|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,238.40
|
|
|
Service Code
|
MS-DRG 983
|
| Min. Negotiated Rate |
$12,457.60 |
| Max. Negotiated Rate |
$35,238.40 |
| Rate for Payer: Aetna Medicare |
$13,637.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,391.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,391.58
|
| Rate for Payer: BCBS MAPPO |
$13,113.26
|
| Rate for Payer: BCBS Trust/PPO |
$35,238.40
|
| Rate for Payer: BCN Medicare Advantage |
$13,113.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,113.26
|
| Rate for Payer: Mclaren Medicare |
$13,113.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,768.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,080.25
|
| Rate for Payer: PACE Medicare |
$12,457.60
|
| Rate for Payer: PACE SWMI |
$13,113.26
|
| Rate for Payer: PHP Medicare Advantage |
$13,113.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,464.99
|
| Rate for Payer: Priority Health Medicare |
$13,113.26
|
| Rate for Payer: Priority Health Narrow Network |
$18,771.99
|
| Rate for Payer: Railroad Medicare Medicare |
$13,113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,943.34
|
| Rate for Payer: UHC Core |
$20,453.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,113.26
|
| Rate for Payer: UHC Exchange |
$16,260.43
|
| Rate for Payer: UHC Medicare Advantage |
$13,506.66
|
| Rate for Payer: VA VA |
$13,113.26
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
|
Facility
|
OP
|
$14,625.04
|
|
|
Service Code
|
CPT 66989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$830.72 |
| Max. Negotiated Rate |
$14,625.04 |
| Rate for Payer: Aetna Medicare |
$4,831.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,807.20
|
| Rate for Payer: BCBS Complete |
$2,668.52
|
| Rate for Payer: BCBS MAPPO |
$4,645.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,102.47
|
| Rate for Payer: BCN Medicare Advantage |
$4,645.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,645.76
|
| Rate for Payer: Mclaren Medicaid |
$2,541.23
|
| Rate for Payer: Mclaren Medicare |
$4,645.76
|
| Rate for Payer: Meridian Medicaid |
$2,668.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,878.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,342.62
|
| Rate for Payer: PACE Medicare |
$4,413.47
|
| Rate for Payer: PACE SWMI |
$4,645.76
|
| Rate for Payer: PHP Medicare Advantage |
$4,645.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,541.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,625.04
|
| Rate for Payer: Priority Health Medicare |
$4,645.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,700.03
|
| Rate for Payer: Railroad Medicare Medicare |
$4,645.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$913.79
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,645.76
|
| Rate for Payer: UHC Exchange |
$830.72
|
| Rate for Payer: UHC Medicare Advantage |
$4,785.13
|
| Rate for Payer: VA VA |
$4,645.76
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$723.97 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$4,403.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$796.37
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$723.97
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH INSERTION OF INTRAOCULAR (EG, TRABECULAR MESHWORK, SUPRACILIARY, SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, ONE OR MORE
|
Facility
|
OP
|
$14,625.04
|
|
|
Service Code
|
CPT 66991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$664.05 |
| Max. Negotiated Rate |
$14,625.04 |
| Rate for Payer: Aetna Medicare |
$4,831.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,807.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,807.20
|
| Rate for Payer: BCBS Complete |
$2,668.52
|
| Rate for Payer: BCBS MAPPO |
$4,645.76
|
| Rate for Payer: BCBS Trust/PPO |
$5,102.47
|
| Rate for Payer: BCN Medicare Advantage |
$4,645.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,645.76
|
| Rate for Payer: Mclaren Medicaid |
$2,541.23
|
| Rate for Payer: Mclaren Medicare |
$4,645.76
|
| Rate for Payer: Meridian Medicaid |
$2,668.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,878.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,342.62
|
| Rate for Payer: PACE Medicare |
$4,413.47
|
| Rate for Payer: PACE SWMI |
$4,645.76
|
| Rate for Payer: PHP Medicare Advantage |
$4,645.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,541.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,625.04
|
| Rate for Payer: Priority Health Medicare |
$4,645.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,700.03
|
| Rate for Payer: Railroad Medicare Medicare |
$4,645.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$730.46
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,645.76
|
| Rate for Payer: UHC Exchange |
$664.05
|
| Rate for Payer: UHC Medicare Advantage |
$4,785.13
|
| Rate for Payer: VA VA |
$4,645.76
|
|
|
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$528.49 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$3,096.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.34
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$528.49
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$31,436.38
|
|
|
Service Code
|
MS-DRG 038
|
| Min. Negotiated Rate |
$12,199.17 |
| Max. Negotiated Rate |
$31,436.38 |
| Rate for Payer: Aetna Medicare |
$13,354.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,051.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,051.54
|
| Rate for Payer: BCBS MAPPO |
$12,841.23
|
| Rate for Payer: BCBS Trust/PPO |
$31,436.38
|
| Rate for Payer: BCN Medicare Advantage |
$12,841.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,841.23
|
| Rate for Payer: Mclaren Medicare |
$12,841.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,483.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,767.41
|
| Rate for Payer: PACE Medicare |
$12,199.17
|
| Rate for Payer: PACE SWMI |
$12,841.23
|
| Rate for Payer: PHP Medicare Advantage |
$12,841.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,958.44
|
| Rate for Payer: Priority Health Medicare |
$12,841.23
|
| Rate for Payer: Priority Health Narrow Network |
$18,366.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,841.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,404.87
|
| Rate for Payer: UHC Core |
$20,011.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,841.23
|
| Rate for Payer: UHC Exchange |
$15,909.41
|
| Rate for Payer: UHC Medicare Advantage |
$13,226.47
|
| Rate for Payer: VA VA |
$12,841.23
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$51,491.40
|
|
|
Service Code
|
MS-DRG 037
|
| Min. Negotiated Rate |
$25,198.60 |
| Max. Negotiated Rate |
$51,491.40 |
| Rate for Payer: Aetna Medicare |
$27,585.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,156.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,156.05
|
| Rate for Payer: BCBS MAPPO |
$26,524.84
|
| Rate for Payer: BCBS Trust/PPO |
$47,692.33
|
| Rate for Payer: BCN Medicare Advantage |
$26,524.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,524.84
|
| Rate for Payer: Mclaren Medicare |
$26,524.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,851.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,503.57
|
| Rate for Payer: PACE Medicare |
$25,198.60
|
| Rate for Payer: PACE SWMI |
$26,524.84
|
| Rate for Payer: PHP Medicare Advantage |
$26,524.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48,439.59
|
| Rate for Payer: Priority Health Medicare |
$26,524.84
|
| Rate for Payer: Priority Health Narrow Network |
$38,751.67
|
| Rate for Payer: Railroad Medicare Medicare |
$26,524.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,491.40
|
| Rate for Payer: UHC Core |
$42,222.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,524.84
|
| Rate for Payer: UHC Exchange |
$33,566.97
|
| Rate for Payer: UHC Medicare Advantage |
$27,320.59
|
| Rate for Payer: VA VA |
$26,524.84
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$30,368.40
|
|
|
Service Code
|
MS-DRG 039
|
| Min. Negotiated Rate |
$8,839.68 |
| Max. Negotiated Rate |
$30,368.40 |
| Rate for Payer: Aetna Medicare |
$9,677.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,631.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,631.16
|
| Rate for Payer: BCBS MAPPO |
$9,304.93
|
| Rate for Payer: BCBS Trust/PPO |
$30,368.40
|
| Rate for Payer: BCN Medicare Advantage |
$9,304.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,304.93
|
| Rate for Payer: Mclaren Medicare |
$9,304.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,770.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,700.67
|
| Rate for Payer: PACE Medicare |
$8,839.68
|
| Rate for Payer: PACE SWMI |
$9,304.93
|
| Rate for Payer: PHP Medicare Advantage |
$9,304.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,373.26
|
| Rate for Payer: Priority Health Medicare |
$9,304.93
|
| Rate for Payer: Priority Health Narrow Network |
$13,098.61
|
| Rate for Payer: Railroad Medicare Medicare |
$9,304.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,404.81
|
| Rate for Payer: UHC Core |
$14,271.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,304.93
|
| Rate for Payer: UHC Exchange |
$11,346.10
|
| Rate for Payer: UHC Medicare Advantage |
$9,584.08
|
| Rate for Payer: VA VA |
$9,304.93
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$23,863.36
|
|
|
Service Code
|
MS-DRG 115
|
| Min. Negotiated Rate |
$11,939.28 |
| Max. Negotiated Rate |
$23,863.36 |
| Rate for Payer: Aetna Medicare |
$13,070.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,709.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,709.58
|
| Rate for Payer: BCBS MAPPO |
$12,567.66
|
| Rate for Payer: BCBS Trust/PPO |
$19,020.14
|
| Rate for Payer: BCN Medicare Advantage |
$12,567.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,567.66
|
| Rate for Payer: Mclaren Medicare |
$12,567.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,196.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,452.81
|
| Rate for Payer: PACE Medicare |
$11,939.28
|
| Rate for Payer: PACE SWMI |
$12,567.66
|
| Rate for Payer: PHP Medicare Advantage |
$12,567.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,449.01
|
| Rate for Payer: Priority Health Medicare |
$12,567.66
|
| Rate for Payer: Priority Health Narrow Network |
$17,959.21
|
| Rate for Payer: Railroad Medicare Medicare |
$12,567.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,863.36
|
| Rate for Payer: UHC Core |
$19,567.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,567.66
|
| Rate for Payer: UHC Exchange |
$15,556.39
|
| Rate for Payer: UHC Medicare Advantage |
$12,944.69
|
| Rate for Payer: VA VA |
$12,567.66
|
|
|
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 41017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$337.27 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,396.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.00
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$337.27
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$91,525.53
|
|
|
Service Code
|
MS-DRG 790
|
| Min. Negotiated Rate |
$21,565.71 |
| Max. Negotiated Rate |
$91,525.53 |
| Rate for Payer: Aetna Medicare |
$48,619.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,436.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,436.66
|
| Rate for Payer: BCBS MAPPO |
$46,749.33
|
| Rate for Payer: BCBS Trust/PPO |
$21,565.71
|
| Rate for Payer: BCN Medicare Advantage |
$46,749.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,749.33
|
| Rate for Payer: Mclaren Medicare |
$46,749.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49,086.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,761.73
|
| Rate for Payer: PACE Medicare |
$44,411.86
|
| Rate for Payer: PACE SWMI |
$46,749.33
|
| Rate for Payer: PHP Medicare Advantage |
$46,749.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86,100.95
|
| Rate for Payer: Priority Health Medicare |
$46,749.33
|
| Rate for Payer: Priority Health Narrow Network |
$68,880.76
|
| Rate for Payer: Railroad Medicare Medicare |
$46,749.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91,525.53
|
| Rate for Payer: UHC Core |
$75,049.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$46,749.33
|
| Rate for Payer: UHC Exchange |
$59,664.99
|
| Rate for Payer: UHC Medicare Advantage |
$48,151.81
|
| Rate for Payer: VA VA |
$46,749.33
|
|
|
EYELASH TINTING
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 00176
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$164.97
|
|
|
Service Code
|
NDC 67877-490-90
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.59 |
| Max. Negotiated Rate |
$148.47 |
| Rate for Payer: Aetna American Axle |
$107.23
|
| Rate for Payer: Aetna Commercial |
$140.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.23
|
| Rate for Payer: Cash Price |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$141.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.98
|
| Rate for Payer: Healthscope Commercial |
$148.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.22
|
| Rate for Payer: PHP Commercial |
$140.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health SBD |
$103.93
|
| Rate for Payer: UMR Bronson Commercial |
$72.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.73
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$331.78
|
|
|
Service Code
|
NDC 60505-2945-9
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.98 |
| Max. Negotiated Rate |
$298.60 |
| Rate for Payer: Aetna American Axle |
$215.66
|
| Rate for Payer: Aetna Commercial |
$282.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.66
|
| Rate for Payer: Cash Price |
$265.42
|
| Rate for Payer: Cofinity Commercial |
$285.33
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.42
|
| Rate for Payer: Healthscope Commercial |
$298.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$248.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.01
|
| Rate for Payer: PHP Commercial |
$282.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.25
|
| Rate for Payer: Priority Health SBD |
$209.02
|
| Rate for Payer: UMR Bronson Commercial |
$145.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$248.84
|
|
|
EZETIMIBE 10 MG TABLET
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 0781-5690-92
|
| Hospital Charge Code |
34153
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna American Axle |
$150.05
|
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.60
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UMR Bronson Commercial |
$101.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.14
|
|
|
FACIAL
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 00174
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
FACTOR IX HUMAN (RECOMBINANT THR 148) 1,500 UNIT INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3.24
|
|
|
Service Code
|
HCPCS J7213
|
| Hospital Charge Code |
168781
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.59
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.75
|
| Rate for Payer: PHP Commercial |
$2.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.27
|
| Rate for Payer: Priority Health SBD |
$2.04
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.43
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
NDC 63323-738-06
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$81.45 |
| Rate for Payer: Aetna American Axle |
$58.82
|
| Rate for Payer: Aetna Commercial |
$76.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.82
|
| Rate for Payer: BCBS Complete |
$36.20
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$63.35
|
| Rate for Payer: Cofinity Commercial |
$77.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$81.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.92
|
| Rate for Payer: PHP Commercial |
$76.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.35
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$548.75
|
|
|
Service Code
|
NDC 55390-026-01
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$493.88 |
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cofinity Commercial |
$384.12
|
| Rate for Payer: Cofinity Commercial |
$471.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.44
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.12
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UMR Bronson Commercial |
$241.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$90.50
|
|
|
Service Code
|
NDC 63323-738-20
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$81.45 |
| Rate for Payer: Aetna American Axle |
$58.82
|
| Rate for Payer: Aetna Commercial |
$76.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.82
|
| Rate for Payer: BCBS Complete |
$36.20
|
| Rate for Payer: Cash Price |
$72.40
|
| Rate for Payer: Cofinity Commercial |
$63.35
|
| Rate for Payer: Cofinity Commercial |
$77.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.40
|
| Rate for Payer: Healthscope Commercial |
$81.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.92
|
| Rate for Payer: PHP Commercial |
$76.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.35
|
| Rate for Payer: Priority Health SBD |
$57.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.88
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$37.40
|
|
|
Service Code
|
NDC 63323-738-09
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna American Axle |
$24.31
|
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: BCBS Complete |
$14.96
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.79
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.18
|
| Rate for Payer: Priority Health SBD |
$23.56
|
| Rate for Payer: UMR Bronson Commercial |
$13.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.40
|
|
|
Service Code
|
NDC 63323-738-09
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$33.66 |
| Rate for Payer: Aetna American Axle |
$24.31
|
| Rate for Payer: Aetna Commercial |
$31.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: Cash Price |
$29.92
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Cofinity Commercial |
$32.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$33.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.79
|
| Rate for Payer: PHP Commercial |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.18
|
| Rate for Payer: Priority Health SBD |
$23.56
|
| Rate for Payer: UMR Bronson Commercial |
$16.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.05
|
|
|
FAMOTIDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
NDC 55390-027-01
|
| Hospital Charge Code |
10009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna American Axle |
$185.25
|
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.25
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$199.50
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.00
|
| Rate for Payer: Healthscope Commercial |
$256.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.25
|
| Rate for Payer: PHP Commercial |
$242.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health SBD |
$179.55
|
| Rate for Payer: UMR Bronson Commercial |
$125.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.75
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$548.75
|
|
|
Service Code
|
NDC 55390-026-01
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$241.45 |
| Max. Negotiated Rate |
$493.88 |
| Rate for Payer: Aetna American Axle |
$356.69
|
| Rate for Payer: Aetna Commercial |
$466.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.69
|
| Rate for Payer: Cash Price |
$439.00
|
| Rate for Payer: Cofinity Commercial |
$384.12
|
| Rate for Payer: Cofinity Commercial |
$471.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$439.00
|
| Rate for Payer: Healthscope Commercial |
$493.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$384.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$411.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$466.44
|
| Rate for Payer: PHP Commercial |
$466.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$384.12
|
| Rate for Payer: Priority Health SBD |
$345.71
|
| Rate for Payer: UMR Bronson Commercial |
$241.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$411.56
|
|
|
FAMOTIDINE 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$39.10
|
|
|
Service Code
|
NDC 67457-448-43
|
| Hospital Charge Code |
163732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$35.19 |
| Rate for Payer: Aetna American Axle |
$25.42
|
| Rate for Payer: Aetna Commercial |
$33.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.42
|
| Rate for Payer: Cash Price |
$31.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Commercial |
$33.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$35.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.24
|
| Rate for Payer: PHP Commercial |
$33.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.37
|
| Rate for Payer: Priority Health SBD |
$24.63
|
| Rate for Payer: UMR Bronson Commercial |
$17.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.32
|
|
