|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,011.00
|
|
|
Service Code
|
MS-DRG 594
|
| Min. Negotiated Rate |
$6,251.09 |
| Max. Negotiated Rate |
$12,011.00 |
| Rate for Payer: Aetna Medicare |
$6,843.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,225.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,225.11
|
| Rate for Payer: BCBS MAPPO |
$6,580.09
|
| Rate for Payer: BCBS Trust/PPO |
$10,350.64
|
| Rate for Payer: BCN Medicare Advantage |
$6,580.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,580.09
|
| Rate for Payer: Mclaren Medicare |
$6,580.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,909.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,567.10
|
| Rate for Payer: PACE Medicare |
$6,251.09
|
| Rate for Payer: PACE SWMI |
$6,580.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,580.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,299.13
|
| Rate for Payer: Priority Health Medicare |
$6,580.09
|
| Rate for Payer: Priority Health Narrow Network |
$9,039.30
|
| Rate for Payer: Railroad Medicare Medicare |
$6,580.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,011.00
|
| Rate for Payer: UHC Core |
$9,848.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,580.09
|
| Rate for Payer: UHC Exchange |
$7,829.91
|
| Rate for Payer: UHC Medicare Advantage |
$6,777.49
|
| Rate for Payer: VA VA |
$6,580.09
|
|
|
SLING OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$35,920.42
|
|
|
Service Code
|
CPT 53440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$736.74 |
| Max. Negotiated Rate |
$35,920.42 |
| Rate for Payer: Aetna Medicare |
$11,866.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,262.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,262.99
|
| Rate for Payer: BCBS Complete |
$6,554.13
|
| Rate for Payer: BCBS MAPPO |
$11,410.39
|
| Rate for Payer: BCBS Trust/PPO |
$10,737.62
|
| Rate for Payer: BCN Medicare Advantage |
$11,410.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,410.39
|
| Rate for Payer: Mclaren Medicaid |
$6,241.48
|
| Rate for Payer: Mclaren Medicare |
$11,410.39
|
| Rate for Payer: Meridian Medicaid |
$6,554.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,980.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,121.95
|
| Rate for Payer: PACE Medicare |
$10,839.87
|
| Rate for Payer: PACE SWMI |
$11,410.39
|
| Rate for Payer: PHP Medicare Advantage |
$11,410.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,241.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35,920.42
|
| Rate for Payer: Priority Health Medicare |
$11,410.39
|
| Rate for Payer: Priority Health Narrow Network |
$28,736.34
|
| Rate for Payer: Railroad Medicare Medicare |
$11,410.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.41
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,410.39
|
| Rate for Payer: UHC Exchange |
$736.74
|
| Rate for Payer: UHC Medicare Advantage |
$11,752.70
|
| Rate for Payer: VA VA |
$11,410.39
|
|
|
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 57288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$734.12 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,492.39
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.53
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$734.12
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN
|
Facility
|
OP
|
$5,699.47
|
|
|
Service Code
|
CPT 54001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$138.51 |
| Max. Negotiated Rate |
$5,699.47 |
| Rate for Payer: Aetna Medicare |
$1,882.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,263.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,263.10
|
| Rate for Payer: BCBS Complete |
$1,039.94
|
| Rate for Payer: BCBS MAPPO |
$1,810.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,421.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,810.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,810.48
|
| Rate for Payer: Mclaren Medicaid |
$990.33
|
| Rate for Payer: Mclaren Medicare |
$1,810.48
|
| Rate for Payer: Meridian Medicaid |
$1,039.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,901.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,082.05
|
| Rate for Payer: PACE Medicare |
$1,719.96
|
| Rate for Payer: PACE SWMI |
$1,810.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,810.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,699.47
|
| Rate for Payer: Priority Health Medicare |
$1,810.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,559.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,810.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.36
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,810.48
|
| Rate for Payer: UHC Exchange |
$138.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,864.79
|
| Rate for Payer: VA VA |
$1,810.48
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44377
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$288.48 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$288.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.16 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.08
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$139.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.24 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.56
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$153.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR)
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,053.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONVERSION OF PERCUTANEOUS GASTROSTOMY TUBE TO PERCUTANEOUS JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44373
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.68 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.15
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$184.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECOND PORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE
|
Facility
|
OP
|
$5,324.53
|
|
|
Service Code
|
CPT 44372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$231.17 |
| Max. Negotiated Rate |
$5,324.53 |
| Rate for Payer: Aetna Medicare |
$1,759.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,114.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,114.21
|
| Rate for Payer: BCBS Complete |
$971.52
|
| Rate for Payer: BCBS MAPPO |
$1,691.37
|
| Rate for Payer: BCBS Trust/PPO |
$903.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,691.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,691.37
|
| Rate for Payer: Mclaren Medicaid |
$925.18
|
| Rate for Payer: Mclaren Medicare |
$1,691.37
|
| Rate for Payer: Meridian Medicaid |
$971.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,775.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,945.08
|
| Rate for Payer: PACE Medicare |
$1,606.80
|
| Rate for Payer: PACE SWMI |
$1,691.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,691.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$925.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,324.53
|
| Rate for Payer: Priority Health Medicare |
$1,691.37
|
| Rate for Payer: Priority Health Narrow Network |
$4,259.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,691.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.29
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,691.37
|
| Rate for Payer: UHC Exchange |
$231.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,742.11
|
| Rate for Payer: VA VA |
$1,691.37
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 212
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 216
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 213
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 215
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 214
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 219
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 217
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 211
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SNF Bill Type
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
LOCAL 218
|
| Min. Negotiated Rate |
$893.00 |
| Max. Negotiated Rate |
$1,133.00 |
| Rate for Payer: UHC Core |
$1,133.00
|
| Rate for Payer: UHC Exchange |
$893.00
|
|
|
SOAP BAR
|
Facility
|
IP
|
$12.56
|
|
|
Service Code
|
NDC 7050101010
|
| Hospital Charge Code |
108564
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna American Axle |
$8.16
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.16
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$11.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.68
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.79
|
| Rate for Payer: Priority Health SBD |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.42
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
NDC 0409-5779-01
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
SODIUM 35 MEQ-POTASSIUM 20 MEQ-MAG 5 MEQ/20 ML-CALCIUM-CHLORID-ACET IV
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
NDC 0409-5779-01
|
| Hospital Charge Code |
10850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: BCBS Complete |
$14.60
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.02
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.54
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$68.53
|
|
|
Service Code
|
NDC 69784-231-20
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.25
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.97
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 0409-3299-25
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.51
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
SODIUM ACETATE 2 MEQ/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.92
|
|
|
Service Code
|
NDC 0409-3299-16
|
| Hospital Charge Code |
7301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$22.43 |
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.18
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.44
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
|
