rate for Payer: Aetna Commercial |
$107.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.52
|
| Rate for Payer: Cash Price |
$101.57
|
| Rate for Payer: Cofinity Commercial |
$109.19
|
| Rate for Payer: Cofinity Commercial |
$88.87
|
| Rate for Payer: Healthscope Commercial |
$114.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.92
|
| Rate for Payer: PHP Commercial |
$107.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.87
|
| Rate for Payer: Priority Health SBD |
$79.98
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$228.48
|
|
|
Service Code
|
NDC 0904-6671-06
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$205.63 |
| Rate for Payer: Aetna Commercial |
$194.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.51
|
| Rate for Payer: Cash Price |
$182.78
|
| Rate for Payer: Cofinity Commercial |
$159.94
|
| Rate for Payer: Cofinity Commercial |
$196.49
|
| Rate for Payer: Healthscope Commercial |
$205.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.21
|
| Rate for Payer: PHP Commercial |
$194.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.94
|
| Rate for Payer: Priority Health SBD |
$143.94
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$18,243.74
|
|
|
Service Code
|
NDC 0069-4190-68
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,493.56 |
| Max. Negotiated Rate |
$16,419.37 |
| Rate for Payer: Aetna Commercial |
$15,507.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,858.43
|
| Rate for Payer: Cash Price |
$14,594.99
|
| Rate for Payer: Cofinity Commercial |
$12,770.62
|
| Rate for Payer: Cofinity Commercial |
$15,689.62
|
| Rate for Payer: Healthscope Commercial |
$16,419.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15,507.18
|
| Rate for Payer: PHP Commercial |
$15,507.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,770.62
|
| Rate for Payer: Priority Health SBD |
$11,493.56
|
|
|
SILDENAFIL (REVATIO) 20 MG TABLET
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 50268-717-11
|
| Hospital Charge Code |
41832
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.65
|
| Rate for Payer: Cash Price |
$2.03
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.16
|
| Rate for Payer: PHP Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.60
|
|
|
SILVER ER TOPICAL GEL,EXTENDED RELEASE
|
Facility
|
IP
|
$70.71
|
|
|
Service Code
|
NDC 8327030909
|
| Hospital Charge Code |
115249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$63.64 |
| Rate for Payer: Aetna Commercial |
$60.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.96
|
| Rate for Payer: Cash Price |
$56.57
|
| Rate for Payer: Cofinity Commercial |
$49.50
|
| Rate for Payer: Cofinity Commercial |
$60.81
|
| Rate for Payer: Healthscope Commercial |
$63.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.10
|
| Rate for Payer: PHP Commercial |
$60.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.50
|
| Rate for Payer: Priority Health SBD |
$44.55
|
|
|
SILVER ER TOPICAL GEL,EXTENDED RELEASE
|
Facility
|
IP
|
$72.54
|
|
|
Service Code
|
NDC 8019629660
|
| Hospital Charge Code |
115249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$65.29 |
| Rate for Payer: Aetna Commercial |
$61.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.15
|
| Rate for Payer: Cash Price |
$58.03
|
| Rate for Payer: Cofinity Commercial |
$50.78
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Healthscope Commercial |
$65.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.66
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.78
|
| Rate for Payer: Priority Health SBD |
$45.70
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
IP
|
$78.05
|
|
|
Service Code
|
NDC 12165-100-01
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.17 |
| Max. Negotiated Rate |
$70.24 |
| Rate for Payer: Aetna Commercial |
$66.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.73
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$54.64
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Healthscope Commercial |
$70.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.34
|
| Rate for Payer: PHP Commercial |
$66.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.64
|
| Rate for Payer: Priority Health SBD |
$49.17
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
IP
|
$5.16
|
|
|
Service Code
|
NDC 9900-0009-76
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.35
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$3.61
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.39
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.61
|
| Rate for Payer: Priority Health SBD |
$3.25
|
|
|
SILVER NITRATE APPLICATORS 75 %-25 % TOPICAL STICK
|
Facility
|
IP
|
$78.05
|
|
|
Service Code
|
NDC 12165-100-03
|
| Hospital Charge Code |
11359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.17 |
| Max. Negotiated Rate |
$70.24 |
| Rate for Payer: Aetna Commercial |
$66.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.73
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Cofinity Commercial |
$54.64
|
| Rate for Payer: Healthscope Commercial |
$70.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$66.34
|
| Rate for Payer: PHP Commercial |
$66.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.64
|
| Rate for Payer: Priority Health SBD |
$49.17
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$26.33
|
|
|
Service Code
|
NDC 43598-210-25
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.59 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.11
|
| Rate for Payer: Cash Price |
$21.06
|
| Rate for Payer: Cofinity Commercial |
$18.43
|
| Rate for Payer: Cofinity Commercial |
$22.64
|
| Rate for Payer: Healthscope Commercial |
$23.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.38
|
| Rate for Payer: PHP Commercial |
$22.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.43
|
| Rate for Payer: Priority Health SBD |
$16.59
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$12.72
|
|
|
Service Code
|
NDC 67877-124-25
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$10.94
|
| Rate for Payer: Cofinity Commercial |
$8.90
|
| Rate for Payer: Healthscope Commercial |
$11.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.81
|
| Rate for Payer: PHP Commercial |
$10.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.90
|
| Rate for Payer: Priority Health SBD |
$8.01
|
|
|
SILVER SULFADIAZINE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$67.20
|
|
|
Service Code
|
NDC 67877-124-40
|
| Hospital Charge Code |
7224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.34 |
| Max. Negotiated Rate |
$60.48 |
| Rate for Payer: Aetna Commercial |
$57.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.68
|
| Rate for Payer: Cash Price |
$53.76
|
| Rate for Payer: Cofinity Commercial |
$47.04
|
| Rate for Payer: Cofinity Commercial |
$57.79
|
| Rate for Payer: Healthscope Commercial |
$60.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$57.12
|
| Rate for Payer: PHP Commercial |
$57.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.04
|
| Rate for Payer: Priority Health SBD |
$42.34
|
|
