|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$87,917.32
|
|
|
Service Code
|
MSDRG 474
|
| Min. Negotiated Rate |
$34,668.52 |
| Max. Negotiated Rate |
$87,917.32 |
| Rate for Payer: Aetna Medicare |
$37,952.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,616.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,616.47
|
| Rate for Payer: BCBS MAPPO |
$36,493.18
|
| Rate for Payer: BCBS Trust/PPO |
$87,917.32
|
| Rate for Payer: BCN Commercial |
$87,917.32
|
| Rate for Payer: BCN Medicare Advantage |
$36,493.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,493.18
|
| Rate for Payer: Mclaren Medicare |
$36,493.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,317.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,967.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$40,142.50
|
| Rate for Payer: Nomi Health Commercial |
$55,378.41
|
| Rate for Payer: PACE Medicare |
$34,668.52
|
| Rate for Payer: PACE SWMI |
$36,493.18
|
| Rate for Payer: PHP Medicare Advantage |
$36,493.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69,210.73
|
| Rate for Payer: Priority Health Medicare |
$36,493.18
|
| Rate for Payer: Priority Health Tiered Network |
$55,368.58
|
| Rate for Payer: Railroad Medicare Medicare |
$36,493.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,974.27
|
| Rate for Payer: UHC Core |
$58,542.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,493.18
|
| Rate for Payer: UHC Exchange |
$47,810.03
|
| Rate for Payer: VA VA |
$36,493.18
|
|
|
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,412.96
|
|
|
Service Code
|
MSDRG 476
|
| Min. Negotiated Rate |
$9,939.49 |
| Max. Negotiated Rate |
$23,412.96 |
| Rate for Payer: Aetna Medicare |
$10,881.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,078.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,078.27
|
| Rate for Payer: BCBS MAPPO |
$10,462.62
|
| Rate for Payer: BCBS Trust/PPO |
$23,412.96
|
| Rate for Payer: BCN Commercial |
$23,412.96
|
| Rate for Payer: BCN Medicare Advantage |
$10,462.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,462.62
|
| Rate for Payer: Mclaren Medicare |
$10,462.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,985.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,032.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,508.88
|
| Rate for Payer: Nomi Health Commercial |
$15,224.58
|
| Rate for Payer: PACE Medicare |
$9,939.49
|
| Rate for Payer: PACE SWMI |
$10,462.62
|
| Rate for Payer: PHP Medicare Advantage |
$10,462.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,027.35
|
| Rate for Payer: Priority Health Medicare |
$10,462.62
|
| Rate for Payer: Priority Health Tiered Network |
$15,221.88
|
| Rate for Payer: Railroad Medicare Medicare |
$10,462.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,237.26
|
| Rate for Payer: UHC Core |
$16,094.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,462.62
|
| Rate for Payer: UHC Exchange |
$13,143.89
|
| Rate for Payer: VA VA |
$10,462.62
|
|
|
AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAY AMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26910
|
|
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 |
$2,866.80
|
| Rate for Payer: BCN Commercial |
$2,866.80
|
| 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
|
|
|
AMPUTATION, METATARSAL, WITH TOE, SINGLE
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28810
|
|
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 |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| 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
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$9,861.95
|
|
|
Service Code
|
APR-DRG 3051
|
| Min. Negotiated Rate |
$9,392.34 |
| Max. Negotiated Rate |
$9,861.95 |
| Rate for Payer: BCBS Complete |
$9,861.95
|
| Rate for Payer: Mclaren Medicaid |
$9,392.34
|
| Rate for Payer: Meridian Medicaid |
$9,861.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,392.34
|
| Rate for Payer: UHC Medicaid |
$9,392.34
|
| Rate for Payer: UHCCP Medicaid |
$9,392.34
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$22,096.18
|
|
|
Service Code
|
APR-DRG 3054
|
| Min. Negotiated Rate |
$21,043.98 |
| Max. Negotiated Rate |
$22,096.18 |
| Rate for Payer: BCBS Complete |
$22,096.18
|
| Rate for Payer: Mclaren Medicaid |
$21,043.98
|
| Rate for Payer: Meridian Medicaid |
$22,096.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,043.98
|
| Rate for Payer: UHC Medicaid |
$21,043.98
|
| Rate for Payer: UHCCP Medicaid |
$21,043.98
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$16,159.76
|
|
|
Service Code
|
APR-DRG 3053
|
| Min. Negotiated Rate |
$15,390.24 |
| Max. Negotiated Rate |
$16,159.76 |
| Rate for Payer: BCBS Complete |
$16,159.76
|
| Rate for Payer: Mclaren Medicaid |
$15,390.24
|
| Rate for Payer: Meridian Medicaid |
$16,159.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,390.24
|
| Rate for Payer: UHC Medicaid |
$15,390.24
|
| Rate for Payer: UHCCP Medicaid |
$15,390.24
|
|
|
AMPUTATION OF LOWER LIMB EXCEPT TOES
|
Facility
|
IP
|
$10,892.22
|
|
|
Service Code
|
APR-DRG 3052
|
| Min. Negotiated Rate |
$10,373.54 |
| Max. Negotiated Rate |
$10,892.22 |
| Rate for Payer: BCBS Complete |
$10,892.22
|
| Rate for Payer: Mclaren Medicaid |
$10,373.54
|
| Rate for Payer: Meridian Medicaid |
$10,892.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,373.54
|
| Rate for Payer: UHC Medicaid |
$10,373.54
|
| Rate for Payer: UHCCP Medicaid |
$10,373.54
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC
|
Facility
|
IP
|
$31,231.00
|
|
|
Service Code
|
MSDRG 617
|
| Min. Negotiated Rate |
$15,422.02 |
| Max. Negotiated Rate |
$31,231.00 |
| Rate for Payer: Aetna Medicare |
$16,883.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,292.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,292.14
|
| Rate for Payer: BCBS MAPPO |
$16,233.71
|
| Rate for Payer: BCBS Trust/PPO |
$31,231.00
|
| Rate for Payer: BCN Commercial |
$31,231.00
|
| Rate for Payer: BCN Medicare Advantage |
$16,233.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,233.71
|
| Rate for Payer: Mclaren Medicare |
$16,233.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,045.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,668.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,857.08
|
| Rate for Payer: Nomi Health Commercial |
$24,126.87
|
| Rate for Payer: PACE Medicare |
$15,422.02
|
| Rate for Payer: PACE SWMI |
$16,233.71
|
| Rate for Payer: PHP Medicare Advantage |
$16,233.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$30,153.24
|
| Rate for Payer: Priority Health Medicare |
$16,233.71
|
| Rate for Payer: Priority Health Tiered Network |
$24,122.59
|
| Rate for Payer: Railroad Medicare Medicare |
$16,233.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,485.89
|
| Rate for Payer: UHC Core |
$25,505.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,233.71
|
| Rate for Payer: UHC Exchange |
$20,829.53
|
| Rate for Payer: VA VA |
$16,233.71
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$56,844.62
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$28,269.17 |
| Max. Negotiated Rate |
$56,844.62 |
| Rate for Payer: Aetna Medicare |
$30,947.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,196.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,196.28
|
| Rate for Payer: BCBS MAPPO |
$29,757.02
|
| Rate for Payer: BCBS Trust/PPO |
$47,635.72
|
| Rate for Payer: BCN Commercial |
$47,635.72
|
| Rate for Payer: BCN Medicare Advantage |
$29,757.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,757.02
|
| Rate for Payer: Mclaren Medicare |
$29,757.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,244.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,220.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,732.72
|
| Rate for Payer: Nomi Health Commercial |
$44,987.46
|
| Rate for Payer: PACE Medicare |
$28,269.17
|
| Rate for Payer: PACE SWMI |
$29,757.02
|
| Rate for Payer: PHP Medicare Advantage |
$29,757.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,224.35
|
| Rate for Payer: Priority Health Medicare |
$29,757.02
|
| Rate for Payer: Priority Health Tiered Network |
$44,979.47
|
| Rate for Payer: Railroad Medicare Medicare |
$29,757.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,844.62
|
| Rate for Payer: UHC Core |
$47,557.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,757.02
|
| Rate for Payer: UHC Exchange |
$38,839.17
|
| Rate for Payer: VA VA |
$29,757.02
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$24,239.23
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$11,831.10 |
| Max. Negotiated Rate |
$24,239.23 |
| Rate for Payer: Aetna Medicare |
$12,951.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,567.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,567.24
|
| Rate for Payer: BCBS MAPPO |
$12,453.79
|
| Rate for Payer: BCBS Trust/PPO |
$24,239.23
|
| Rate for Payer: BCN Commercial |
$24,239.23
|
| Rate for Payer: BCN Medicare Advantage |
$12,453.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,453.79
|
| Rate for Payer: Mclaren Medicare |
$12,453.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,076.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,321.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,699.17
|
| Rate for Payer: Nomi Health Commercial |
$18,296.07
|
| Rate for Payer: PACE Medicare |
$11,831.10
|
| Rate for Payer: PACE SWMI |
$12,453.79
|
| Rate for Payer: PHP Medicare Advantage |
$12,453.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,866.03
|
| Rate for Payer: Priority Health Medicare |
$12,453.79
|
| Rate for Payer: Priority Health Tiered Network |
$18,292.82
|
| Rate for Payer: Railroad Medicare Medicare |
$12,453.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,118.29
|
| Rate for Payer: UHC Core |
$19,341.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,453.79
|
| Rate for Payer: UHC Exchange |
$15,795.61
|
| Rate for Payer: VA VA |
$12,453.79
|
|
|
AMPUTATION, TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28825
|
|
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 |
$3,075.54
|
| Rate for Payer: BCN Commercial |
$3,075.54
|
| 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
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28820
|
|
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 |
$3,078.11
|
| Rate for Payer: BCN Commercial |
$3,078.11
|
| 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
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$323.52
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.35 |
| Max. Negotiated Rate |
$291.17 |
| Rate for Payer: Aetna American Axle |
$210.29
|
| Rate for Payer: Aetna Commercial |
$274.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.29
|
| Rate for Payer: Cash Price |
$258.82
|
| Rate for Payer: Cofinity Advantage |
$226.46
|
| Rate for Payer: Cofinity Commercial |
$278.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.82
|
| Rate for Payer: Healthscope Commercial |
$291.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.64
|
| Rate for Payer: PHP Commercial |
$274.99
|
| Rate for Payer: Priority Health SBD |
$203.82
|
| Rate for Payer: UMR Bronson Commercial |
$142.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.64
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
NDC 00172524160
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.64 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Aetna American Axle |
$241.80
|
| Rate for Payer: Aetna Commercial |
$316.20
|
| Rate for Payer: Aetna Medicare |
$186.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.80
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$297.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.00
|
| Rate for Payer: PHP Commercial |
$316.20
|
| Rate for Payer: Priority Health SBD |
$234.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.80
|
| Rate for Payer: UHC Core |
$193.81
|
| Rate for Payer: UHC Exchange |
$146.20
|
| Rate for Payer: UMR Bronson Commercial |
$137.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.00
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
OP
|
$323.52
|
|
|
Service Code
|
NDC 13668045301
|
| Hospital Charge Code |
20446
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$291.17 |
| Rate for Payer: Aetna American Axle |
$210.29
|
| Rate for Payer: Aetna Commercial |
$274.99
|
| Rate for Payer: Aetna Medicare |
$161.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.29
|
| Rate for Payer: BCBS Complete |
$129.41
|
| Rate for Payer: Cash Price |
$258.82
|
| Rate for Payer: Cofinity Advantage |
$226.46
|
| Rate for Payer: Cofinity Commercial |
$278.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.82
|
| Rate for Payer: Healthscope Commercial |
$291.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.64
|
| Rate for Payer: PHP Commercial |
$274.99
|
| Rate for Payer: Priority Health SBD |
$203.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.29
|
| Rate for Payer: UHC Core |
$168.55
|
| Rate for Payer: UHC Exchange |
$127.14
|
| Rate for Payer: UMR Bronson Commercial |
$119.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.64
|
|
|
ANAGRELIDE 0.5 MG CAPSULE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
NDC 00172524160
|
| 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 Advantage |
$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 Commercial |
$316.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.00
|
| Rate for Payer: PHP Commercial |
$316.20
|
| 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
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$800.29
|
|
|
Service Code
|
NDC 66658023407
|
| Hospital Charge Code |
31784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$720.26 |
| Rate for Payer: Aetna American Axle |
$520.19
|
| Rate for Payer: Aetna Commercial |
$680.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.19
|
| Rate for Payer: Cash Price |
$640.23
|
| Rate for Payer: Cofinity Advantage |
$560.20
|
| Rate for Payer: Cofinity Commercial |
$688.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.23
|
| Rate for Payer: Healthscope Commercial |
$720.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.22
|
| Rate for Payer: PHP Commercial |
$680.25
|
| Rate for Payer: Priority Health SBD |
$504.18
|
| Rate for Payer: UMR Bronson Commercial |
$352.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.22
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$800.29
|
|
|
Service Code
|
NDC 66658023401
|
| Hospital Charge Code |
31784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$720.26 |
| Rate for Payer: Aetna American Axle |
$520.19
|
| Rate for Payer: Aetna Commercial |
$680.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.19
|
| Rate for Payer: Cash Price |
$640.23
|
| Rate for Payer: Cofinity Advantage |
$560.20
|
| Rate for Payer: Cofinity Commercial |
$688.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.23
|
| Rate for Payer: Healthscope Commercial |
$720.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.22
|
| Rate for Payer: PHP Commercial |
$680.25
|
| Rate for Payer: Priority Health SBD |
$504.18
|
| Rate for Payer: UMR Bronson Commercial |
$352.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.22
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$800.29
|
|
|
Service Code
|
NDC 66658023401
|
| Hospital Charge Code |
31784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$296.11 |
| Max. Negotiated Rate |
$720.26 |
| Rate for Payer: Aetna American Axle |
$520.19
|
| Rate for Payer: Aetna Commercial |
$680.25
|
| Rate for Payer: Aetna Medicare |
$400.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.19
|
| Rate for Payer: BCBS Complete |
$320.12
|
| Rate for Payer: Cash Price |
$640.23
|
| Rate for Payer: Cofinity Advantage |
$560.20
|
| Rate for Payer: Cofinity Commercial |
$688.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.23
|
| Rate for Payer: Healthscope Commercial |
$720.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.22
|
| Rate for Payer: PHP Commercial |
$680.25
|
| Rate for Payer: Priority Health SBD |
$504.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.19
|
| Rate for Payer: UHC Core |
$416.95
|
| Rate for Payer: UHC Exchange |
$314.51
|
| Rate for Payer: UMR Bronson Commercial |
$296.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.22
|
|
|
ANAKINRA 100 MG/0.67 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$800.29
|
|
|
Service Code
|
NDC 66658023407
|
| Hospital Charge Code |
31784
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$296.11 |
| Max. Negotiated Rate |
$720.26 |
| Rate for Payer: Aetna American Axle |
$520.19
|
| Rate for Payer: Aetna Commercial |
$680.25
|
| Rate for Payer: Aetna Medicare |
$400.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.19
|
| Rate for Payer: BCBS Complete |
$320.12
|
| Rate for Payer: Cash Price |
$640.23
|
| Rate for Payer: Cofinity Advantage |
$560.20
|
| Rate for Payer: Cofinity Commercial |
$688.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$640.23
|
| Rate for Payer: Healthscope Commercial |
$720.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$560.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$600.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$640.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$680.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$600.22
|
| Rate for Payer: PHP Commercial |
$680.25
|
| Rate for Payer: Priority Health SBD |
$504.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$520.19
|
| Rate for Payer: UHC Core |
$416.95
|
| Rate for Payer: UHC Exchange |
$314.51
|
| Rate for Payer: UMR Bronson Commercial |
$296.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$600.22
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$6,320.80
|
|
|
Service Code
|
APR-DRG 2261
|
| Min. Negotiated Rate |
$6,019.81 |
| Max. Negotiated Rate |
$6,320.80 |
| Rate for Payer: BCBS Complete |
$6,320.80
|
| Rate for Payer: Mclaren Medicaid |
$6,019.81
|
| Rate for Payer: Meridian Medicaid |
$6,320.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,019.81
|
| Rate for Payer: UHC Medicaid |
$6,019.81
|
| Rate for Payer: UHCCP Medicaid |
$6,019.81
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$6,900.10
|
|
|
Service Code
|
APR-DRG 2262
|
| Min. Negotiated Rate |
$6,571.52 |
| Max. Negotiated Rate |
$6,900.10 |
| Rate for Payer: BCBS Complete |
$6,900.10
|
| Rate for Payer: Mclaren Medicaid |
$6,571.52
|
| Rate for Payer: Meridian Medicaid |
$6,900.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,571.52
|
| Rate for Payer: UHC Medicaid |
$6,571.52
|
| Rate for Payer: UHCCP Medicaid |
$6,571.52
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$12,803.23
|
|
|
Service Code
|
APR-DRG 2263
|
| Min. Negotiated Rate |
$12,193.55 |
| Max. Negotiated Rate |
$12,803.23 |
| Rate for Payer: BCBS Complete |
$12,803.23
|
| Rate for Payer: Mclaren Medicaid |
$12,193.55
|
| Rate for Payer: Meridian Medicaid |
$12,803.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,193.55
|
| Rate for Payer: UHC Medicaid |
$12,193.55
|
| Rate for Payer: UHCCP Medicaid |
$12,193.55
|
|
|
ANAL AND PERINEAL PROCEDURES
|
Facility
|
IP
|
$20,749.33
|
|
|
Service Code
|
APR-DRG 2264
|
| Min. Negotiated Rate |
$19,761.27 |
| Max. Negotiated Rate |
$20,749.33 |
| Rate for Payer: BCBS Complete |
$20,749.33
|
| Rate for Payer: Mclaren Medicaid |
$19,761.27
|
| Rate for Payer: Meridian Medicaid |
$20,749.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,761.27
|
| Rate for Payer: UHC Medicaid |
$19,761.27
|
| Rate for Payer: UHCCP Medicaid |
$19,761.27
|
|
