|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC
|
Facility
IP
|
$73,322.93
|
|
|
Service Code
|
MS-DRG 239
|
| Min. Negotiated Rate |
$35,676.04 |
| Max. Negotiated Rate |
$73,322.93 |
| Rate for Payer: Aetna Medicare |
$39,055.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46,942.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46,942.16
|
| Rate for Payer: BCBS MAPPO |
$37,553.73
|
| Rate for Payer: BCBS Trust/PPO |
$70,207.91
|
| Rate for Payer: BCN Medicare Advantage |
$37,553.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,553.73
|
| Rate for Payer: Mclaren Medicare |
$37,553.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,431.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,186.79
|
| Rate for Payer: PACE Medicare |
$35,676.04
|
| Rate for Payer: PACE SWMI |
$37,553.73
|
| Rate for Payer: PHP Medicare Advantage |
$37,553.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,977.20
|
| Rate for Payer: Priority Health Medicare |
$37,553.73
|
| Rate for Payer: Priority Health Narrow Network |
$55,181.76
|
| Rate for Payer: Railroad Medicare Medicare |
$37,553.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73,322.93
|
| Rate for Payer: UHC Core |
$60,123.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,553.73
|
| Rate for Payer: UHC Exchange |
$47,798.82
|
| Rate for Payer: UHC Medicare Advantage |
$38,680.34
|
| Rate for Payer: VA VA |
$37,553.73
|
|
|
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC
|
Facility
IP
|
$23,138.78
|
|
|
Service Code
|
MS-DRG 241
|
| Min. Negotiated Rate |
$10,691.85 |
| Max. Negotiated Rate |
$23,138.78 |
| Rate for Payer: Aetna Medicare |
$11,704.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,068.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,068.22
|
| Rate for Payer: BCBS MAPPO |
$11,254.58
|
| Rate for Payer: BCBS Trust/PPO |
$23,138.78
|
| Rate for Payer: BCN Medicare Advantage |
$11,254.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,254.58
|
| Rate for Payer: Mclaren Medicare |
$11,254.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,817.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,942.77
|
| Rate for Payer: PACE Medicare |
$10,691.85
|
| Rate for Payer: PACE SWMI |
$11,254.58
|
| Rate for Payer: PHP Medicare Advantage |
$11,254.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,943.52
|
| Rate for Payer: Priority Health Medicare |
$11,254.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,954.82
|
| Rate for Payer: Railroad Medicare Medicare |
$11,254.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,200.01
|
| Rate for Payer: UHC Core |
$17,383.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,254.58
|
| Rate for Payer: UHC Exchange |
$13,820.17
|
| Rate for Payer: UHC Medicare Advantage |
$11,592.22
|
| Rate for Payer: VA VA |
$11,254.58
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$38,593.12
|
|
|
Service Code
|
MS-DRG 475
|
| Min. Negotiated Rate |
$16,187.52 |
| Max. Negotiated Rate |
$38,593.12 |
| Rate for Payer: Aetna Medicare |
$17,721.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,299.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,299.38
|
| Rate for Payer: BCBS MAPPO |
$17,039.50
|
| Rate for Payer: BCBS Trust/PPO |
$38,593.12
|
| Rate for Payer: BCN Medicare Advantage |
$17,039.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,039.50
|
| Rate for Payer: Mclaren Medicare |
$17,039.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,891.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,595.42
|
| Rate for Payer: PACE Medicare |
$16,187.52
|
| Rate for Payer: PACE SWMI |
$17,039.50
|
| Rate for Payer: PHP Medicare Advantage |
$17,039.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,776.27
|
| Rate for Payer: Priority Health Medicare |
$17,039.50
|
| Rate for Payer: Priority Health Narrow Network |
$24,621.02
|
| Rate for Payer: Railroad Medicare Medicare |
$17,039.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,715.25
|
| Rate for Payer: UHC Core |
$26,825.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,039.50
|
| Rate for Payer: UHC Exchange |
$21,326.90
|
| Rate for Payer: UHC Medicare Advantage |
$17,550.68
|
| Rate for Payer: VA VA |
$17,039.50
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$80,480.65
|
|
|
Service Code
|
MS-DRG 474
|
| Min. Negotiated Rate |
$31,986.39 |
| Max. Negotiated Rate |
$80,480.65 |
| Rate for Payer: Aetna Medicare |
$35,016.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,087.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,087.35
|
| Rate for Payer: BCBS MAPPO |
$33,669.88
|
| Rate for Payer: BCBS Trust/PPO |
$80,480.65
|
| Rate for Payer: BCN Medicare Advantage |
$33,669.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,669.88
|
| Rate for Payer: Mclaren Medicare |
$33,669.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35,353.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,720.36
|
| Rate for Payer: PACE Medicare |
$31,986.39
|
| Rate for Payer: PACE SWMI |
$33,669.88
|
| Rate for Payer: PHP Medicare Advantage |
$33,669.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,744.84
|
| Rate for Payer: Priority Health Medicare |
$33,669.88
|
| Rate for Payer: Priority Health Narrow Network |
$49,395.87
|
| Rate for Payer: Railroad Medicare Medicare |
$33,669.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65,634.91
|
| Rate for Payer: UHC Core |
$53,819.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$33,669.88
|
| Rate for Payer: UHC Exchange |
$42,787.04
|
| Rate for Payer: UHC Medicare Advantage |
$34,679.98
|
| Rate for Payer: VA VA |
$33,669.88
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$21,432.52
|
|
|
Service Code
|
MS-DRG 476
|
| Min. Negotiated Rate |
$9,102.50 |
| Max. Negotiated Rate |
$21,432.52 |
| Rate for Payer: Aetna Medicare |
$9,964.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,976.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,976.98
|
| Rate for Payer: BCBS MAPPO |
$9,581.58
|
| Rate for Payer: BCBS Trust/PPO |
$21,432.52
|
| Rate for Payer: BCN Medicare Advantage |
$9,581.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,581.58
|
| Rate for Payer: Mclaren Medicare |
$9,581.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,060.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,018.82
|
| Rate for Payer: PACE Medicare |
$9,102.50
|
| Rate for Payer: PACE SWMI |
$9,581.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,581.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,888.42
|
| Rate for Payer: Priority Health Medicare |
$9,581.58
|
| Rate for Payer: Priority Health Narrow Network |
$13,510.74
|
| Rate for Payer: Railroad Medicare Medicare |
$9,581.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,952.43
|
| Rate for Payer: UHC Core |
$14,720.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,581.58
|
| Rate for Payer: UHC Exchange |
$11,703.09
|
| Rate for Payer: UHC Medicare Advantage |
$9,869.03
|
| Rate for Payer: VA VA |
$9,581.58
|
|
|
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26910
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$758.03 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$833.83
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$758.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$417.16 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$458.88
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$417.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
IP
|
$30,271.56
|
|
|
Service Code
|
MS-DRG 617
|
| Min. Negotiated Rate |
$15,014.72 |
| Max. Negotiated Rate |
$30,271.56 |
| Rate for Payer: Aetna Medicare |
$16,437.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,756.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,756.21
|
| Rate for Payer: BCBS MAPPO |
$15,804.97
|
| Rate for Payer: BCBS Trust/PPO |
$28,727.47
|
| Rate for Payer: BCN Medicare Advantage |
$15,804.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,804.97
|
| Rate for Payer: Mclaren Medicare |
$15,804.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,595.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,175.72
|
| Rate for Payer: PACE Medicare |
$15,014.72
|
| Rate for Payer: PACE SWMI |
$15,804.97
|
| Rate for Payer: PHP Medicare Advantage |
$15,804.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,477.42
|
| Rate for Payer: Priority Health Medicare |
$15,804.97
|
| Rate for Payer: Priority Health Narrow Network |
$22,781.94
|
| Rate for Payer: Railroad Medicare Medicare |
$15,804.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,271.56
|
| Rate for Payer: UHC Core |
$24,822.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,804.97
|
| Rate for Payer: UHC Exchange |
$19,733.87
|
| Rate for Payer: UHC Medicare Advantage |
$16,279.12
|
| Rate for Payer: VA VA |
$15,804.97
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
IP
|
$60,370.76
|
|
|
Service Code
|
MS-DRG 616
|
| Min. Negotiated Rate |
$29,459.99 |
| Max. Negotiated Rate |
$60,370.76 |
| Rate for Payer: Aetna Medicare |
$32,250.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,763.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,763.15
|
| Rate for Payer: BCBS MAPPO |
$31,010.52
|
| Rate for Payer: BCBS Trust/PPO |
$45,111.58
|
| Rate for Payer: BCN Medicare Advantage |
$31,010.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,010.52
|
| Rate for Payer: Mclaren Medicare |
$31,010.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,561.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,662.10
|
| Rate for Payer: PACE Medicare |
$29,459.99
|
| Rate for Payer: PACE SWMI |
$31,010.52
|
| Rate for Payer: PHP Medicare Advantage |
$31,010.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,792.68
|
| Rate for Payer: Priority Health Medicare |
$31,010.52
|
| Rate for Payer: Priority Health Narrow Network |
$45,434.14
|
| Rate for Payer: Railroad Medicare Medicare |
$31,010.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60,370.76
|
| Rate for Payer: UHC Core |
$49,502.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,010.52
|
| Rate for Payer: UHC Exchange |
$39,355.37
|
| Rate for Payer: UHC Medicare Advantage |
$31,940.84
|
| Rate for Payer: VA VA |
$31,010.52
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$19,874.53
|
|
|
Service Code
|
MS-DRG 618
|
| Min. Negotiated Rate |
$8,989.77 |
| Max. Negotiated Rate |
$19,874.53 |
| Rate for Payer: Aetna Medicare |
$9,841.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,828.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,828.65
|
| Rate for Payer: BCBS MAPPO |
$9,462.92
|
| Rate for Payer: BCBS Trust/PPO |
$19,874.53
|
| Rate for Payer: BCN Medicare Advantage |
$9,462.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,462.92
|
| Rate for Payer: Mclaren Medicare |
$9,462.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,936.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,882.36
|
| Rate for Payer: PACE Medicare |
$8,989.77
|
| Rate for Payer: PACE SWMI |
$9,462.92
|
| Rate for Payer: PHP Medicare Advantage |
$9,462.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,667.43
|
| Rate for Payer: Priority Health Medicare |
$9,462.92
|
| Rate for Payer: Priority Health Narrow Network |
$13,333.94
|
| Rate for Payer: Railroad Medicare Medicare |
$9,462.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,717.52
|
| Rate for Payer: UHC Core |
$14,528.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,462.92
|
| Rate for Payer: UHC Exchange |
$11,549.96
|
| Rate for Payer: UHC Medicare Advantage |
$9,746.81
|
| Rate for Payer: VA VA |
$9,462.92
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$169.29 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$169.29
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$173.54 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,429.32
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.89
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$173.54
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
IP
|
$257.76
|
|
|
Service Code
|
NDC 13668-453-01
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.41 |
| Max. Negotiated Rate |
$231.98 |
| Rate for Payer: Aetna American Axle |
$167.54
|
| Rate for Payer: Aetna Commercial |
$219.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.54
|
| Rate for Payer: Cash Price |
$206.21
|
| Rate for Payer: Cofinity Commercial |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$221.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.21
|
| Rate for Payer: Healthscope Commercial |
$231.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.10
|
| Rate for Payer: PHP Commercial |
$219.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.43
|
| Rate for Payer: Priority Health SBD |
$162.39
|
| Rate for Payer: UMR Bronson Commercial |
$113.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.32
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
IP
|
$372.00
|
|
|
Service Code
|
NDC 0172-5241-60
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.68 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna American Axle |
$241.80
|
| Rate for Payer: Aetna Commercial |
$316.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$260.40
|
| Rate for Payer: Cofinity Commercial |
$319.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.60
|
| Rate for Payer: Healthscope Commercial |
$334.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.20
|
| Rate for Payer: PHP Commercial |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health SBD |
$234.36
|
| Rate for Payer: UMR Bronson Commercial |
$163.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.00
|
|
|
ANAL AND STOMAL PROCEDURES WITH CC
|
Facility
IP
|
$26,792.54
|
|
|
Service Code
|
MS-DRG 348
|
| Min. Negotiated Rate |
$10,013.94 |
| Max. Negotiated Rate |
$26,792.54 |
| Rate for Payer: Aetna Medicare |
$10,962.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,176.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,176.24
|
| Rate for Payer: BCBS MAPPO |
$10,540.99
|
| Rate for Payer: BCBS Trust/PPO |
$26,792.54
|
| Rate for Payer: BCN Medicare Advantage |
$10,540.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,540.99
|
| Rate for Payer: Mclaren Medicare |
$10,540.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,068.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,122.14
|
| Rate for Payer: PACE Medicare |
$10,013.94
|
| Rate for Payer: PACE SWMI |
$10,540.99
|
| Rate for Payer: PHP Medicare Advantage |
$10,540.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,674.99
|
| Rate for Payer: Priority Health Medicare |
$10,540.99
|
| Rate for Payer: Priority Health Narrow Network |
$14,939.99
|
| Rate for Payer: Railroad Medicare Medicare |
$10,540.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,851.56
|
| Rate for Payer: UHC Core |
$16,277.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,540.99
|
| Rate for Payer: UHC Exchange |
$12,941.12
|
| Rate for Payer: UHC Medicare Advantage |
$10,857.22
|
| Rate for Payer: VA VA |
$10,540.99
|
|
|
ANAL AND STOMAL PROCEDURES WITH MCC
|
Facility
IP
|
$69,657.59
|
|
|
Service Code
|
MS-DRG 347
|
| Min. Negotiated Rate |
$19,148.01 |
| Max. Negotiated Rate |
$69,657.59 |
| Rate for Payer: Aetna Medicare |
$20,962.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,194.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,194.75
|
| Rate for Payer: BCBS MAPPO |
$20,155.80
|
| Rate for Payer: BCBS Trust/PPO |
$69,657.59
|
| Rate for Payer: BCN Medicare Advantage |
$20,155.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,155.80
|
| Rate for Payer: Mclaren Medicare |
$20,155.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,163.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,179.17
|
| Rate for Payer: PACE Medicare |
$19,148.01
|
| Rate for Payer: PACE SWMI |
$20,155.80
|
| Rate for Payer: PHP Medicare Advantage |
$20,155.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,579.38
|
| Rate for Payer: Priority Health Medicare |
$20,155.80
|
| Rate for Payer: Priority Health Narrow Network |
$29,263.50
|
| Rate for Payer: Railroad Medicare Medicare |
$20,155.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38,883.97
|
| Rate for Payer: UHC Core |
$31,884.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,155.80
|
| Rate for Payer: UHC Exchange |
$25,348.25
|
| Rate for Payer: UHC Medicare Advantage |
$20,760.47
|
| Rate for Payer: VA VA |
$20,155.80
|
|
|
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,987.88
|
|
|
Service Code
|
MS-DRG 349
|
| Min. Negotiated Rate |
$7,630.30 |
| Max. Negotiated Rate |
$21,987.88 |
| Rate for Payer: Aetna Medicare |
$8,353.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,039.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,039.88
|
| Rate for Payer: BCBS MAPPO |
$8,031.90
|
| Rate for Payer: BCBS Trust/PPO |
$21,987.88
|
| Rate for Payer: BCN Medicare Advantage |
$8,031.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,031.90
|
| Rate for Payer: Mclaren Medicare |
$8,031.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,433.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,236.68
|
| Rate for Payer: PACE Medicare |
$7,630.30
|
| Rate for Payer: PACE SWMI |
$8,031.90
|
| Rate for Payer: PHP Medicare Advantage |
$8,031.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,002.65
|
| Rate for Payer: Priority Health Medicare |
$8,031.90
|
| Rate for Payer: Priority Health Narrow Network |
$11,202.12
|
| Rate for Payer: Railroad Medicare Medicare |
$8,031.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,884.85
|
| Rate for Payer: UHC Core |
$12,205.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,031.90
|
| Rate for Payer: UHC Exchange |
$9,703.36
|
| Rate for Payer: UHC Medicare Advantage |
$8,272.86
|
| Rate for Payer: VA VA |
$8,031.90
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$70.68
|
|
|
Service Code
|
NDC 62756-250-83
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$63.61 |
| Rate for Payer: Aetna American Axle |
$45.94
|
| Rate for Payer: Aetna Commercial |
$60.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.94
|
| Rate for Payer: Cash Price |
$56.54
|
| Rate for Payer: Cofinity Commercial |
$49.48
|
| Rate for Payer: Cofinity Commercial |
$60.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.54
|
| Rate for Payer: Healthscope Commercial |
$63.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.08
|
| Rate for Payer: PHP Commercial |
$60.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.48
|
| Rate for Payer: Priority Health SBD |
$44.53
|
| Rate for Payer: UMR Bronson Commercial |
$31.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.01
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$132.53
|
|
|
Service Code
|
NDC 68382-209-06
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$119.28 |
| Rate for Payer: Aetna American Axle |
$86.14
|
| Rate for Payer: Aetna Commercial |
$112.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.14
|
| Rate for Payer: Cash Price |
$106.02
|
| Rate for Payer: Cofinity Commercial |
$113.98
|
| Rate for Payer: Cofinity Commercial |
$92.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.02
|
| Rate for Payer: Healthscope Commercial |
$119.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$112.65
|
| Rate for Payer: PHP Commercial |
$112.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.77
|
| Rate for Payer: Priority Health SBD |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$58.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.40
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$81.23
|
|
|
Service Code
|
NDC 51991-620-33
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.74 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna American Axle |
$52.80
|
| Rate for Payer: Aetna Commercial |
$69.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: Cash Price |
$64.98
|
| Rate for Payer: Cofinity Commercial |
$56.86
|
| Rate for Payer: Cofinity Commercial |
$69.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.98
|
| Rate for Payer: Healthscope Commercial |
$73.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.05
|
| Rate for Payer: PHP Commercial |
$69.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.86
|
| Rate for Payer: Priority Health SBD |
$51.17
|
| Rate for Payer: UMR Bronson Commercial |
$35.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.92
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$81.78
|
|
|
Service Code
|
NDC 16729-035-10
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$1,280.75
|
|
|
Service Code
|
NDC 16729-035-16
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$563.53 |
| Max. Negotiated Rate |
$1,152.68 |
| Rate for Payer: Aetna American Axle |
$832.49
|
| Rate for Payer: Aetna Commercial |
$1,088.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$832.49
|
| Rate for Payer: Cash Price |
$1,024.60
|
| Rate for Payer: Cofinity Commercial |
$1,101.44
|
| Rate for Payer: Cofinity Commercial |
$896.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,024.60
|
| Rate for Payer: Healthscope Commercial |
$1,152.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$896.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$960.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,088.64
|
| Rate for Payer: PHP Commercial |
$1,088.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.52
|
| Rate for Payer: Priority Health SBD |
$806.87
|
| Rate for Payer: UMR Bronson Commercial |
$563.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$960.56
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$127.20
|
|
|
Service Code
|
NDC 50268-075-15
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.97 |
| Max. Negotiated Rate |
$114.48 |
| Rate for Payer: Aetna American Axle |
$82.68
|
| Rate for Payer: Aetna Commercial |
$108.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.68
|
| Rate for Payer: Cash Price |
$101.76
|
| Rate for Payer: Cofinity Commercial |
$109.39
|
| Rate for Payer: Cofinity Commercial |
$89.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.76
|
| Rate for Payer: Healthscope Commercial |
$114.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.12
|
| Rate for Payer: PHP Commercial |
$108.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.04
|
| Rate for Payer: Priority Health SBD |
$80.14
|
| Rate for Payer: UMR Bronson Commercial |
$55.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.40
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$104.34
|
|
|
Service Code
|
NDC 0904-6195-46
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.91 |
| Max. Negotiated Rate |
$93.91 |
| Rate for Payer: Aetna American Axle |
$67.82
|
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.82
|
| Rate for Payer: Cash Price |
$83.47
|
| Rate for Payer: Cofinity Commercial |
$73.04
|
| Rate for Payer: Cofinity Commercial |
$89.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.47
|
| Rate for Payer: Healthscope Commercial |
$93.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$73.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.69
|
| Rate for Payer: PHP Commercial |
$88.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.04
|
| Rate for Payer: Priority Health SBD |
$65.73
|
| Rate for Payer: UMR Bronson Commercial |
$45.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.26
|
|
|
ANASTROZOLE 1 MG TABLET
|
Facility
IP
|
$2.55
|
|
|
Service Code
|
NDC 50268-075-11
|
| Hospital Charge Code |
16205
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna American Axle |
$1.66
|
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health SBD |
$1.61
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
