|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$11,628.90
|
|
|
Service Code
|
APR-DRG 0403
|
| Min. Negotiated Rate |
$11,075.14 |
| Max. Negotiated Rate |
$11,628.90 |
| Rate for Payer: BCBS Complete |
$11,628.90
|
| Rate for Payer: Mclaren Medicaid |
$11,075.14
|
| Rate for Payer: Meridian Medicaid |
$11,628.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,075.14
|
| Rate for Payer: UHC Medicaid |
$11,075.14
|
| Rate for Payer: UHCCP Medicaid |
$11,075.14
|
|
|
SPINAL DISORDERS AND INJURIES
|
Facility
|
IP
|
$15,407.94
|
|
|
Service Code
|
APR-DRG 0404
|
| Min. Negotiated Rate |
$14,674.23 |
| Max. Negotiated Rate |
$15,407.94 |
| Rate for Payer: BCBS Complete |
$15,407.94
|
| Rate for Payer: Mclaren Medicaid |
$14,674.23
|
| Rate for Payer: Meridian Medicaid |
$15,407.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,674.23
|
| Rate for Payer: UHC Medicaid |
$14,674.23
|
| Rate for Payer: UHCCP Medicaid |
$14,674.23
|
|
|
SPINAL DISORDERS AND INJURIES WITH CC/MCC
|
Facility
|
IP
|
$33,169.04
|
|
|
Service Code
|
MSDRG 052
|
| Min. Negotiated Rate |
$14,953.29 |
| Max. Negotiated Rate |
$33,169.04 |
| Rate for Payer: Aetna Medicare |
$16,369.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,675.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,675.39
|
| Rate for Payer: BCBS MAPPO |
$15,740.31
|
| Rate for Payer: BCBS Trust/PPO |
$33,169.04
|
| Rate for Payer: BCN Commercial |
$33,169.04
|
| Rate for Payer: BCN Medicare Advantage |
$15,740.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,740.31
|
| Rate for Payer: Mclaren Medicare |
$15,740.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,527.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,101.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,314.34
|
| Rate for Payer: Nomi Health Commercial |
$22,972.32
|
| Rate for Payer: PACE Medicare |
$14,953.29
|
| Rate for Payer: PACE SWMI |
$15,740.31
|
| Rate for Payer: PHP Medicare Advantage |
$15,740.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,202.03
|
| Rate for Payer: Priority Health Medicare |
$15,740.31
|
| Rate for Payer: Priority Health Tiered Network |
$23,361.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15,740.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,027.04
|
| Rate for Payer: UHC Core |
$24,284.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,740.31
|
| Rate for Payer: UHC Exchange |
$19,832.77
|
| Rate for Payer: VA VA |
$15,740.31
|
|
|
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,926.29
|
|
|
Service Code
|
MSDRG 053
|
| Min. Negotiated Rate |
$8,342.62 |
| Max. Negotiated Rate |
$23,926.29 |
| Rate for Payer: Aetna Medicare |
$9,132.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,977.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,977.14
|
| Rate for Payer: BCBS MAPPO |
$8,781.71
|
| Rate for Payer: BCBS Trust/PPO |
$23,926.29
|
| Rate for Payer: BCN Commercial |
$23,926.29
|
| Rate for Payer: BCN Medicare Advantage |
$8,781.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,781.71
|
| Rate for Payer: Mclaren Medicare |
$8,781.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,220.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,098.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,659.88
|
| Rate for Payer: Nomi Health Commercial |
$12,631.68
|
| Rate for Payer: PACE Medicare |
$8,342.62
|
| Rate for Payer: PACE SWMI |
$8,781.71
|
| Rate for Payer: PHP Medicare Advantage |
$8,781.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,786.80
|
| Rate for Payer: Priority Health Medicare |
$8,781.71
|
| Rate for Payer: Priority Health Tiered Network |
$12,629.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8,781.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,960.96
|
| Rate for Payer: UHC Core |
$13,353.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,781.71
|
| Rate for Payer: UHC Exchange |
$10,905.35
|
| Rate for Payer: VA VA |
$8,781.71
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$10,717.28
|
|
|
Service Code
|
APR-DRG 3211
|
| Min. Negotiated Rate |
$10,206.93 |
| Max. Negotiated Rate |
$10,717.28 |
| Rate for Payer: BCBS Complete |
$10,717.28
|
| Rate for Payer: Mclaren Medicaid |
$10,206.93
|
| Rate for Payer: Meridian Medicaid |
$10,717.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,206.93
|
| Rate for Payer: UHC Medicaid |
$10,206.93
|
| Rate for Payer: UHCCP Medicaid |
$10,206.93
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$27,914.56
|
|
|
Service Code
|
APR-DRG 3214
|
| Min. Negotiated Rate |
$26,585.30 |
| Max. Negotiated Rate |
$27,914.56 |
| Rate for Payer: BCBS Complete |
$27,914.56
|
| Rate for Payer: Mclaren Medicaid |
$26,585.30
|
| Rate for Payer: Meridian Medicaid |
$27,914.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,585.30
|
| Rate for Payer: UHC Medicaid |
$26,585.30
|
| Rate for Payer: UHCCP Medicaid |
$26,585.30
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$14,045.96
|
|
|
Service Code
|
APR-DRG 3212
|
| Min. Negotiated Rate |
$13,377.11 |
| Max. Negotiated Rate |
$14,045.96 |
| Rate for Payer: BCBS Complete |
$14,045.96
|
| Rate for Payer: Mclaren Medicaid |
$13,377.11
|
| Rate for Payer: Meridian Medicaid |
$14,045.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,377.11
|
| Rate for Payer: UHC Medicaid |
$13,377.11
|
| Rate for Payer: UHCCP Medicaid |
$13,377.11
|
|
|
SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES
|
Facility
|
IP
|
$23,114.94
|
|
|
Service Code
|
APR-DRG 3213
|
| Min. Negotiated Rate |
$22,014.23 |
| Max. Negotiated Rate |
$23,114.94 |
| Rate for Payer: BCBS Complete |
$23,114.94
|
| Rate for Payer: Mclaren Medicaid |
$22,014.23
|
| Rate for Payer: Meridian Medicaid |
$23,114.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,014.23
|
| Rate for Payer: UHC Medicaid |
$22,014.23
|
| Rate for Payer: UHCCP Medicaid |
$22,014.23
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC
|
Facility
|
IP
|
$118,632.24
|
|
|
Service Code
|
MSDRG 457
|
| Min. Negotiated Rate |
$47,937.52 |
| Max. Negotiated Rate |
$118,632.24 |
| Rate for Payer: Aetna Medicare |
$52,478.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63,075.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63,075.69
|
| Rate for Payer: BCBS MAPPO |
$50,460.55
|
| Rate for Payer: BCBS Trust/PPO |
$118,632.24
|
| Rate for Payer: BCN Commercial |
$118,632.24
|
| Rate for Payer: BCN Medicare Advantage |
$50,460.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,460.55
|
| Rate for Payer: Mclaren Medicare |
$50,460.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,983.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,029.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$55,506.61
|
| Rate for Payer: Nomi Health Commercial |
$76,923.99
|
| Rate for Payer: PACE Medicare |
$47,937.52
|
| Rate for Payer: PACE SWMI |
$50,460.55
|
| Rate for Payer: PHP Medicare Advantage |
$50,460.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96,137.93
|
| Rate for Payer: Priority Health Medicare |
$50,460.55
|
| Rate for Payer: Priority Health Tiered Network |
$76,910.33
|
| Rate for Payer: Railroad Medicare Medicare |
$50,460.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97,198.53
|
| Rate for Payer: UHC Core |
$81,318.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50,460.55
|
| Rate for Payer: UHC Exchange |
$66,411.04
|
| Rate for Payer: VA VA |
$50,460.55
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC
|
Facility
|
IP
|
$146,923.24
|
|
|
Service Code
|
MSDRG 456
|
| Min. Negotiated Rate |
$67,324.64 |
| Max. Negotiated Rate |
$146,923.24 |
| Rate for Payer: Aetna Medicare |
$73,702.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88,585.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88,585.05
|
| Rate for Payer: BCBS MAPPO |
$70,868.04
|
| Rate for Payer: BCBS Trust/PPO |
$146,923.24
|
| Rate for Payer: BCN Commercial |
$146,923.24
|
| Rate for Payer: BCN Medicare Advantage |
$70,868.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70,868.04
|
| Rate for Payer: Mclaren Medicare |
$70,868.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74,411.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81,498.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$77,954.84
|
| Rate for Payer: Nomi Health Commercial |
$108,403.86
|
| Rate for Payer: PACE Medicare |
$67,324.64
|
| Rate for Payer: PACE SWMI |
$70,868.04
|
| Rate for Payer: PHP Medicare Advantage |
$70,868.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$135,480.79
|
| Rate for Payer: Priority Health Medicare |
$70,868.04
|
| Rate for Payer: Priority Health Tiered Network |
$108,384.62
|
| Rate for Payer: Railroad Medicare Medicare |
$70,868.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136,975.42
|
| Rate for Payer: UHC Core |
$114,597.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70,868.04
|
| Rate for Payer: UHC Exchange |
$93,588.67
|
| Rate for Payer: VA VA |
$70,868.04
|
|
|
SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$112,873.02
|
|
|
Service Code
|
MSDRG 458
|
| Min. Negotiated Rate |
$33,712.77 |
| Max. Negotiated Rate |
$112,873.02 |
| Rate for Payer: Aetna Medicare |
$36,906.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,358.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,358.91
|
| Rate for Payer: BCBS MAPPO |
$35,487.13
|
| Rate for Payer: BCBS Trust/PPO |
$112,873.02
|
| Rate for Payer: BCN Commercial |
$112,873.02
|
| Rate for Payer: BCN Medicare Advantage |
$35,487.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,487.13
|
| Rate for Payer: Mclaren Medicare |
$35,487.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,261.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,810.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,035.84
|
| Rate for Payer: Nomi Health Commercial |
$53,826.54
|
| Rate for Payer: PACE Medicare |
$33,712.77
|
| Rate for Payer: PACE SWMI |
$35,487.13
|
| Rate for Payer: PHP Medicare Advantage |
$35,487.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67,271.24
|
| Rate for Payer: Priority Health Medicare |
$35,487.13
|
| Rate for Payer: Priority Health Tiered Network |
$53,816.98
|
| Rate for Payer: Railroad Medicare Medicare |
$35,487.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,013.38
|
| Rate for Payer: UHC Core |
$56,901.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,487.13
|
| Rate for Payer: UHC Exchange |
$46,470.25
|
| Rate for Payer: VA VA |
$35,487.13
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$31,092.52
|
|
|
Service Code
|
APR-DRG 0234
|
| Min. Negotiated Rate |
$29,611.92 |
| Max. Negotiated Rate |
$31,092.52 |
| Rate for Payer: BCBS Complete |
$31,092.52
|
| Rate for Payer: Mclaren Medicaid |
$29,611.92
|
| Rate for Payer: Meridian Medicaid |
$31,092.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$29,611.92
|
| Rate for Payer: UHC Medicaid |
$29,611.92
|
| Rate for Payer: UHCCP Medicaid |
$29,611.92
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$10,299.00
|
|
|
Service Code
|
APR-DRG 0231
|
| Min. Negotiated Rate |
$9,808.57 |
| Max. Negotiated Rate |
$10,299.00 |
| Rate for Payer: BCBS Complete |
$10,299.00
|
| Rate for Payer: Mclaren Medicaid |
$9,808.57
|
| Rate for Payer: Meridian Medicaid |
$10,299.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,808.57
|
| Rate for Payer: UHC Medicaid |
$9,808.57
|
| Rate for Payer: UHCCP Medicaid |
$9,808.57
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$15,604.07
|
|
|
Service Code
|
APR-DRG 0232
|
| Min. Negotiated Rate |
$14,861.02 |
| Max. Negotiated Rate |
$15,604.07 |
| Rate for Payer: BCBS Complete |
$15,604.07
|
| Rate for Payer: Mclaren Medicaid |
$14,861.02
|
| Rate for Payer: Meridian Medicaid |
$15,604.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,861.02
|
| Rate for Payer: UHC Medicaid |
$14,861.02
|
| Rate for Payer: UHCCP Medicaid |
$14,861.02
|
|
|
SPINAL PROCEDURES
|
Facility
|
IP
|
$24,360.70
|
|
|
Service Code
|
APR-DRG 0233
|
| Min. Negotiated Rate |
$23,200.67 |
| Max. Negotiated Rate |
$24,360.70 |
| Rate for Payer: BCBS Complete |
$24,360.70
|
| Rate for Payer: Mclaren Medicaid |
$23,200.67
|
| Rate for Payer: Meridian Medicaid |
$24,360.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,200.67
|
| Rate for Payer: UHC Medicaid |
$23,200.67
|
| Rate for Payer: UHCCP Medicaid |
$23,200.67
|
|
|
SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS
|
Facility
|
IP
|
$70,318.48
|
|
|
Service Code
|
MSDRG 029
|
| Min. Negotiated Rate |
$27,666.99 |
| Max. Negotiated Rate |
$70,318.48 |
| Rate for Payer: Aetna Medicare |
$30,288.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,403.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,403.94
|
| Rate for Payer: BCBS MAPPO |
$29,123.15
|
| Rate for Payer: BCBS Trust/PPO |
$70,318.48
|
| Rate for Payer: BCN Commercial |
$70,318.48
|
| Rate for Payer: BCN Medicare Advantage |
$29,123.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,123.15
|
| Rate for Payer: Mclaren Medicare |
$29,123.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,579.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,491.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,035.47
|
| Rate for Payer: Nomi Health Commercial |
$44,009.64
|
| Rate for Payer: PACE Medicare |
$27,666.99
|
| Rate for Payer: PACE SWMI |
$29,123.15
|
| Rate for Payer: PHP Medicare Advantage |
$29,123.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$55,002.29
|
| Rate for Payer: Priority Health Medicare |
$29,123.15
|
| Rate for Payer: Priority Health Tiered Network |
$44,001.83
|
| Rate for Payer: Railroad Medicare Medicare |
$29,123.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,609.08
|
| Rate for Payer: UHC Core |
$46,523.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,123.15
|
| Rate for Payer: UHC Exchange |
$37,994.99
|
| Rate for Payer: VA VA |
$29,123.15
|
|
|
SPINAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$106,748.70
|
|
|
Service Code
|
MSDRG 028
|
| Min. Negotiated Rate |
$48,296.62 |
| Max. Negotiated Rate |
$106,748.70 |
| Rate for Payer: Aetna Medicare |
$52,872.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63,548.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63,548.19
|
| Rate for Payer: BCBS MAPPO |
$50,838.55
|
| Rate for Payer: BCBS Trust/PPO |
$106,748.70
|
| Rate for Payer: BCN Commercial |
$106,748.70
|
| Rate for Payer: BCN Medicare Advantage |
$50,838.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,838.55
|
| Rate for Payer: Mclaren Medicare |
$50,838.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53,380.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,464.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$55,922.40
|
| Rate for Payer: Nomi Health Commercial |
$77,507.07
|
| Rate for Payer: PACE Medicare |
$48,296.62
|
| Rate for Payer: PACE SWMI |
$50,838.55
|
| Rate for Payer: PHP Medicare Advantage |
$50,838.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96,866.65
|
| Rate for Payer: Priority Health Medicare |
$50,838.55
|
| Rate for Payer: Priority Health Tiered Network |
$77,493.31
|
| Rate for Payer: Railroad Medicare Medicare |
$50,838.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97,935.29
|
| Rate for Payer: UHC Core |
$81,935.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50,838.55
|
| Rate for Payer: UHC Exchange |
$66,914.44
|
| Rate for Payer: VA VA |
$50,838.55
|
|
|
SPINAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$51,478.86
|
|
|
Service Code
|
MSDRG 030
|
| Min. Negotiated Rate |
$18,003.21 |
| Max. Negotiated Rate |
$51,478.86 |
| Rate for Payer: Aetna Medicare |
$19,708.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,688.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,688.44
|
| Rate for Payer: BCBS MAPPO |
$18,950.75
|
| Rate for Payer: BCBS Trust/PPO |
$51,478.86
|
| Rate for Payer: BCN Commercial |
$51,478.86
|
| Rate for Payer: BCN Medicare Advantage |
$18,950.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,950.75
|
| Rate for Payer: Mclaren Medicare |
$18,950.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,898.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,793.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,845.83
|
| Rate for Payer: Nomi Health Commercial |
$28,318.08
|
| Rate for Payer: PACE Medicare |
$18,003.21
|
| Rate for Payer: PACE SWMI |
$18,950.75
|
| Rate for Payer: PHP Medicare Advantage |
$18,950.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,391.32
|
| Rate for Payer: Priority Health Medicare |
$18,950.75
|
| Rate for Payer: Priority Health Tiered Network |
$28,313.05
|
| Rate for Payer: Railroad Medicare Medicare |
$18,950.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,781.76
|
| Rate for Payer: UHC Core |
$29,935.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,950.75
|
| Rate for Payer: UHC Exchange |
$24,447.94
|
| Rate for Payer: VA VA |
$18,950.75
|
|
|
SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC;
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 62270
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.31
|
| Rate for Payer: BCN Commercial |
$1,149.31
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF CEREBROSPINAL FLUID (BY NEEDLE OR CATHETER);
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 62272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$515.73
|
| Rate for Payer: BCN Commercial |
$515.73
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
OP
|
$301.44
|
|
|
Service Code
|
NDC 60687048701
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna American Axle |
$195.94
|
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna Medicare |
$150.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: BCBS Complete |
$120.58
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Advantage |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.08
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.94
|
| Rate for Payer: UHC Core |
$157.05
|
| Rate for Payer: UHC Exchange |
$118.47
|
| Rate for Payer: UMR Bronson Commercial |
$111.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.08
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$301.44
|
|
|
Service Code
|
NDC 60687048701
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.63 |
| Max. Negotiated Rate |
$271.30 |
| Rate for Payer: Aetna American Axle |
$195.94
|
| Rate for Payer: Aetna Commercial |
$256.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.94
|
| Rate for Payer: Cash Price |
$241.15
|
| Rate for Payer: Cofinity Advantage |
$211.01
|
| Rate for Payer: Cofinity Commercial |
$259.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.15
|
| Rate for Payer: Healthscope Commercial |
$271.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$226.08
|
| Rate for Payer: PHP Commercial |
$256.22
|
| Rate for Payer: Priority Health SBD |
$189.91
|
| Rate for Payer: UMR Bronson Commercial |
$132.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.08
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
IP
|
$3.02
|
|
|
Service Code
|
NDC 60687048711
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
SPIRONOLACTONE 100 MG TABLET
|
Facility
|
OP
|
$3.02
|
|
|
Service Code
|
NDC 60687048711
|
| Hospital Charge Code |
11425
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Aetna American Axle |
$1.96
|
| Rate for Payer: Aetna Commercial |
$2.57
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.96
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.57
|
| Rate for Payer: Priority Health SBD |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.96
|
| Rate for Payer: UHC Core |
$1.57
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
SPIRONOLACTONE 25 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,373.11
|
|
|
Service Code
|
NDC 46287002004
|
| Hospital Charge Code |
184259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$508.05 |
| Max. Negotiated Rate |
$1,235.80 |
| Rate for Payer: Aetna American Axle |
$892.52
|
| Rate for Payer: Aetna Commercial |
$1,167.14
|
| Rate for Payer: Aetna Medicare |
$686.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.52
|
| Rate for Payer: BCBS Complete |
$549.24
|
| Rate for Payer: Cash Price |
$1,098.49
|
| Rate for Payer: Cofinity Advantage |
$961.18
|
| Rate for Payer: Cofinity Commercial |
$1,180.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,098.49
|
| Rate for Payer: Healthscope Commercial |
$1,235.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$961.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,098.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,029.83
|
| Rate for Payer: PHP Commercial |
$1,167.14
|
| Rate for Payer: Priority Health SBD |
$865.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$892.52
|
| Rate for Payer: UHC Core |
$715.39
|
| Rate for Payer: UHC Exchange |
$539.63
|
| Rate for Payer: UMR Bronson Commercial |
$508.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.83
|
|
