|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
OP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$965.87 |
| Max. Negotiated Rate |
$3,806.87 |
| Rate for Payer: Aetna American Axle |
$1,748.43
|
| Rate for Payer: Aetna Commercial |
$2,286.41
|
| Rate for Payer: Aetna Medicare |
$1,344.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.43
|
| Rate for Payer: BCBS Complete |
$1,075.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,806.87
|
| Rate for Payer: BCN Commercial |
$3,806.87
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Advantage |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,017.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,151.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,017.42
|
| Rate for Payer: PHP Commercial |
$2,286.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,207.34
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
| Rate for Payer: Priority Health Tiered Network |
$965.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,349.60
|
| Rate for Payer: UHC Core |
$2,349.60
|
| Rate for Payer: UHC Exchange |
$2,349.60
|
| Rate for Payer: UMR Bronson Commercial |
$995.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,017.42
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
IP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,183.56 |
| Max. Negotiated Rate |
$2,420.91 |
| Rate for Payer: Aetna American Axle |
$1,748.43
|
| Rate for Payer: Aetna Commercial |
$2,286.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.43
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Advantage |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,882.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,017.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,017.42
|
| Rate for Payer: PHP Commercial |
$2,286.41
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,183.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,017.42
|
|
|
COPPER GLUCONATE 2 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 00536143901
|
| Hospital Charge Code |
110015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.24 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UMR Bronson Commercial |
$68.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
COPPER GLUCONATE 2 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 00536143901
|
| Hospital Charge Code |
110015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$37,831.00
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$36,029.52 |
| Max. Negotiated Rate |
$37,831.00 |
| Rate for Payer: BCBS Complete |
$37,831.00
|
| Rate for Payer: Mclaren Medicaid |
$36,029.52
|
| Rate for Payer: Meridian Medicaid |
$37,831.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,029.52
|
| Rate for Payer: UHC Medicaid |
$36,029.52
|
| Rate for Payer: UHCCP Medicaid |
$36,029.52
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$33,461.76
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$31,868.34 |
| Max. Negotiated Rate |
$33,461.76 |
| Rate for Payer: BCBS Complete |
$33,461.76
|
| Rate for Payer: Mclaren Medicaid |
$31,868.34
|
| Rate for Payer: Meridian Medicaid |
$33,461.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,868.34
|
| Rate for Payer: UHC Medicaid |
$31,868.34
|
| Rate for Payer: UHCCP Medicaid |
$31,868.34
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$24,300.17
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$23,143.02 |
| Max. Negotiated Rate |
$24,300.17 |
| Rate for Payer: BCBS Complete |
$24,300.17
|
| Rate for Payer: Mclaren Medicaid |
$23,143.02
|
| Rate for Payer: Meridian Medicaid |
$24,300.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,143.02
|
| Rate for Payer: UHC Medicaid |
$23,143.02
|
| Rate for Payer: UHCCP Medicaid |
$23,143.02
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$27,909.11
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$26,580.11 |
| Max. Negotiated Rate |
$27,909.11 |
| Rate for Payer: BCBS Complete |
$27,909.11
|
| Rate for Payer: Mclaren Medicaid |
$26,580.11
|
| Rate for Payer: Meridian Medicaid |
$27,909.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,580.11
|
| Rate for Payer: UHC Medicaid |
$26,580.11
|
| Rate for Payer: UHCCP Medicaid |
$26,580.11
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$133,126.37
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$61,301.07 |
| Max. Negotiated Rate |
$133,126.37 |
| Rate for Payer: Aetna Medicare |
$67,108.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80,659.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80,659.30
|
| Rate for Payer: BCBS MAPPO |
$64,527.44
|
| Rate for Payer: BCBS Trust/PPO |
$133,126.37
|
| Rate for Payer: BCN Commercial |
$133,126.37
|
| Rate for Payer: BCN Medicare Advantage |
$64,527.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64,527.44
|
| Rate for Payer: Mclaren Medicare |
$64,527.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67,753.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74,206.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$70,980.18
|
| Rate for Payer: Nomi Health Commercial |
$98,623.08
|
| Rate for Payer: PACE Medicare |
$61,301.07
|
| Rate for Payer: PACE SWMI |
$64,527.44
|
| Rate for Payer: PHP Medicare Advantage |
$64,527.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123,256.98
|
| Rate for Payer: Priority Health Medicare |
$64,527.44
|
| Rate for Payer: Priority Health Tiered Network |
$98,605.57
|
| Rate for Payer: Railroad Medicare Medicare |
$64,527.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124,616.76
|
| Rate for Payer: UHC Core |
$104,257.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$64,527.44
|
| Rate for Payer: UHC Exchange |
$85,144.59
|
| Rate for Payer: VA VA |
$64,527.44
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$109,905.57
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$43,962.06 |
| Max. Negotiated Rate |
$109,905.57 |
| Rate for Payer: Aetna Medicare |
$48,126.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57,844.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57,844.81
|
| Rate for Payer: BCBS MAPPO |
$46,275.85
|
| Rate for Payer: BCBS Trust/PPO |
$109,905.57
|
| Rate for Payer: BCN Commercial |
$109,905.57
|
| Rate for Payer: BCN Medicare Advantage |
$46,275.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46,275.85
|
| Rate for Payer: Mclaren Medicare |
$46,275.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48,589.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53,217.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$50,903.43
|
| Rate for Payer: Nomi Health Commercial |
$70,468.83
|
| Rate for Payer: PACE Medicare |
$43,962.06
|
| Rate for Payer: PACE SWMI |
$46,275.85
|
| Rate for Payer: PHP Medicare Advantage |
$46,275.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88,070.41
|
| Rate for Payer: Priority Health Medicare |
$46,275.85
|
| Rate for Payer: Priority Health Tiered Network |
$70,456.32
|
| Rate for Payer: Railroad Medicare Medicare |
$46,275.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89,042.01
|
| Rate for Payer: UHC Core |
$74,494.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46,275.85
|
| Rate for Payer: UHC Exchange |
$60,838.09
|
| Rate for Payer: VA VA |
$46,275.85
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$23,614.33
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$22,489.84 |
| Max. Negotiated Rate |
$23,614.33 |
| Rate for Payer: BCBS Complete |
$23,614.33
|
| Rate for Payer: Mclaren Medicaid |
$22,489.84
|
| Rate for Payer: Meridian Medicaid |
$23,614.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,489.84
|
| Rate for Payer: UHC Medicaid |
$22,489.84
|
| Rate for Payer: UHCCP Medicaid |
$22,489.84
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$19,676.69
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$18,739.71 |
| Max. Negotiated Rate |
$19,676.69 |
| Rate for Payer: BCBS Complete |
$19,676.69
|
| Rate for Payer: Mclaren Medicaid |
$18,739.71
|
| Rate for Payer: Meridian Medicaid |
$19,676.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,739.71
|
| Rate for Payer: UHC Medicaid |
$18,739.71
|
| Rate for Payer: UHCCP Medicaid |
$18,739.71
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$37,697.83
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$35,902.69 |
| Max. Negotiated Rate |
$37,697.83 |
| Rate for Payer: BCBS Complete |
$37,697.83
|
| Rate for Payer: Mclaren Medicaid |
$35,902.69
|
| Rate for Payer: Meridian Medicaid |
$37,697.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$35,902.69
|
| Rate for Payer: UHC Medicaid |
$35,902.69
|
| Rate for Payer: UHCCP Medicaid |
$35,902.69
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$24,903.07
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$23,717.21 |
| Max. Negotiated Rate |
$24,903.07 |
| Rate for Payer: BCBS Complete |
$24,903.07
|
| Rate for Payer: Mclaren Medicaid |
$23,717.21
|
| Rate for Payer: Meridian Medicaid |
$24,903.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,717.21
|
| Rate for Payer: UHC Medicaid |
$23,717.21
|
| Rate for Payer: UHCCP Medicaid |
$23,717.21
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$113,282.04
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$47,186.77 |
| Max. Negotiated Rate |
$113,282.04 |
| Rate for Payer: Aetna Medicare |
$51,657.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,087.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,087.85
|
| Rate for Payer: BCBS MAPPO |
$49,670.28
|
| Rate for Payer: BCBS Trust/PPO |
$113,282.04
|
| Rate for Payer: BCN Commercial |
$113,282.04
|
| Rate for Payer: BCN Medicare Advantage |
$49,670.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49,670.28
|
| Rate for Payer: Mclaren Medicare |
$49,670.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,153.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,120.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$54,637.31
|
| Rate for Payer: Nomi Health Commercial |
$75,704.94
|
| Rate for Payer: PACE Medicare |
$47,186.77
|
| Rate for Payer: PACE SWMI |
$49,670.28
|
| Rate for Payer: PHP Medicare Advantage |
$49,670.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$94,614.39
|
| Rate for Payer: Priority Health Medicare |
$49,670.28
|
| Rate for Payer: Priority Health Tiered Network |
$75,691.50
|
| Rate for Payer: Railroad Medicare Medicare |
$49,670.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95,658.18
|
| Rate for Payer: UHC Core |
$80,030.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49,670.28
|
| Rate for Payer: UHC Exchange |
$65,358.60
|
| Rate for Payer: VA VA |
$49,670.28
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$90,116.14
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$33,841.48 |
| Max. Negotiated Rate |
$90,116.14 |
| Rate for Payer: Aetna Medicare |
$37,047.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44,528.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44,528.26
|
| Rate for Payer: BCBS MAPPO |
$35,622.61
|
| Rate for Payer: BCBS Trust/PPO |
$90,116.14
|
| Rate for Payer: BCN Commercial |
$90,116.14
|
| Rate for Payer: BCN Medicare Advantage |
$35,622.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,622.61
|
| Rate for Payer: Mclaren Medicare |
$35,622.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,403.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,966.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,184.87
|
| Rate for Payer: Nomi Health Commercial |
$54,035.52
|
| Rate for Payer: PACE Medicare |
$33,841.48
|
| Rate for Payer: PACE SWMI |
$35,622.61
|
| Rate for Payer: PHP Medicare Advantage |
$35,622.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67,532.42
|
| Rate for Payer: Priority Health Medicare |
$35,622.61
|
| Rate for Payer: Priority Health Tiered Network |
$54,025.93
|
| Rate for Payer: Railroad Medicare Medicare |
$35,622.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,277.44
|
| Rate for Payer: UHC Core |
$57,122.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,622.61
|
| Rate for Payer: UHC Exchange |
$46,650.67
|
| Rate for Payer: VA VA |
$35,622.61
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$168,000.12
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$67,535.14 |
| Max. Negotiated Rate |
$168,000.12 |
| Rate for Payer: Aetna Medicare |
$73,933.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88,862.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88,862.02
|
| Rate for Payer: BCBS MAPPO |
$71,089.62
|
| Rate for Payer: BCBS Trust/PPO |
$168,000.12
|
| Rate for Payer: BCN Commercial |
$168,000.12
|
| Rate for Payer: BCN Medicare Advantage |
$71,089.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71,089.62
|
| Rate for Payer: Mclaren Medicare |
$71,089.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74,644.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81,753.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$78,198.58
|
| Rate for Payer: Nomi Health Commercial |
$108,745.71
|
| Rate for Payer: PACE Medicare |
$67,535.14
|
| Rate for Payer: PACE SWMI |
$71,089.62
|
| Rate for Payer: PHP Medicare Advantage |
$71,089.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$135,908.03
|
| Rate for Payer: Priority Health Medicare |
$71,089.62
|
| Rate for Payer: Priority Health Tiered Network |
$108,726.41
|
| Rate for Payer: Railroad Medicare Medicare |
$71,089.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137,407.37
|
| Rate for Payer: UHC Core |
$114,958.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71,089.62
|
| Rate for Payer: UHC Exchange |
$93,883.80
|
| Rate for Payer: VA VA |
$71,089.62
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$150,511.09
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$48,727.99 |
| Max. Negotiated Rate |
$150,511.09 |
| Rate for Payer: Aetna Medicare |
$53,344.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64,115.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64,115.78
|
| Rate for Payer: BCBS MAPPO |
$51,292.62
|
| Rate for Payer: BCBS Trust/PPO |
$150,511.09
|
| Rate for Payer: BCN Commercial |
$150,511.09
|
| Rate for Payer: BCN Medicare Advantage |
$51,292.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51,292.62
|
| Rate for Payer: Mclaren Medicare |
$51,292.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53,857.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58,986.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$56,421.88
|
| Rate for Payer: Nomi Health Commercial |
$78,207.54
|
| Rate for Payer: PACE Medicare |
$48,727.99
|
| Rate for Payer: PACE SWMI |
$51,292.62
|
| Rate for Payer: PHP Medicare Advantage |
$51,292.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97,742.09
|
| Rate for Payer: Priority Health Medicare |
$51,292.62
|
| Rate for Payer: Priority Health Tiered Network |
$78,193.66
|
| Rate for Payer: Railroad Medicare Medicare |
$51,292.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98,820.38
|
| Rate for Payer: UHC Core |
$82,675.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51,292.62
|
| Rate for Payer: UHC Exchange |
$67,519.18
|
| Rate for Payer: VA VA |
$51,292.62
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$114,349.89
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$34,942.61 |
| Max. Negotiated Rate |
$114,349.89 |
| Rate for Payer: Aetna Medicare |
$38,252.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,977.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,977.11
|
| Rate for Payer: BCBS MAPPO |
$36,781.69
|
| Rate for Payer: BCBS Trust/PPO |
$114,349.89
|
| Rate for Payer: BCN Commercial |
$114,349.89
|
| Rate for Payer: BCN Medicare Advantage |
$36,781.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,781.69
|
| Rate for Payer: Mclaren Medicare |
$36,781.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,620.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42,298.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$40,459.86
|
| Rate for Payer: Nomi Health Commercial |
$55,823.46
|
| Rate for Payer: PACE Medicare |
$34,942.61
|
| Rate for Payer: PACE SWMI |
$36,781.69
|
| Rate for Payer: PHP Medicare Advantage |
$36,781.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69,766.95
|
| Rate for Payer: Priority Health Medicare |
$36,781.69
|
| Rate for Payer: Priority Health Tiered Network |
$55,813.55
|
| Rate for Payer: Railroad Medicare Medicare |
$36,781.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70,536.62
|
| Rate for Payer: UHC Core |
$59,012.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,781.69
|
| Rate for Payer: UHC Exchange |
$48,194.25
|
| Rate for Payer: VA VA |
$36,781.69
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$75,396.92
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$25,596.62 |
| Max. Negotiated Rate |
$75,396.92 |
| Rate for Payer: Aetna Medicare |
$28,021.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,679.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,679.76
|
| Rate for Payer: BCBS MAPPO |
$26,943.81
|
| Rate for Payer: BCBS Trust/PPO |
$75,396.92
|
| Rate for Payer: BCN Commercial |
$75,396.92
|
| Rate for Payer: BCN Medicare Advantage |
$26,943.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,943.81
|
| Rate for Payer: Mclaren Medicare |
$26,943.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,291.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,985.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,638.19
|
| Rate for Payer: Nomi Health Commercial |
$40,647.90
|
| Rate for Payer: PACE Medicare |
$25,596.62
|
| Rate for Payer: PACE SWMI |
$26,943.81
|
| Rate for Payer: PHP Medicare Advantage |
$26,943.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50,800.86
|
| Rate for Payer: Priority Health Medicare |
$26,943.81
|
| Rate for Payer: Priority Health Tiered Network |
$40,640.68
|
| Rate for Payer: Railroad Medicare Medicare |
$26,943.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51,361.30
|
| Rate for Payer: UHC Core |
$42,970.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26,943.81
|
| Rate for Payer: UHC Exchange |
$35,092.69
|
| Rate for Payer: VA VA |
$26,943.81
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$52,329.52
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$26,068.54 |
| Max. Negotiated Rate |
$52,329.52 |
| Rate for Payer: Aetna Medicare |
$28,538.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,300.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,300.71
|
| Rate for Payer: BCBS MAPPO |
$27,440.57
|
| Rate for Payer: BCBS Trust/PPO |
$44,671.01
|
| Rate for Payer: BCN Commercial |
$44,671.01
|
| Rate for Payer: BCN Medicare Advantage |
$27,440.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,440.57
|
| Rate for Payer: Mclaren Medicare |
$27,440.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,812.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,556.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,184.63
|
| Rate for Payer: Nomi Health Commercial |
$41,414.16
|
| Rate for Payer: PACE Medicare |
$26,068.54
|
| Rate for Payer: PACE SWMI |
$27,440.57
|
| Rate for Payer: PHP Medicare Advantage |
$27,440.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,758.52
|
| Rate for Payer: Priority Health Medicare |
$27,440.57
|
| Rate for Payer: Priority Health Tiered Network |
$41,406.81
|
| Rate for Payer: Railroad Medicare Medicare |
$27,440.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,329.52
|
| Rate for Payer: UHC Core |
$43,780.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,440.57
|
| Rate for Payer: UHC Exchange |
$35,754.22
|
| Rate for Payer: VA VA |
$27,440.57
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,217.69
|
| Rate for Payer: BCN Commercial |
$3,217.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,693.82
|
| Rate for Payer: BCN Commercial |
$5,693.82
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$7,958.71
|
| Rate for Payer: BCN Commercial |
$7,958.71
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.26
|
| Rate for Payer: BCN Commercial |
$3,921.26
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
