|
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$35,183.11
|
|
|
Service Code
|
MS-DRG 658
|
| Min. Negotiated Rate |
$11,324.33 |
| Max. Negotiated Rate |
$35,183.11 |
| Rate for Payer: Aetna Medicare |
$12,397.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,900.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,900.44
|
| Rate for Payer: BCBS MAPPO |
$11,920.35
|
| Rate for Payer: BCBS Trust/PPO |
$35,183.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,920.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,920.35
|
| Rate for Payer: Mclaren Medicare |
$11,920.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,516.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,708.40
|
| Rate for Payer: PACE Medicare |
$11,324.33
|
| Rate for Payer: PACE SWMI |
$11,920.35
|
| Rate for Payer: PHP Medicare Advantage |
$11,920.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,243.62
|
| Rate for Payer: Priority Health Medicare |
$11,920.35
|
| Rate for Payer: Priority Health Narrow Network |
$16,994.90
|
| Rate for Payer: Railroad Medicare Medicare |
$11,920.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,582.02
|
| Rate for Payer: UHC Core |
$18,516.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,920.35
|
| Rate for Payer: UHC Exchange |
$14,721.10
|
| Rate for Payer: UHC Medicare Advantage |
$12,277.96
|
| Rate for Payer: VA VA |
$11,920.35
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC
|
Facility
|
IP
|
$22,570.87
|
|
|
Service Code
|
MS-DRG 660
|
| Min. Negotiated Rate |
$10,339.70 |
| Max. Negotiated Rate |
$22,570.87 |
| Rate for Payer: Aetna Medicare |
$11,319.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,604.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,604.88
|
| Rate for Payer: BCBS MAPPO |
$10,883.90
|
| Rate for Payer: BCBS Trust/PPO |
$22,570.87
|
| Rate for Payer: BCN Medicare Advantage |
$10,883.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,883.90
|
| Rate for Payer: Mclaren Medicare |
$10,883.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,428.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,516.48
|
| Rate for Payer: PACE Medicare |
$10,339.70
|
| Rate for Payer: PACE SWMI |
$10,883.90
|
| Rate for Payer: PHP Medicare Advantage |
$10,883.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,313.56
|
| Rate for Payer: Priority Health Medicare |
$10,883.90
|
| Rate for Payer: Priority Health Narrow Network |
$15,450.85
|
| Rate for Payer: Railroad Medicare Medicare |
$10,883.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,530.36
|
| Rate for Payer: UHC Core |
$16,834.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,883.90
|
| Rate for Payer: UHC Exchange |
$13,383.63
|
| Rate for Payer: UHC Medicare Advantage |
$11,210.42
|
| Rate for Payer: VA VA |
$10,883.90
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC
|
Facility
|
IP
|
$39,491.08
|
|
|
Service Code
|
MS-DRG 659
|
| Min. Negotiated Rate |
$19,439.37 |
| Max. Negotiated Rate |
$39,491.08 |
| Rate for Payer: Aetna Medicare |
$21,280.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,578.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,578.11
|
| Rate for Payer: BCBS MAPPO |
$20,462.49
|
| Rate for Payer: BCBS Trust/PPO |
$36,813.99
|
| Rate for Payer: BCN Medicare Advantage |
$20,462.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,462.49
|
| Rate for Payer: Mclaren Medicare |
$20,462.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,485.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,531.86
|
| Rate for Payer: PACE Medicare |
$19,439.37
|
| Rate for Payer: PACE SWMI |
$20,462.49
|
| Rate for Payer: PHP Medicare Advantage |
$20,462.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,150.51
|
| Rate for Payer: Priority Health Medicare |
$20,462.49
|
| Rate for Payer: Priority Health Narrow Network |
$29,720.41
|
| Rate for Payer: Railroad Medicare Medicare |
$20,462.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,491.08
|
| Rate for Payer: UHC Core |
$32,381.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,462.49
|
| Rate for Payer: UHC Exchange |
$25,744.02
|
| Rate for Payer: UHC Medicare Advantage |
$21,076.36
|
| Rate for Payer: VA VA |
$20,462.49
|
|
|
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC
|
Facility
|
IP
|
$20,912.35
|
|
|
Service Code
|
MS-DRG 661
|
| Min. Negotiated Rate |
$8,161.79 |
| Max. Negotiated Rate |
$20,912.35 |
| Rate for Payer: Aetna Medicare |
$8,935.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,739.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,739.20
|
| Rate for Payer: BCBS MAPPO |
$8,591.36
|
| Rate for Payer: BCBS Trust/PPO |
$20,912.35
|
| Rate for Payer: BCN Medicare Advantage |
$8,591.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,591.36
|
| Rate for Payer: Mclaren Medicare |
$8,591.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,020.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,880.06
|
| Rate for Payer: PACE Medicare |
$8,161.79
|
| Rate for Payer: PACE SWMI |
$8,591.36
|
| Rate for Payer: PHP Medicare Advantage |
$8,591.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,044.46
|
| Rate for Payer: Priority Health Medicare |
$8,591.36
|
| Rate for Payer: Priority Health Narrow Network |
$12,035.57
|
| Rate for Payer: Railroad Medicare Medicare |
$8,591.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,992.29
|
| Rate for Payer: UHC Core |
$13,113.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,591.36
|
| Rate for Payer: UHC Exchange |
$10,425.29
|
| Rate for Payer: UHC Medicare Advantage |
$8,849.10
|
| Rate for Payer: VA VA |
$8,591.36
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC
|
Facility
|
IP
|
$18,379.35
|
|
|
Service Code
|
MS-DRG 689
|
| Min. Negotiated Rate |
$9,084.20 |
| Max. Negotiated Rate |
$18,379.35 |
| Rate for Payer: Aetna Medicare |
$9,944.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,952.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,952.90
|
| Rate for Payer: BCBS MAPPO |
$9,562.32
|
| Rate for Payer: BCBS Trust/PPO |
$18,379.35
|
| Rate for Payer: BCN Medicare Advantage |
$9,562.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,562.32
|
| Rate for Payer: Mclaren Medicare |
$9,562.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,040.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,996.67
|
| Rate for Payer: PACE Medicare |
$9,084.20
|
| Rate for Payer: PACE SWMI |
$9,562.32
|
| Rate for Payer: PHP Medicare Advantage |
$9,562.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,852.55
|
| Rate for Payer: Priority Health Medicare |
$9,562.32
|
| Rate for Payer: Priority Health Narrow Network |
$13,482.04
|
| Rate for Payer: Railroad Medicare Medicare |
$9,562.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,914.30
|
| Rate for Payer: UHC Core |
$14,689.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,562.32
|
| Rate for Payer: UHC Exchange |
$11,678.23
|
| Rate for Payer: UHC Medicare Advantage |
$9,849.19
|
| Rate for Payer: VA VA |
$9,562.32
|
|
|
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$12,308.45
|
|
|
Service Code
|
MS-DRG 690
|
| Min. Negotiated Rate |
$6,393.82 |
| Max. Negotiated Rate |
$12,308.45 |
| Rate for Payer: Aetna Medicare |
$6,999.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,412.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,412.92
|
| Rate for Payer: BCBS MAPPO |
$6,730.34
|
| Rate for Payer: BCBS Trust/PPO |
$11,612.11
|
| Rate for Payer: BCN Medicare Advantage |
$6,730.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,730.34
|
| Rate for Payer: Mclaren Medicare |
$6,730.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,066.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,739.89
|
| Rate for Payer: PACE Medicare |
$6,393.82
|
| Rate for Payer: PACE SWMI |
$6,730.34
|
| Rate for Payer: PHP Medicare Advantage |
$6,730.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,578.95
|
| Rate for Payer: Priority Health Medicare |
$6,730.34
|
| Rate for Payer: Priority Health Narrow Network |
$9,263.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6,730.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,308.45
|
| Rate for Payer: UHC Core |
$10,092.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,730.34
|
| Rate for Payer: UHC Exchange |
$8,023.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,932.25
|
| Rate for Payer: VA VA |
$6,730.34
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC
|
Facility
|
IP
|
$20,872.15
|
|
|
Service Code
|
MS-DRG 687
|
| Min. Negotiated Rate |
$8,139.09 |
| Max. Negotiated Rate |
$20,872.15 |
| Rate for Payer: Aetna Medicare |
$8,910.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,709.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,709.32
|
| Rate for Payer: BCBS MAPPO |
$8,567.46
|
| Rate for Payer: BCBS Trust/PPO |
$20,872.15
|
| Rate for Payer: BCN Medicare Advantage |
$8,567.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,567.46
|
| Rate for Payer: Mclaren Medicare |
$8,567.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,995.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,852.58
|
| Rate for Payer: PACE Medicare |
$8,139.09
|
| Rate for Payer: PACE SWMI |
$8,567.46
|
| Rate for Payer: PHP Medicare Advantage |
$8,567.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,999.97
|
| Rate for Payer: Priority Health Medicare |
$8,567.46
|
| Rate for Payer: Priority Health Narrow Network |
$11,999.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8,567.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,945.01
|
| Rate for Payer: UHC Core |
$13,074.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,567.46
|
| Rate for Payer: UHC Exchange |
$10,394.46
|
| Rate for Payer: UHC Medicare Advantage |
$8,824.48
|
| Rate for Payer: VA VA |
$8,567.46
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC
|
Facility
|
IP
|
$49,524.23
|
|
|
Service Code
|
MS-DRG 686
|
| Min. Negotiated Rate |
$13,952.49 |
| Max. Negotiated Rate |
$49,524.23 |
| Rate for Payer: Aetna Medicare |
$15,274.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,358.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,358.54
|
| Rate for Payer: BCBS MAPPO |
$14,686.83
|
| Rate for Payer: BCBS Trust/PPO |
$49,524.23
|
| Rate for Payer: BCN Medicare Advantage |
$14,686.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,686.83
|
| Rate for Payer: Mclaren Medicare |
$14,686.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,421.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,889.85
|
| Rate for Payer: PACE Medicare |
$13,952.49
|
| Rate for Payer: PACE SWMI |
$14,686.83
|
| Rate for Payer: PHP Medicare Advantage |
$14,686.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,395.24
|
| Rate for Payer: Priority Health Medicare |
$14,686.83
|
| Rate for Payer: Priority Health Narrow Network |
$21,116.19
|
| Rate for Payer: Railroad Medicare Medicare |
$14,686.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,058.21
|
| Rate for Payer: UHC Core |
$23,007.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,686.83
|
| Rate for Payer: UHC Exchange |
$18,290.99
|
| Rate for Payer: UHC Medicare Advantage |
$15,127.43
|
| Rate for Payer: VA VA |
$14,686.83
|
|
|
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,193.26
|
|
|
Service Code
|
MS-DRG 688
|
| Min. Negotiated Rate |
$6,203.49 |
| Max. Negotiated Rate |
$17,193.26 |
| Rate for Payer: Aetna Medicare |
$6,791.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,162.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,162.49
|
| Rate for Payer: BCBS MAPPO |
$6,529.99
|
| Rate for Payer: BCBS Trust/PPO |
$17,193.26
|
| Rate for Payer: BCN Medicare Advantage |
$6,529.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,529.99
|
| Rate for Payer: Mclaren Medicare |
$6,529.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,856.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,509.49
|
| Rate for Payer: PACE Medicare |
$6,203.49
|
| Rate for Payer: PACE SWMI |
$6,529.99
|
| Rate for Payer: PHP Medicare Advantage |
$6,529.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,205.85
|
| Rate for Payer: Priority Health Medicare |
$6,529.99
|
| Rate for Payer: Priority Health Narrow Network |
$8,964.68
|
| Rate for Payer: Railroad Medicare Medicare |
$6,529.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,911.85
|
| Rate for Payer: UHC Core |
$9,767.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,529.99
|
| Rate for Payer: UHC Exchange |
$7,765.27
|
| Rate for Payer: UHC Medicare Advantage |
$6,725.89
|
| Rate for Payer: VA VA |
$6,529.99
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$18,243.78
|
|
|
Service Code
|
MS-DRG 695
|
| Min. Negotiated Rate |
$9,242.32 |
| Max. Negotiated Rate |
$18,243.78 |
| Rate for Payer: Aetna Medicare |
$10,117.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,160.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,160.95
|
| Rate for Payer: BCBS MAPPO |
$9,728.76
|
| Rate for Payer: BCBS Trust/PPO |
$17,846.62
|
| Rate for Payer: BCN Medicare Advantage |
$9,728.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,728.76
|
| Rate for Payer: Mclaren Medicare |
$9,728.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,215.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,188.07
|
| Rate for Payer: PACE Medicare |
$9,242.32
|
| Rate for Payer: PACE SWMI |
$9,728.76
|
| Rate for Payer: PHP Medicare Advantage |
$9,728.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,162.50
|
| Rate for Payer: Priority Health Medicare |
$9,728.76
|
| Rate for Payer: Priority Health Narrow Network |
$13,730.00
|
| Rate for Payer: Railroad Medicare Medicare |
$9,728.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,243.78
|
| Rate for Payer: UHC Core |
$14,959.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,728.76
|
| Rate for Payer: UHC Exchange |
$11,893.02
|
| Rate for Payer: UHC Medicare Advantage |
$10,020.62
|
| Rate for Payer: VA VA |
$9,728.76
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$10,557.29
|
|
|
Service Code
|
MS-DRG 696
|
| Min. Negotiated Rate |
$5,553.42 |
| Max. Negotiated Rate |
$10,557.29 |
| Rate for Payer: Aetna Medicare |
$6,079.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,307.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,307.12
|
| Rate for Payer: BCBS MAPPO |
$5,845.70
|
| Rate for Payer: BCBS Trust/PPO |
$9,827.95
|
| Rate for Payer: BCN Medicare Advantage |
$5,845.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,845.70
|
| Rate for Payer: Mclaren Medicare |
$5,845.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,137.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,722.56
|
| Rate for Payer: PACE Medicare |
$5,553.42
|
| Rate for Payer: PACE SWMI |
$5,845.70
|
| Rate for Payer: PHP Medicare Advantage |
$5,845.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,931.58
|
| Rate for Payer: Priority Health Medicare |
$5,845.70
|
| Rate for Payer: Priority Health Narrow Network |
$7,945.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,845.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,557.29
|
| Rate for Payer: UHC Core |
$8,656.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,845.70
|
| Rate for Payer: UHC Exchange |
$6,882.24
|
| Rate for Payer: UHC Medicare Advantage |
$6,021.07
|
| Rate for Payer: VA VA |
$5,845.70
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$153,553.27
|
|
|
Service Code
|
MS-DRG 652
|
| Min. Negotiated Rate |
$22,481.14 |
| Max. Negotiated Rate |
$153,553.27 |
| Rate for Payer: Aetna Medicare |
$24,610.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,580.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,580.45
|
| Rate for Payer: BCBS MAPPO |
$23,664.36
|
| Rate for Payer: BCBS Trust/PPO |
$153,553.27
|
| Rate for Payer: BCN Medicare Advantage |
$23,664.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,664.36
|
| Rate for Payer: Mclaren Medicare |
$23,664.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,847.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,214.01
|
| Rate for Payer: PACE Medicare |
$22,481.14
|
| Rate for Payer: PACE SWMI |
$23,664.36
|
| Rate for Payer: PHP Medicare Advantage |
$23,664.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,112.90
|
| Rate for Payer: Priority Health Medicare |
$23,664.36
|
| Rate for Payer: Priority Health Narrow Network |
$34,490.32
|
| Rate for Payer: Railroad Medicare Medicare |
$23,664.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,829.12
|
| Rate for Payer: UHC Core |
$37,579.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,664.36
|
| Rate for Payer: UHC Exchange |
$29,875.75
|
| Rate for Payer: UHC Medicare Advantage |
$24,374.29
|
| Rate for Payer: VA VA |
$23,664.36
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$192,965.59
|
|
|
Service Code
|
MS-DRG 650
|
| Min. Negotiated Rate |
$33,411.72 |
| Max. Negotiated Rate |
$192,965.59 |
| Rate for Payer: Aetna Medicare |
$36,577.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,962.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,962.79
|
| Rate for Payer: BCBS MAPPO |
$35,170.23
|
| Rate for Payer: BCBS Trust/PPO |
$192,965.59
|
| Rate for Payer: BCN Medicare Advantage |
$35,170.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,170.23
|
| Rate for Payer: Mclaren Medicare |
$35,170.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,928.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,445.76
|
| Rate for Payer: PACE Medicare |
$33,411.72
|
| Rate for Payer: PACE SWMI |
$35,170.23
|
| Rate for Payer: PHP Medicare Advantage |
$35,170.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64,538.77
|
| Rate for Payer: Priority Health Medicare |
$35,170.23
|
| Rate for Payer: Priority Health Narrow Network |
$51,631.02
|
| Rate for Payer: Railroad Medicare Medicare |
$35,170.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,604.87
|
| Rate for Payer: UHC Core |
$56,254.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$35,170.23
|
| Rate for Payer: UHC Exchange |
$44,723.14
|
| Rate for Payer: UHC Medicare Advantage |
$36,225.34
|
| Rate for Payer: VA VA |
$35,170.23
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$123,197.44
|
|
|
Service Code
|
MS-DRG 651
|
| Min. Negotiated Rate |
$25,804.76 |
| Max. Negotiated Rate |
$123,197.44 |
| Rate for Payer: Aetna Medicare |
$28,249.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,953.62
|
| Rate for Payer: BCBS MAPPO |
$27,162.90
|
| Rate for Payer: BCBS Trust/PPO |
$123,197.44
|
| Rate for Payer: BCN Medicare Advantage |
$27,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,162.90
|
| Rate for Payer: Mclaren Medicare |
$27,162.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,521.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,237.34
|
| Rate for Payer: PACE Medicare |
$25,804.76
|
| Rate for Payer: PACE SWMI |
$27,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$27,162.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,627.76
|
| Rate for Payer: Priority Health Medicare |
$27,162.90
|
| Rate for Payer: Priority Health Narrow Network |
$39,702.21
|
| Rate for Payer: Railroad Medicare Medicare |
$27,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,754.43
|
| Rate for Payer: UHC Core |
$43,257.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,162.90
|
| Rate for Payer: UHC Exchange |
$34,390.33
|
| Rate for Payer: UHC Medicare Advantage |
$27,977.79
|
| Rate for Payer: VA VA |
$27,162.90
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$45,053.78
|
|
|
Service Code
|
MS-DRG 488
|
| Min. Negotiated Rate |
$15,908.59 |
| Max. Negotiated Rate |
$45,053.78 |
| Rate for Payer: Aetna Medicare |
$17,415.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,932.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,932.35
|
| Rate for Payer: BCBS MAPPO |
$16,745.88
|
| Rate for Payer: BCBS Trust/PPO |
$45,053.78
|
| Rate for Payer: BCN Medicare Advantage |
$16,745.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,745.88
|
| Rate for Payer: Mclaren Medicare |
$16,745.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,583.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,257.76
|
| Rate for Payer: PACE Medicare |
$15,908.59
|
| Rate for Payer: PACE SWMI |
$16,745.88
|
| Rate for Payer: PHP Medicare Advantage |
$16,745.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,229.54
|
| Rate for Payer: Priority Health Medicare |
$16,745.88
|
| Rate for Payer: Priority Health Narrow Network |
$24,183.63
|
| Rate for Payer: Railroad Medicare Medicare |
$16,745.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,134.08
|
| Rate for Payer: UHC Core |
$26,349.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,745.88
|
| Rate for Payer: UHC Exchange |
$20,948.03
|
| Rate for Payer: UHC Medicare Advantage |
$17,248.26
|
| Rate for Payer: VA VA |
$16,745.88
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,601.56
|
|
|
Service Code
|
MS-DRG 489
|
| Min. Negotiated Rate |
$9,547.60 |
| Max. Negotiated Rate |
$26,601.56 |
| Rate for Payer: Aetna Medicare |
$10,452.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,562.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,562.64
|
| Rate for Payer: BCBS MAPPO |
$10,050.11
|
| Rate for Payer: BCBS Trust/PPO |
$26,601.56
|
| Rate for Payer: BCN Medicare Advantage |
$10,050.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,050.11
|
| Rate for Payer: Mclaren Medicare |
$10,050.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,552.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,557.63
|
| Rate for Payer: PACE Medicare |
$9,547.60
|
| Rate for Payer: PACE SWMI |
$10,050.11
|
| Rate for Payer: PHP Medicare Advantage |
$10,050.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,760.90
|
| Rate for Payer: Priority Health Medicare |
$10,050.11
|
| Rate for Payer: Priority Health Narrow Network |
$14,208.72
|
| Rate for Payer: Railroad Medicare Medicare |
$10,050.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,879.88
|
| Rate for Payer: UHC Core |
$15,481.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,050.11
|
| Rate for Payer: UHC Exchange |
$12,307.69
|
| Rate for Payer: UHC Medicare Advantage |
$10,351.61
|
| Rate for Payer: VA VA |
$10,050.11
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$34,009.59
|
|
|
Service Code
|
MS-DRG 486
|
| Min. Negotiated Rate |
$15,188.97 |
| Max. Negotiated Rate |
$34,009.59 |
| Rate for Payer: Aetna Medicare |
$16,627.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,985.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,985.49
|
| Rate for Payer: BCBS MAPPO |
$15,988.39
|
| Rate for Payer: BCBS Trust/PPO |
$34,009.59
|
| Rate for Payer: BCN Medicare Advantage |
$15,988.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,988.39
|
| Rate for Payer: Mclaren Medicare |
$15,988.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,787.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,386.65
|
| Rate for Payer: PACE Medicare |
$15,188.97
|
| Rate for Payer: PACE SWMI |
$15,988.39
|
| Rate for Payer: PHP Medicare Advantage |
$15,988.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,818.94
|
| Rate for Payer: Priority Health Medicare |
$15,988.39
|
| Rate for Payer: Priority Health Narrow Network |
$23,055.15
|
| Rate for Payer: Railroad Medicare Medicare |
$15,988.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30,634.61
|
| Rate for Payer: UHC Core |
$25,119.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,988.39
|
| Rate for Payer: UHC Exchange |
$19,970.54
|
| Rate for Payer: UHC Medicare Advantage |
$16,468.04
|
| Rate for Payer: VA VA |
$15,988.39
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$50,933.97
|
|
|
Service Code
|
MS-DRG 485
|
| Min. Negotiated Rate |
$24,601.24 |
| Max. Negotiated Rate |
$50,933.97 |
| Rate for Payer: Aetna Medicare |
$26,931.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,370.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,370.05
|
| Rate for Payer: BCBS MAPPO |
$25,896.04
|
| Rate for Payer: BCBS Trust/PPO |
$50,933.97
|
| Rate for Payer: BCN Medicare Advantage |
$25,896.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,896.04
|
| Rate for Payer: Mclaren Medicare |
$25,896.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,190.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,780.45
|
| Rate for Payer: PACE Medicare |
$24,601.24
|
| Rate for Payer: PACE SWMI |
$25,896.04
|
| Rate for Payer: PHP Medicare Advantage |
$25,896.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47,268.64
|
| Rate for Payer: Priority Health Medicare |
$25,896.04
|
| Rate for Payer: Priority Health Narrow Network |
$37,814.91
|
| Rate for Payer: Railroad Medicare Medicare |
$25,896.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,246.68
|
| Rate for Payer: UHC Core |
$41,201.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,896.04
|
| Rate for Payer: UHC Exchange |
$32,755.54
|
| Rate for Payer: UHC Medicare Advantage |
$26,672.92
|
| Rate for Payer: VA VA |
$25,896.04
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,850.34
|
|
|
Service Code
|
MS-DRG 487
|
| Min. Negotiated Rate |
$11,796.53 |
| Max. Negotiated Rate |
$26,850.34 |
| Rate for Payer: Aetna Medicare |
$12,914.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,521.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,521.75
|
| Rate for Payer: BCBS MAPPO |
$12,417.40
|
| Rate for Payer: BCBS Trust/PPO |
$26,850.34
|
| Rate for Payer: BCN Medicare Advantage |
$12,417.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,417.40
|
| Rate for Payer: Mclaren Medicare |
$12,417.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,038.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,280.01
|
| Rate for Payer: PACE Medicare |
$11,796.53
|
| Rate for Payer: PACE SWMI |
$12,417.40
|
| Rate for Payer: PHP Medicare Advantage |
$12,417.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,169.19
|
| Rate for Payer: Priority Health Medicare |
$12,417.40
|
| Rate for Payer: Priority Health Narrow Network |
$17,735.35
|
| Rate for Payer: Railroad Medicare Medicare |
$12,417.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,565.90
|
| Rate for Payer: UHC Core |
$19,323.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,417.40
|
| Rate for Payer: UHC Exchange |
$15,362.49
|
| Rate for Payer: UHC Medicare Advantage |
$12,789.92
|
| Rate for Payer: VA VA |
$12,417.40
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$359.10
|
|
|
Service Code
|
NDC 49884-122-01
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$323.19 |
| Rate for Payer: Aetna American Axle |
$233.42
|
| Rate for Payer: Aetna Commercial |
$305.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.42
|
| Rate for Payer: Cash Price |
$287.28
|
| Rate for Payer: Cofinity Commercial |
$251.37
|
| Rate for Payer: Cofinity Commercial |
$308.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.28
|
| Rate for Payer: Healthscope Commercial |
$323.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.24
|
| Rate for Payer: PHP Commercial |
$305.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.37
|
| Rate for Payer: Priority Health SBD |
$226.23
|
| Rate for Payer: UMR Bronson Commercial |
$158.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.32
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 68382-798-01
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 51079-928-01
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna American Axle |
$1.86
|
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.86
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Commercial |
$2.00
|
| Rate for Payer: Cofinity Commercial |
$2.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.29
|
| Rate for Payer: Healthscope Commercial |
$2.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.43
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$216.60
|
|
|
Service Code
|
NDC 0904-7109-61
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$194.94 |
| Rate for Payer: Aetna American Axle |
$140.79
|
| Rate for Payer: Aetna Commercial |
$184.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.79
|
| Rate for Payer: Cash Price |
$173.28
|
| Rate for Payer: Cofinity Commercial |
$151.62
|
| Rate for Payer: Cofinity Commercial |
$186.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.28
|
| Rate for Payer: Healthscope Commercial |
$194.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.11
|
| Rate for Payer: PHP Commercial |
$184.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.62
|
| Rate for Payer: Priority Health SBD |
$136.46
|
| Rate for Payer: UMR Bronson Commercial |
$95.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.45
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$290.70
|
|
|
Service Code
|
NDC 0904-7110-61
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$261.63 |
| Rate for Payer: Aetna American Axle |
$188.96
|
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.96
|
| Rate for Payer: Cash Price |
$232.56
|
| Rate for Payer: Cofinity Commercial |
$203.49
|
| Rate for Payer: Cofinity Commercial |
$250.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.56
|
| Rate for Payer: Healthscope Commercial |
$261.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.10
|
| Rate for Payer: PHP Commercial |
$247.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.49
|
| Rate for Payer: Priority Health SBD |
$183.14
|
| Rate for Payer: UMR Bronson Commercial |
$127.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.02
|
|
|
LABETALOL 200 MG TABLET
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
NDC 51079-929-01
|
| Hospital Charge Code |
10374
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.08
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.27
|
| Rate for Payer: PHP Commercial |
$3.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.89
|
|
