|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$7,300.40
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$6,952.76 |
| Max. Negotiated Rate |
$7,300.40 |
| Rate for Payer: BCBS Complete |
$7,300.40
|
| Rate for Payer: Mclaren Medicaid |
$6,952.76
|
| Rate for Payer: Meridian Medicaid |
$7,300.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,952.76
|
| Rate for Payer: UHC Medicaid |
$6,952.76
|
| Rate for Payer: UHCCP Medicaid |
$6,952.76
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$9,374.03
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$8,927.65 |
| Max. Negotiated Rate |
$9,374.03 |
| Rate for Payer: BCBS Complete |
$9,374.03
|
| Rate for Payer: Mclaren Medicaid |
$8,927.65
|
| Rate for Payer: Meridian Medicaid |
$9,374.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,927.65
|
| Rate for Payer: UHC Medicaid |
$8,927.65
|
| Rate for Payer: UHCCP Medicaid |
$8,927.65
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$12,694.58
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$12,090.08 |
| Max. Negotiated Rate |
$12,694.58 |
| Rate for Payer: BCBS Complete |
$12,694.58
|
| Rate for Payer: Mclaren Medicaid |
$12,090.08
|
| Rate for Payer: Meridian Medicaid |
$12,694.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,090.08
|
| Rate for Payer: UHC Medicaid |
$12,090.08
|
| Rate for Payer: UHCCP Medicaid |
$12,090.08
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$20,971.89
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$19,973.23 |
| Max. Negotiated Rate |
$20,971.89 |
| Rate for Payer: BCBS Complete |
$20,971.89
|
| Rate for Payer: Mclaren Medicaid |
$19,973.23
|
| Rate for Payer: Meridian Medicaid |
$20,971.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,973.23
|
| Rate for Payer: UHC Medicaid |
$19,973.23
|
| Rate for Payer: UHCCP Medicaid |
$19,973.23
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$36,411.14
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$15,723.40 |
| Max. Negotiated Rate |
$36,411.14 |
| Rate for Payer: Aetna Medicare |
$17,212.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,688.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,688.69
|
| Rate for Payer: BCBS MAPPO |
$16,550.95
|
| Rate for Payer: BCBS Trust/PPO |
$36,411.14
|
| Rate for Payer: BCN Commercial |
$36,411.14
|
| Rate for Payer: BCN Medicare Advantage |
$16,550.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,550.95
|
| Rate for Payer: Mclaren Medicare |
$16,550.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,378.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,033.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,206.04
|
| Rate for Payer: Nomi Health Commercial |
$26,660.43
|
| Rate for Payer: PACE Medicare |
$15,723.40
|
| Rate for Payer: PACE SWMI |
$16,550.95
|
| Rate for Payer: PHP Medicare Advantage |
$16,550.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,319.63
|
| Rate for Payer: Priority Health Medicare |
$16,550.95
|
| Rate for Payer: Priority Health Tiered Network |
$26,655.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,550.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,687.21
|
| Rate for Payer: UHC Core |
$28,183.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,550.95
|
| Rate for Payer: UHC Exchange |
$23,016.84
|
| Rate for Payer: VA VA |
$16,550.95
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$63,203.94
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$26,706.00 |
| Max. Negotiated Rate |
$63,203.94 |
| Rate for Payer: Aetna Medicare |
$29,236.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,139.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,139.47
|
| Rate for Payer: BCBS MAPPO |
$28,111.58
|
| Rate for Payer: BCBS Trust/PPO |
$63,203.94
|
| Rate for Payer: BCN Commercial |
$63,203.94
|
| Rate for Payer: BCN Medicare Advantage |
$28,111.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,111.58
|
| Rate for Payer: Mclaren Medicare |
$28,111.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,517.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,328.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,922.74
|
| Rate for Payer: Nomi Health Commercial |
$45,957.54
|
| Rate for Payer: PACE Medicare |
$26,706.00
|
| Rate for Payer: PACE SWMI |
$28,111.58
|
| Rate for Payer: PHP Medicare Advantage |
$28,111.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57,436.74
|
| Rate for Payer: Priority Health Medicare |
$28,111.58
|
| Rate for Payer: Priority Health Tiered Network |
$45,949.38
|
| Rate for Payer: Railroad Medicare Medicare |
$28,111.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,070.38
|
| Rate for Payer: UHC Core |
$48,583.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,111.58
|
| Rate for Payer: UHC Exchange |
$39,676.68
|
| Rate for Payer: VA VA |
$28,111.58
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$28,218.34
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$10,559.16 |
| Max. Negotiated Rate |
$28,218.34 |
| Rate for Payer: Aetna Medicare |
$11,559.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,893.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,893.62
|
| Rate for Payer: BCBS MAPPO |
$11,114.90
|
| Rate for Payer: BCBS Trust/PPO |
$28,218.34
|
| Rate for Payer: BCN Commercial |
$28,218.34
|
| Rate for Payer: BCN Medicare Advantage |
$11,114.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,114.90
|
| Rate for Payer: Mclaren Medicare |
$11,114.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,670.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,782.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,226.39
|
| Rate for Payer: Nomi Health Commercial |
$17,586.57
|
| Rate for Payer: PACE Medicare |
$10,559.16
|
| Rate for Payer: PACE SWMI |
$11,114.90
|
| Rate for Payer: PHP Medicare Advantage |
$11,114.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,979.31
|
| Rate for Payer: Priority Health Medicare |
$11,114.90
|
| Rate for Payer: Priority Health Tiered Network |
$17,583.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11,114.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,221.79
|
| Rate for Payer: UHC Core |
$18,591.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,114.90
|
| Rate for Payer: UHC Exchange |
$15,183.07
|
| Rate for Payer: VA VA |
$11,114.90
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$34,270.75
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$15,986.21 |
| Max. Negotiated Rate |
$34,270.75 |
| Rate for Payer: Aetna Medicare |
$17,500.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,034.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,034.49
|
| Rate for Payer: BCBS MAPPO |
$16,827.59
|
| Rate for Payer: BCBS Trust/PPO |
$31,352.68
|
| Rate for Payer: BCN Commercial |
$31,352.68
|
| Rate for Payer: BCN Medicare Advantage |
$16,827.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,827.59
|
| Rate for Payer: Mclaren Medicare |
$16,827.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,668.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,510.35
|
| Rate for Payer: Nomi Health Commercial |
$27,122.25
|
| Rate for Payer: PACE Medicare |
$15,986.21
|
| Rate for Payer: PACE SWMI |
$16,827.59
|
| Rate for Payer: PHP Medicare Advantage |
$16,827.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,896.80
|
| Rate for Payer: Priority Health Medicare |
$16,827.59
|
| Rate for Payer: Priority Health Tiered Network |
$27,117.44
|
| Rate for Payer: Railroad Medicare Medicare |
$16,827.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,270.75
|
| Rate for Payer: UHC Core |
$28,671.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,827.59
|
| Rate for Payer: UHC Exchange |
$23,415.54
|
| Rate for Payer: VA VA |
$16,827.59
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$53,843.79
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$24,802.26 |
| Max. Negotiated Rate |
$53,843.79 |
| Rate for Payer: Aetna Medicare |
$27,151.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,634.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,634.55
|
| Rate for Payer: BCBS MAPPO |
$26,107.64
|
| Rate for Payer: BCBS Trust/PPO |
$47,061.78
|
| Rate for Payer: BCN Commercial |
$47,061.78
|
| Rate for Payer: BCN Medicare Advantage |
$26,107.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,107.64
|
| Rate for Payer: Mclaren Medicare |
$26,107.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27,413.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,023.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,718.40
|
| Rate for Payer: Nomi Health Commercial |
$42,612.57
|
| Rate for Payer: PACE Medicare |
$24,802.26
|
| Rate for Payer: PACE SWMI |
$26,107.64
|
| Rate for Payer: PHP Medicare Advantage |
$26,107.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,256.27
|
| Rate for Payer: Priority Health Medicare |
$26,107.64
|
| Rate for Payer: Priority Health Tiered Network |
$42,605.01
|
| Rate for Payer: Railroad Medicare Medicare |
$26,107.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,843.79
|
| Rate for Payer: UHC Core |
$45,047.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,107.64
|
| Rate for Payer: UHC Exchange |
$36,788.85
|
| Rate for Payer: VA VA |
$26,107.64
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$28,384.54
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$12,741.14 |
| Max. Negotiated Rate |
$28,384.54 |
| Rate for Payer: Aetna Medicare |
$13,948.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,764.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,764.66
|
| Rate for Payer: BCBS MAPPO |
$13,411.73
|
| Rate for Payer: BCBS Trust/PPO |
$28,384.54
|
| Rate for Payer: BCN Commercial |
$28,384.54
|
| Rate for Payer: BCN Medicare Advantage |
$13,411.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,411.73
|
| Rate for Payer: Mclaren Medicare |
$13,411.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,082.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,423.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,752.90
|
| Rate for Payer: Nomi Health Commercial |
$21,420.45
|
| Rate for Payer: PACE Medicare |
$12,741.14
|
| Rate for Payer: PACE SWMI |
$13,411.73
|
| Rate for Payer: PHP Medicare Advantage |
$13,411.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,770.81
|
| Rate for Payer: Priority Health Medicare |
$13,411.73
|
| Rate for Payer: Priority Health Tiered Network |
$21,416.65
|
| Rate for Payer: Railroad Medicare Medicare |
$13,411.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,066.15
|
| Rate for Payer: UHC Core |
$22,644.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,411.73
|
| Rate for Payer: UHC Exchange |
$18,492.99
|
| Rate for Payer: VA VA |
$13,411.73
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Advantage |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.71
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health SBD |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.22
|
| Rate for Payer: UHC Core |
$2.58
|
| Rate for Payer: UHC Exchange |
$1.95
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$296.64
|
|
|
Service Code
|
NDC 49884046565
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.88 |
| Max. Negotiated Rate |
$266.98 |
| Rate for Payer: Aetna Commercial |
$252.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.82
|
| Rate for Payer: Cash Price |
$237.31
|
| Rate for Payer: Cofinity Advantage |
$207.65
|
| Rate for Payer: Cofinity Commercial |
$255.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.31
|
| Rate for Payer: Healthscope Commercial |
$266.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.48
|
| Rate for Payer: PHP Commercial |
$252.14
|
| Rate for Payer: Priority Health SBD |
$186.88
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
OP
|
$296.64
|
|
|
Service Code
|
NDC 49884046565
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.58 |
| Max. Negotiated Rate |
$266.98 |
| Rate for Payer: Aetna Commercial |
$252.14
|
| Rate for Payer: Aetna Medicare |
$148.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.82
|
| Rate for Payer: BCBS Complete |
$118.66
|
| Rate for Payer: Cash Price |
$237.31
|
| Rate for Payer: Cofinity Advantage |
$207.65
|
| Rate for Payer: Cofinity Commercial |
$255.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.31
|
| Rate for Payer: Healthscope Commercial |
$266.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$237.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.48
|
| Rate for Payer: PHP Commercial |
$252.14
|
| Rate for Payer: Priority Health SBD |
$186.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.82
|
| Rate for Payer: UHC Core |
$154.55
|
| Rate for Payer: UHC Exchange |
$116.58
|
|
|
CHOLESTYRAMINE (WITH SUGAR) 4 GRAM POWDER FOR SUSP IN A PACKET
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 49884046564
|
| Hospital Charge Code |
9588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.22
|
| Rate for Payer: Cash Price |
$3.96
|
| Rate for Payer: Cofinity Advantage |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$4.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.96
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.71
|
| Rate for Payer: PHP Commercial |
$4.21
|
| Rate for Payer: Priority Health SBD |
$3.12
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$258.83
|
|
|
Service Code
|
NDC 00409409301
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$163.06 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Advantage |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.12
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health SBD |
$163.06
|
|
|
CHROMIUM CHLORIDE 4 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$258.83
|
|
|
Service Code
|
NDC 00409409301
|
| Hospital Charge Code |
1685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.72 |
| Max. Negotiated Rate |
$232.95 |
| Rate for Payer: Aetna Commercial |
$220.01
|
| Rate for Payer: Aetna Medicare |
$129.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.24
|
| Rate for Payer: BCBS Complete |
$103.53
|
| Rate for Payer: Cash Price |
$207.06
|
| Rate for Payer: Cofinity Advantage |
$181.18
|
| Rate for Payer: Cofinity Commercial |
$222.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.06
|
| Rate for Payer: Healthscope Commercial |
$232.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$207.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.12
|
| Rate for Payer: PHP Commercial |
$220.01
|
| Rate for Payer: Priority Health SBD |
$163.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.24
|
| Rate for Payer: UHC Core |
$134.85
|
| Rate for Payer: UHC Exchange |
$101.72
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,898.49 |
| 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 |
$1,898.49
|
| Rate for Payer: BCN Commercial |
$1,898.49
|
| 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
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$3,255.77
|
|
|
Service Code
|
APR-DRG 4701
|
| Min. Negotiated Rate |
$3,100.73 |
| Max. Negotiated Rate |
$3,255.77 |
| Rate for Payer: BCBS Complete |
$3,255.77
|
| Rate for Payer: Mclaren Medicaid |
$3,100.73
|
| Rate for Payer: Meridian Medicaid |
$3,255.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,100.73
|
| Rate for Payer: UHC Medicaid |
$3,100.73
|
| Rate for Payer: UHCCP Medicaid |
$3,100.73
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$7,518.26
|
|
|
Service Code
|
APR-DRG 4703
|
| Min. Negotiated Rate |
$7,160.24 |
| Max. Negotiated Rate |
$7,518.26 |
| Rate for Payer: BCBS Complete |
$7,518.26
|
| Rate for Payer: Mclaren Medicaid |
$7,160.24
|
| Rate for Payer: Meridian Medicaid |
$7,518.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,160.24
|
| Rate for Payer: UHC Medicaid |
$7,160.24
|
| Rate for Payer: UHCCP Medicaid |
$7,160.24
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$4,056.67
|
|
|
Service Code
|
APR-DRG 4702
|
| Min. Negotiated Rate |
$3,863.50 |
| Max. Negotiated Rate |
$4,056.67 |
| Rate for Payer: BCBS Complete |
$4,056.67
|
| Rate for Payer: Mclaren Medicaid |
$3,863.50
|
| Rate for Payer: Meridian Medicaid |
$4,056.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,863.50
|
| Rate for Payer: UHC Medicaid |
$3,863.50
|
| Rate for Payer: UHCCP Medicaid |
$3,863.50
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$14,175.99
|
|
|
Service Code
|
APR-DRG 4704
|
| Min. Negotiated Rate |
$13,500.94 |
| Max. Negotiated Rate |
$14,175.99 |
| Rate for Payer: BCBS Complete |
$14,175.99
|
| Rate for Payer: Mclaren Medicaid |
$13,500.94
|
| Rate for Payer: Meridian Medicaid |
$14,175.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,500.94
|
| Rate for Payer: UHC Medicaid |
$13,500.94
|
| Rate for Payer: UHCCP Medicaid |
$13,500.94
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$4,370.27
|
|
|
Service Code
|
APR-DRG 1402
|
| Min. Negotiated Rate |
$4,162.16 |
| Max. Negotiated Rate |
$4,370.27 |
| Rate for Payer: BCBS Complete |
$4,370.27
|
| Rate for Payer: Mclaren Medicaid |
$4,162.16
|
| Rate for Payer: Meridian Medicaid |
$4,370.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,162.16
|
| Rate for Payer: UHC Medicaid |
$4,162.16
|
| Rate for Payer: UHCCP Medicaid |
$4,162.16
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$3,670.27
|
|
|
Service Code
|
APR-DRG 1401
|
| Min. Negotiated Rate |
$3,495.49 |
| Max. Negotiated Rate |
$3,670.27 |
| Rate for Payer: BCBS Complete |
$3,670.27
|
| Rate for Payer: Mclaren Medicaid |
$3,495.49
|
| Rate for Payer: Meridian Medicaid |
$3,670.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,495.49
|
| Rate for Payer: UHC Medicaid |
$3,495.49
|
| Rate for Payer: UHCCP Medicaid |
$3,495.49
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$5,761.09
|
|
|
Service Code
|
APR-DRG 1403
|
| Min. Negotiated Rate |
$5,486.75 |
| Max. Negotiated Rate |
$5,761.09 |
| Rate for Payer: BCBS Complete |
$5,761.09
|
| Rate for Payer: Mclaren Medicaid |
$5,486.75
|
| Rate for Payer: Meridian Medicaid |
$5,761.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,486.75
|
| Rate for Payer: UHC Medicaid |
$5,486.75
|
| Rate for Payer: UHCCP Medicaid |
$5,486.75
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$9,222.10
|
|
|
Service Code
|
APR-DRG 1404
|
| Min. Negotiated Rate |
$8,782.96 |
| Max. Negotiated Rate |
$9,222.10 |
| Rate for Payer: BCBS Complete |
$9,222.10
|
| Rate for Payer: Mclaren Medicaid |
$8,782.96
|
| Rate for Payer: Meridian Medicaid |
$9,222.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,782.96
|
| Rate for Payer: UHC Medicaid |
$8,782.96
|
| Rate for Payer: UHCCP Medicaid |
$8,782.96
|
|
