|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$56,349.10
|
|
|
Service Code
|
APR-DRG 8413
|
| Min. Negotiated Rate |
$53,665.81 |
| Max. Negotiated Rate |
$56,349.10 |
| Rate for Payer: BCBS Complete |
$56,349.10
|
| Rate for Payer: Mclaren Medicaid |
$53,665.81
|
| Rate for Payer: Meridian Medicaid |
$56,349.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$53,665.81
|
| Rate for Payer: UHC Medicaid |
$53,665.81
|
| Rate for Payer: UHCCP Medicaid |
$53,665.81
|
|
|
EXTENSIVE THIRD DEGREE BURNS WITH SKIN GRAFT
|
Facility
|
IP
|
$34,715.99
|
|
|
Service Code
|
APR-DRG 8411
|
| Min. Negotiated Rate |
$33,062.85 |
| Max. Negotiated Rate |
$34,715.99 |
| Rate for Payer: BCBS Complete |
$34,715.99
|
| Rate for Payer: Mclaren Medicaid |
$33,062.85
|
| Rate for Payer: Meridian Medicaid |
$34,715.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,062.85
|
| Rate for Payer: UHC Medicaid |
$33,062.85
|
| Rate for Payer: UHCCP Medicaid |
$33,062.85
|
|
|
EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 59412
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$977.38 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$977.38
|
| Rate for Payer: BCN Commercial |
$977.38
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
EXTERNAL ELECTROCARDIOGRAPHIC RECORDING FOR MORE THAN 48 HOURS UP TO 7 DAYS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; RECORDING (INCLUDES CONNECTION AND INITIAL RECORDING)
|
Facility
|
OP
|
$120.34
|
|
|
Service Code
|
CPT 93242
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$120.34 |
| Rate for Payer: Aetna Medicare |
$38.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$46.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$46.52
|
| Rate for Payer: BCBS Complete |
$20.44
|
| Rate for Payer: BCBS MAPPO |
$37.22
|
| Rate for Payer: BCBS Trust/PPO |
$37.77
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: BCN Medicare Advantage |
$37.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.22
|
| Rate for Payer: Mclaren Medicaid |
$37.22
|
| Rate for Payer: Mclaren Medicare |
$37.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.08
|
| Rate for Payer: Meridian Medicaid |
$39.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.94
|
| Rate for Payer: Nomi Health Commercial |
$111.66
|
| Rate for Payer: PACE Medicare |
$35.36
|
| Rate for Payer: PACE SWMI |
$37.22
|
| Rate for Payer: PHP Medicare Advantage |
$37.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$120.34
|
| Rate for Payer: Priority Health Medicare |
$37.22
|
| Rate for Payer: Priority Health Tiered Network |
$96.27
|
| Rate for Payer: Railroad Medicare Medicare |
$37.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.22
|
| Rate for Payer: UHC Medicaid |
$19.47
|
| Rate for Payer: UHCCP Medicaid |
$19.47
|
| Rate for Payer: VA VA |
$37.22
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$43,229.89
|
|
|
Service Code
|
APR-DRG 1784
|
| Min. Negotiated Rate |
$41,171.32 |
| Max. Negotiated Rate |
$43,229.89 |
| Rate for Payer: BCBS Complete |
$43,229.89
|
| Rate for Payer: Mclaren Medicaid |
$41,171.32
|
| Rate for Payer: Meridian Medicaid |
$43,229.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$41,171.32
|
| Rate for Payer: UHC Medicaid |
$41,171.32
|
| Rate for Payer: UHCCP Medicaid |
$41,171.32
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$33,282.58
|
|
|
Service Code
|
APR-DRG 1783
|
| Min. Negotiated Rate |
$31,697.70 |
| Max. Negotiated Rate |
$33,282.58 |
| Rate for Payer: BCBS Complete |
$33,282.58
|
| Rate for Payer: Mclaren Medicaid |
$31,697.70
|
| Rate for Payer: Meridian Medicaid |
$33,282.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$31,697.70
|
| Rate for Payer: UHC Medicaid |
$31,697.70
|
| Rate for Payer: UHCCP Medicaid |
$31,697.70
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$27,259.60
|
|
|
Service Code
|
APR-DRG 1782
|
| Min. Negotiated Rate |
$25,961.52 |
| Max. Negotiated Rate |
$27,259.60 |
| Rate for Payer: BCBS Complete |
$27,259.60
|
| Rate for Payer: Mclaren Medicaid |
$25,961.52
|
| Rate for Payer: Meridian Medicaid |
$27,259.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,961.52
|
| Rate for Payer: UHC Medicaid |
$25,961.52
|
| Rate for Payer: UHCCP Medicaid |
$25,961.52
|
|
|
EXTERNAL HEART ASSIST DEVICES
|
Facility
|
IP
|
$24,573.77
|
|
|
Service Code
|
APR-DRG 1781
|
| Min. Negotiated Rate |
$23,403.59 |
| Max. Negotiated Rate |
$24,573.77 |
| Rate for Payer: BCBS Complete |
$24,573.77
|
| Rate for Payer: Mclaren Medicaid |
$23,403.59
|
| Rate for Payer: Meridian Medicaid |
$24,573.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,403.59
|
| Rate for Payer: UHC Medicaid |
$23,403.59
|
| Rate for Payer: UHCCP Medicaid |
$23,403.59
|
|
|
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
|
$17,146.74
|
|
|
Service Code
|
CPT 66989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,773.03 |
| Max. Negotiated Rate |
$17,146.74 |
| Rate for Payer: Aetna Medicare |
$5,514.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,627.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,627.71
|
| Rate for Payer: BCBS Complete |
$2,911.95
|
| Rate for Payer: BCBS MAPPO |
$5,302.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,465.17
|
| Rate for Payer: BCN Commercial |
$6,465.17
|
| Rate for Payer: BCN Medicare Advantage |
$5,302.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,302.17
|
| Rate for Payer: Mclaren Medicaid |
$5,302.17
|
| Rate for Payer: Mclaren Medicare |
$5,302.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,567.28
|
| Rate for Payer: Meridian Medicaid |
$5,567.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,097.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,832.39
|
| Rate for Payer: Nomi Health Commercial |
$15,906.51
|
| Rate for Payer: PACE Medicare |
$5,037.06
|
| Rate for Payer: PACE SWMI |
$5,302.17
|
| Rate for Payer: PHP Medicare Advantage |
$5,302.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,773.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,146.74
|
| Rate for Payer: Priority Health Medicare |
$5,302.17
|
| Rate for Payer: Priority Health Tiered Network |
$13,717.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5,302.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,302.17
|
| Rate for Payer: UHC Medicaid |
$2,773.03
|
| Rate for Payer: UHCCP Medicaid |
$2,773.03
|
| Rate for Payer: VA VA |
$5,302.17
|
|
|
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
|
$7,436.46
|
|
|
Service Code
|
CPT 66982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.65 |
| Max. Negotiated Rate |
$7,436.46 |
| Rate for Payer: Aetna Medicare |
$2,391.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,874.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,874.40
|
| Rate for Payer: BCBS Complete |
$1,262.90
|
| Rate for Payer: BCBS MAPPO |
$2,299.52
|
| Rate for Payer: BCBS Trust/PPO |
$5,579.38
|
| Rate for Payer: BCN Commercial |
$5,579.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,299.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,299.52
|
| Rate for Payer: Mclaren Medicaid |
$2,299.52
|
| Rate for Payer: Mclaren Medicare |
$2,299.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,414.50
|
| Rate for Payer: Meridian Medicaid |
$2,414.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,644.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,529.47
|
| Rate for Payer: Nomi Health Commercial |
$6,898.56
|
| Rate for Payer: PACE Medicare |
$2,184.54
|
| Rate for Payer: PACE SWMI |
$2,299.52
|
| Rate for Payer: PHP Medicare Advantage |
$2,299.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,202.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,436.46
|
| Rate for Payer: Priority Health Medicare |
$2,299.52
|
| Rate for Payer: Priority Health Tiered Network |
$5,949.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,299.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,299.52
|
| Rate for Payer: UHC Medicaid |
$1,202.65
|
| Rate for Payer: UHCCP Medicaid |
$1,202.65
|
| Rate for Payer: VA VA |
$2,299.52
|
|
|
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
|
$17,146.74
|
|
|
Service Code
|
CPT 66991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,773.03 |
| Max. Negotiated Rate |
$17,146.74 |
| Rate for Payer: Aetna Medicare |
$5,514.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,627.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,627.71
|
| Rate for Payer: BCBS Complete |
$2,911.95
|
| Rate for Payer: BCBS MAPPO |
$5,302.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,465.17
|
| Rate for Payer: BCN Commercial |
$6,465.17
|
| Rate for Payer: BCN Medicare Advantage |
$5,302.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,302.17
|
| Rate for Payer: Mclaren Medicaid |
$5,302.17
|
| Rate for Payer: Mclaren Medicare |
$5,302.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,567.28
|
| Rate for Payer: Meridian Medicaid |
$5,567.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,097.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,832.39
|
| Rate for Payer: Nomi Health Commercial |
$15,906.51
|
| Rate for Payer: PACE Medicare |
$5,037.06
|
| Rate for Payer: PACE SWMI |
$5,302.17
|
| Rate for Payer: PHP Medicare Advantage |
$5,302.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,773.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,146.74
|
| Rate for Payer: Priority Health Medicare |
$5,302.17
|
| Rate for Payer: Priority Health Tiered Network |
$13,717.39
|
| Rate for Payer: Railroad Medicare Medicare |
$5,302.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,302.17
|
| Rate for Payer: UHC Medicaid |
$2,773.03
|
| Rate for Payer: UHCCP Medicaid |
$2,773.03
|
| Rate for Payer: VA VA |
$5,302.17
|
|
|
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
|
$7,436.46
|
|
|
Service Code
|
CPT 66984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.65 |
| Max. Negotiated Rate |
$7,436.46 |
| Rate for Payer: Aetna Medicare |
$2,391.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,874.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,874.40
|
| Rate for Payer: BCBS Complete |
$1,262.90
|
| Rate for Payer: BCBS MAPPO |
$2,299.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,923.21
|
| Rate for Payer: BCN Commercial |
$3,923.21
|
| Rate for Payer: BCN Medicare Advantage |
$2,299.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,299.52
|
| Rate for Payer: Mclaren Medicaid |
$2,299.52
|
| Rate for Payer: Mclaren Medicare |
$2,299.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,414.50
|
| Rate for Payer: Meridian Medicaid |
$2,414.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,644.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,529.47
|
| Rate for Payer: Nomi Health Commercial |
$6,898.56
|
| Rate for Payer: PACE Medicare |
$2,184.54
|
| Rate for Payer: PACE SWMI |
$2,299.52
|
| Rate for Payer: PHP Medicare Advantage |
$2,299.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,202.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,436.46
|
| Rate for Payer: Priority Health Medicare |
$2,299.52
|
| Rate for Payer: Priority Health Tiered Network |
$5,949.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,299.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,299.52
|
| Rate for Payer: UHC Medicaid |
$1,202.65
|
| Rate for Payer: UHCCP Medicaid |
$1,202.65
|
| Rate for Payer: VA VA |
$2,299.52
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$40,150.00
|
|
|
Service Code
|
APR-DRG 0092
|
| Min. Negotiated Rate |
$38,238.09 |
| Max. Negotiated Rate |
$40,150.00 |
| Rate for Payer: BCBS Complete |
$40,150.00
|
| Rate for Payer: Mclaren Medicaid |
$38,238.09
|
| Rate for Payer: Meridian Medicaid |
$40,150.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$38,238.09
|
| Rate for Payer: UHC Medicaid |
$38,238.09
|
| Rate for Payer: UHCCP Medicaid |
$38,238.09
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$37,270.47
|
|
|
Service Code
|
APR-DRG 0091
|
| Min. Negotiated Rate |
$35,495.68 |
| Max. Negotiated Rate |
$37,270.47 |
| Rate for Payer: BCBS Complete |
$37,270.47
|
| Rate for Payer: Mclaren Medicaid |
$35,495.68
|
| Rate for Payer: Meridian Medicaid |
$37,270.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$35,495.68
|
| Rate for Payer: UHC Medicaid |
$35,495.68
|
| Rate for Payer: UHCCP Medicaid |
$35,495.68
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$134,201.76
|
|
|
Service Code
|
APR-DRG 0094
|
| Min. Negotiated Rate |
$127,811.20 |
| Max. Negotiated Rate |
$134,201.76 |
| Rate for Payer: BCBS Complete |
$134,201.76
|
| Rate for Payer: Mclaren Medicaid |
$127,811.20
|
| Rate for Payer: Meridian Medicaid |
$134,201.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$127,811.20
|
| Rate for Payer: UHC Medicaid |
$127,811.20
|
| Rate for Payer: UHCCP Medicaid |
$127,811.20
|
|
|
EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)
|
Facility
|
IP
|
$80,712.82
|
|
|
Service Code
|
APR-DRG 0093
|
| Min. Negotiated Rate |
$76,869.36 |
| Max. Negotiated Rate |
$80,712.82 |
| Rate for Payer: BCBS Complete |
$80,712.82
|
| Rate for Payer: Mclaren Medicaid |
$76,869.36
|
| Rate for Payer: Meridian Medicaid |
$80,712.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$76,869.36
|
| Rate for Payer: UHC Medicaid |
$76,869.36
|
| Rate for Payer: UHCCP Medicaid |
$76,869.36
|
|
|
EXTRACRANIAL PROCEDURES WITH CC
|
Facility
|
IP
|
$34,341.20
|
|
|
Service Code
|
MSDRG 038
|
| Min. Negotiated Rate |
$13,454.17 |
| Max. Negotiated Rate |
$34,341.20 |
| Rate for Payer: Aetna Medicare |
$14,728.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,702.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,702.85
|
| Rate for Payer: BCBS MAPPO |
$14,162.28
|
| Rate for Payer: BCBS Trust/PPO |
$34,341.20
|
| Rate for Payer: BCN Commercial |
$34,341.20
|
| Rate for Payer: BCN Medicare Advantage |
$14,162.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,162.28
|
| Rate for Payer: Mclaren Medicare |
$14,162.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,870.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,286.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,578.51
|
| Rate for Payer: Nomi Health Commercial |
$20,931.54
|
| Rate for Payer: PACE Medicare |
$13,454.17
|
| Rate for Payer: PACE SWMI |
$14,162.28
|
| Rate for Payer: PHP Medicare Advantage |
$14,162.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,159.78
|
| Rate for Payer: Priority Health Medicare |
$14,162.28
|
| Rate for Payer: Priority Health Tiered Network |
$20,927.82
|
| Rate for Payer: Railroad Medicare Medicare |
$14,162.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,448.38
|
| Rate for Payer: UHC Core |
$22,127.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,162.28
|
| Rate for Payer: UHC Exchange |
$18,070.90
|
| Rate for Payer: VA VA |
$14,162.28
|
|
|
EXTRACRANIAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$53,661.23
|
|
|
Service Code
|
MSDRG 037
|
| Min. Negotiated Rate |
$26,717.59 |
| Max. Negotiated Rate |
$53,661.23 |
| Rate for Payer: Aetna Medicare |
$29,248.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,154.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,154.72
|
| Rate for Payer: BCBS MAPPO |
$28,123.78
|
| Rate for Payer: BCBS Trust/PPO |
$52,099.25
|
| Rate for Payer: BCN Commercial |
$52,099.25
|
| Rate for Payer: BCN Medicare Advantage |
$28,123.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,123.78
|
| Rate for Payer: Mclaren Medicare |
$28,123.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,529.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,342.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,936.16
|
| Rate for Payer: Nomi Health Commercial |
$42,468.09
|
| Rate for Payer: PACE Medicare |
$26,717.59
|
| Rate for Payer: PACE SWMI |
$28,123.78
|
| Rate for Payer: PHP Medicare Advantage |
$28,123.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,075.70
|
| Rate for Payer: Priority Health Medicare |
$28,123.78
|
| Rate for Payer: Priority Health Tiered Network |
$42,460.55
|
| Rate for Payer: Railroad Medicare Medicare |
$28,123.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,661.23
|
| Rate for Payer: UHC Core |
$44,894.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,123.78
|
| Rate for Payer: UHC Exchange |
$36,664.12
|
| Rate for Payer: VA VA |
$28,123.78
|
|
|
EXTRACRANIAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,174.53
|
|
|
Service Code
|
MSDRG 039
|
| Min. Negotiated Rate |
$9,902.15 |
| Max. Negotiated Rate |
$33,174.53 |
| Rate for Payer: Aetna Medicare |
$10,840.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,029.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,029.15
|
| Rate for Payer: BCBS MAPPO |
$10,423.32
|
| Rate for Payer: BCBS Trust/PPO |
$33,174.53
|
| Rate for Payer: BCN Commercial |
$33,174.53
|
| Rate for Payer: BCN Medicare Advantage |
$10,423.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,423.32
|
| Rate for Payer: Mclaren Medicare |
$10,423.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,944.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,986.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,465.65
|
| Rate for Payer: Nomi Health Commercial |
$15,163.95
|
| Rate for Payer: PACE Medicare |
$9,902.15
|
| Rate for Payer: PACE SWMI |
$10,423.32
|
| Rate for Payer: PHP Medicare Advantage |
$10,423.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,951.58
|
| Rate for Payer: Priority Health Medicare |
$10,423.32
|
| Rate for Payer: Priority Health Tiered Network |
$15,161.26
|
| Rate for Payer: Railroad Medicare Medicare |
$10,423.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,160.65
|
| Rate for Payer: UHC Core |
$16,030.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,423.32
|
| Rate for Payer: UHC Exchange |
$13,091.54
|
| Rate for Payer: VA VA |
$10,423.32
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$25,018.87
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$12,757.42 |
| Max. Negotiated Rate |
$25,018.87 |
| Rate for Payer: Aetna Medicare |
$13,966.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,786.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,786.08
|
| Rate for Payer: BCBS MAPPO |
$13,428.86
|
| Rate for Payer: BCBS Trust/PPO |
$20,777.66
|
| Rate for Payer: BCN Commercial |
$20,777.66
|
| Rate for Payer: BCN Medicare Advantage |
$13,428.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,428.86
|
| Rate for Payer: Mclaren Medicare |
$13,428.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,100.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,443.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,771.75
|
| Rate for Payer: Nomi Health Commercial |
$19,800.21
|
| Rate for Payer: PACE Medicare |
$12,757.42
|
| Rate for Payer: PACE SWMI |
$13,428.86
|
| Rate for Payer: PHP Medicare Advantage |
$13,428.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,745.87
|
| Rate for Payer: Priority Health Medicare |
$13,428.86
|
| Rate for Payer: Priority Health Tiered Network |
$19,796.70
|
| Rate for Payer: Railroad Medicare Medicare |
$13,428.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,018.87
|
| Rate for Payer: UHC Core |
$20,931.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,428.86
|
| Rate for Payer: UHC Exchange |
$17,094.18
|
| Rate for Payer: VA VA |
$13,428.86
|
|
|
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR HEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 41017
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.51
|
| Rate for Payer: BCN Commercial |
$1,769.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$167,036.59
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$47,781.81 |
| Max. Negotiated Rate |
$167,036.59 |
| Rate for Payer: Aetna Medicare |
$52,308.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,870.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,870.80
|
| Rate for Payer: BCBS MAPPO |
$50,296.64
|
| Rate for Payer: BCBS Trust/PPO |
$167,036.59
|
| Rate for Payer: BCN Commercial |
$167,036.59
|
| Rate for Payer: BCN Medicare Advantage |
$50,296.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,296.64
|
| Rate for Payer: Mclaren Medicare |
$50,296.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52,811.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,841.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$55,326.30
|
| Rate for Payer: Nomi Health Commercial |
$76,671.15
|
| Rate for Payer: PACE Medicare |
$47,781.81
|
| Rate for Payer: PACE SWMI |
$50,296.64
|
| Rate for Payer: PHP Medicare Advantage |
$50,296.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$137,831.40
|
| Rate for Payer: Priority Health Medicare |
$50,296.64
|
| Rate for Payer: Priority Health Tiered Network |
$110,265.10
|
| Rate for Payer: Railroad Medicare Medicare |
$50,296.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96,879.05
|
| Rate for Payer: UHC Core |
$81,051.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50,296.64
|
| Rate for Payer: UHC Exchange |
$66,192.76
|
| Rate for Payer: VA VA |
$50,296.64
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$10,765.10
|
|
|
Service Code
|
APR-DRG 0823
|
| Min. Negotiated Rate |
$10,252.48 |
| Max. Negotiated Rate |
$10,765.10 |
| Rate for Payer: BCBS Complete |
$10,765.10
|
| Rate for Payer: Mclaren Medicaid |
$10,252.48
|
| Rate for Payer: Meridian Medicaid |
$10,765.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,252.48
|
| Rate for Payer: UHC Medicaid |
$10,252.48
|
| Rate for Payer: UHCCP Medicaid |
$10,252.48
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$5,837.75
|
|
|
Service Code
|
APR-DRG 0822
|
| Min. Negotiated Rate |
$5,559.77 |
| Max. Negotiated Rate |
$5,837.75 |
| Rate for Payer: BCBS Complete |
$5,837.75
|
| Rate for Payer: Mclaren Medicaid |
$5,559.77
|
| Rate for Payer: Meridian Medicaid |
$5,837.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,559.77
|
| Rate for Payer: UHC Medicaid |
$5,559.77
|
| Rate for Payer: UHCCP Medicaid |
$5,559.77
|
|
|
EYE INFECTIONS AND OTHER EYE DISORDERS
|
Facility
|
IP
|
$3,547.20
|
|
|
Service Code
|
APR-DRG 0821
|
| Min. Negotiated Rate |
$3,378.29 |
| Max. Negotiated Rate |
$3,547.20 |
| Rate for Payer: BCBS Complete |
$3,547.20
|
| Rate for Payer: Mclaren Medicaid |
$3,378.29
|
| Rate for Payer: Meridian Medicaid |
$3,547.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,378.29
|
| Rate for Payer: UHC Medicaid |
$3,378.29
|
| Rate for Payer: UHCCP Medicaid |
$3,378.29
|
|
