|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$22,176.69
|
|
|
Service Code
|
APR-DRG 4434
|
| Min. Negotiated Rate |
$21,120.65 |
| Max. Negotiated Rate |
$22,176.69 |
| Rate for Payer: BCBS Complete |
$22,176.69
|
| Rate for Payer: Mclaren Medicaid |
$21,120.65
|
| Rate for Payer: Meridian Medicaid |
$22,176.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,120.65
|
| Rate for Payer: UHC Medicaid |
$21,120.65
|
| Rate for Payer: UHCCP Medicaid |
$21,120.65
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$11,124.66
|
|
|
Service Code
|
APR-DRG 4432
|
| Min. Negotiated Rate |
$10,594.92 |
| Max. Negotiated Rate |
$11,124.66 |
| Rate for Payer: BCBS Complete |
$11,124.66
|
| Rate for Payer: Mclaren Medicaid |
$10,594.92
|
| Rate for Payer: Meridian Medicaid |
$11,124.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,594.92
|
| Rate for Payer: UHC Medicaid |
$10,594.92
|
| Rate for Payer: UHCCP Medicaid |
$10,594.92
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$9,662.20
|
|
|
Service Code
|
APR-DRG 4431
|
| Min. Negotiated Rate |
$9,202.09 |
| Max. Negotiated Rate |
$9,662.20 |
| Rate for Payer: BCBS Complete |
$9,662.20
|
| Rate for Payer: Mclaren Medicaid |
$9,202.09
|
| Rate for Payer: Meridian Medicaid |
$9,662.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,202.09
|
| Rate for Payer: UHC Medicaid |
$9,202.09
|
| Rate for Payer: UHCCP Medicaid |
$9,202.09
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$19,495.70
|
|
|
Service Code
|
MSDRG 695
|
| Min. Negotiated Rate |
$9,650.31 |
| Max. Negotiated Rate |
$19,495.70 |
| Rate for Payer: Aetna Medicare |
$10,564.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,697.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,697.77
|
| Rate for Payer: BCBS MAPPO |
$10,158.22
|
| Rate for Payer: BCBS Trust/PPO |
$19,495.70
|
| Rate for Payer: BCN Commercial |
$19,495.70
|
| Rate for Payer: BCN Medicare Advantage |
$10,158.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,158.22
|
| Rate for Payer: Mclaren Medicare |
$10,158.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,666.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,681.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,174.04
|
| Rate for Payer: Nomi Health Commercial |
$14,755.02
|
| Rate for Payer: PACE Medicare |
$9,650.31
|
| Rate for Payer: PACE SWMI |
$10,158.22
|
| Rate for Payer: PHP Medicare Advantage |
$10,158.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,440.50
|
| Rate for Payer: Priority Health Medicare |
$10,158.22
|
| Rate for Payer: Priority Health Tiered Network |
$14,752.40
|
| Rate for Payer: Railroad Medicare Medicare |
$10,158.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,643.94
|
| Rate for Payer: UHC Core |
$15,598.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,158.22
|
| Rate for Payer: UHC Exchange |
$12,738.50
|
| Rate for Payer: VA VA |
$10,158.22
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$11,230.70
|
|
|
Service Code
|
MSDRG 696
|
| Min. Negotiated Rate |
$6,037.13 |
| Max. Negotiated Rate |
$11,230.70 |
| Rate for Payer: Aetna Medicare |
$6,609.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,943.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,943.59
|
| Rate for Payer: BCBS MAPPO |
$6,354.87
|
| Rate for Payer: BCBS Trust/PPO |
$10,736.09
|
| Rate for Payer: BCN Commercial |
$10,736.09
|
| Rate for Payer: BCN Medicare Advantage |
$6,354.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,354.87
|
| Rate for Payer: Mclaren Medicare |
$6,354.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,672.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,308.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,990.36
|
| Rate for Payer: Nomi Health Commercial |
$8,888.10
|
| Rate for Payer: PACE Medicare |
$6,037.13
|
| Rate for Payer: PACE SWMI |
$6,354.87
|
| Rate for Payer: PHP Medicare Advantage |
$6,354.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,108.15
|
| Rate for Payer: Priority Health Medicare |
$6,354.87
|
| Rate for Payer: Priority Health Tiered Network |
$8,886.52
|
| Rate for Payer: Railroad Medicare Medicare |
$6,354.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,230.70
|
| Rate for Payer: UHC Core |
$9,395.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,354.87
|
| Rate for Payer: UHC Exchange |
$7,673.39
|
| Rate for Payer: VA VA |
$6,354.87
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$167,742.08
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$26,220.28 |
| Max. Negotiated Rate |
$167,742.08 |
| Rate for Payer: Aetna Medicare |
$28,704.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,500.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,500.36
|
| Rate for Payer: BCBS MAPPO |
$27,600.29
|
| Rate for Payer: BCBS Trust/PPO |
$167,742.08
|
| Rate for Payer: BCN Commercial |
$167,742.08
|
| Rate for Payer: BCN Medicare Advantage |
$27,600.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,600.29
|
| Rate for Payer: Mclaren Medicare |
$27,600.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,980.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,740.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,360.32
|
| Rate for Payer: Nomi Health Commercial |
$41,660.55
|
| Rate for Payer: PACE Medicare |
$26,220.28
|
| Rate for Payer: PACE SWMI |
$27,600.29
|
| Rate for Payer: PHP Medicare Advantage |
$27,600.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,066.45
|
| Rate for Payer: Priority Health Medicare |
$27,600.29
|
| Rate for Payer: Priority Health Tiered Network |
$41,653.15
|
| Rate for Payer: Railroad Medicare Medicare |
$27,600.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,640.85
|
| Rate for Payer: UHC Core |
$44,040.69
|
| Rate for Payer: UHC Exchange |
$35,966.94
|
| Rate for Payer: VA VA |
$27,600.29
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$210,796.23
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$37,913.87 |
| Max. Negotiated Rate |
$210,796.23 |
| Rate for Payer: Aetna Medicare |
$41,505.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49,886.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49,886.68
|
| Rate for Payer: BCBS MAPPO |
$39,909.34
|
| Rate for Payer: BCBS Trust/PPO |
$210,796.23
|
| Rate for Payer: BCN Commercial |
$210,796.23
|
| Rate for Payer: BCN Medicare Advantage |
$39,909.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39,909.34
|
| Rate for Payer: Mclaren Medicare |
$39,909.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41,904.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45,895.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$43,900.27
|
| Rate for Payer: Nomi Health Commercial |
$60,648.06
|
| Rate for Payer: PACE Medicare |
$37,913.87
|
| Rate for Payer: PACE SWMI |
$39,909.34
|
| Rate for Payer: PHP Medicare Advantage |
$39,909.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75,796.63
|
| Rate for Payer: Priority Health Medicare |
$39,909.34
|
| Rate for Payer: Priority Health Tiered Network |
$60,637.29
|
| Rate for Payer: Railroad Medicare Medicare |
$39,909.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76,632.82
|
| Rate for Payer: UHC Core |
$64,112.99
|
| Rate for Payer: UHC Exchange |
$52,359.49
|
| Rate for Payer: VA VA |
$39,909.34
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$134,581.27
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$30,004.27 |
| Max. Negotiated Rate |
$134,581.27 |
| Rate for Payer: Aetna Medicare |
$32,846.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,479.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,479.30
|
| Rate for Payer: BCBS MAPPO |
$31,583.44
|
| Rate for Payer: BCBS Trust/PPO |
$134,581.27
|
| Rate for Payer: BCN Commercial |
$134,581.27
|
| Rate for Payer: BCN Medicare Advantage |
$31,583.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,583.44
|
| Rate for Payer: Mclaren Medicare |
$31,583.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,162.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,320.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,741.78
|
| Rate for Payer: Nomi Health Commercial |
$47,804.82
|
| Rate for Payer: PACE Medicare |
$30,004.27
|
| Rate for Payer: PACE SWMI |
$31,583.44
|
| Rate for Payer: PHP Medicare Advantage |
$31,583.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,745.43
|
| Rate for Payer: Priority Health Medicare |
$31,583.44
|
| Rate for Payer: Priority Health Tiered Network |
$47,796.33
|
| Rate for Payer: Railroad Medicare Medicare |
$31,583.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60,404.54
|
| Rate for Payer: UHC Core |
$50,535.99
|
| Rate for Payer: UHC Exchange |
$41,271.49
|
| Rate for Payer: VA VA |
$31,583.44
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$12,976.35
|
|
|
Service Code
|
APR-DRG 3132
|
| Min. Negotiated Rate |
$12,358.43 |
| Max. Negotiated Rate |
$12,976.35 |
| Rate for Payer: BCBS Complete |
$12,976.35
|
| Rate for Payer: Mclaren Medicaid |
$12,358.43
|
| Rate for Payer: Meridian Medicaid |
$12,976.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,358.43
|
| Rate for Payer: UHC Medicaid |
$12,358.43
|
| Rate for Payer: UHCCP Medicaid |
$12,358.43
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$26,110.69
|
|
|
Service Code
|
APR-DRG 3134
|
| Min. Negotiated Rate |
$24,867.33 |
| Max. Negotiated Rate |
$26,110.69 |
| Rate for Payer: BCBS Complete |
$26,110.69
|
| Rate for Payer: Mclaren Medicaid |
$24,867.33
|
| Rate for Payer: Meridian Medicaid |
$26,110.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,867.33
|
| Rate for Payer: UHC Medicaid |
$24,867.33
|
| Rate for Payer: UHCCP Medicaid |
$24,867.33
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$10,252.39
|
|
|
Service Code
|
APR-DRG 3131
|
| Min. Negotiated Rate |
$9,764.18 |
| Max. Negotiated Rate |
$10,252.39 |
| Rate for Payer: BCBS Complete |
$10,252.39
|
| Rate for Payer: Mclaren Medicaid |
$9,764.18
|
| Rate for Payer: Meridian Medicaid |
$10,252.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,764.18
|
| Rate for Payer: UHC Medicaid |
$9,764.18
|
| Rate for Payer: UHCCP Medicaid |
$9,764.18
|
|
|
KNEE AND LOWER LEG PROCEDURES EXCEPT FOOT
|
Facility
|
IP
|
$15,636.76
|
|
|
Service Code
|
APR-DRG 3133
|
| Min. Negotiated Rate |
$14,892.15 |
| Max. Negotiated Rate |
$15,636.76 |
| Rate for Payer: BCBS Complete |
$15,636.76
|
| Rate for Payer: Mclaren Medicaid |
$14,892.15
|
| Rate for Payer: Meridian Medicaid |
$15,636.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,892.15
|
| Rate for Payer: UHC Medicaid |
$14,892.15
|
| Rate for Payer: UHCCP Medicaid |
$14,892.15
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC
|
Facility
|
IP
|
$35,222.38
|
|
|
Service Code
|
MSDRG 488
|
| Min. Negotiated Rate |
$14,616.46 |
| Max. Negotiated Rate |
$35,222.38 |
| Rate for Payer: Aetna Medicare |
$16,001.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,232.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,232.19
|
| Rate for Payer: BCBS MAPPO |
$15,385.75
|
| Rate for Payer: BCBS Trust/PPO |
$35,222.38
|
| Rate for Payer: BCN Commercial |
$35,222.38
|
| Rate for Payer: BCN Medicare Advantage |
$15,385.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,385.75
|
| Rate for Payer: Mclaren Medicare |
$15,385.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,155.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,693.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,924.33
|
| Rate for Payer: Nomi Health Commercial |
$19,654.44
|
| Rate for Payer: PACE Medicare |
$14,616.46
|
| Rate for Payer: PACE SWMI |
$15,385.75
|
| Rate for Payer: PHP Medicare Advantage |
$15,385.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,518.45
|
| Rate for Payer: Priority Health Medicare |
$15,385.75
|
| Rate for Payer: Priority Health Tiered Network |
$22,814.76
|
| Rate for Payer: Railroad Medicare Medicare |
$15,385.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,834.68
|
| Rate for Payer: UHC Core |
$20,777.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,385.75
|
| Rate for Payer: UHC Exchange |
$16,968.33
|
| Rate for Payer: VA VA |
$15,385.75
|
|
|
KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$22,551.00
|
|
|
Service Code
|
MSDRG 489
|
| Min. Negotiated Rate |
$9,435.81 |
| Max. Negotiated Rate |
$22,551.00 |
| Rate for Payer: Aetna Medicare |
$10,329.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,415.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,415.54
|
| Rate for Payer: BCBS MAPPO |
$9,932.43
|
| Rate for Payer: BCBS Trust/PPO |
$22,551.00
|
| Rate for Payer: BCN Commercial |
$22,551.00
|
| Rate for Payer: BCN Medicare Advantage |
$9,932.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,932.43
|
| Rate for Payer: Mclaren Medicare |
$9,932.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,429.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,422.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,925.67
|
| Rate for Payer: Nomi Health Commercial |
$14,406.72
|
| Rate for Payer: PACE Medicare |
$9,435.81
|
| Rate for Payer: PACE SWMI |
$9,932.43
|
| Rate for Payer: PHP Medicare Advantage |
$9,932.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,005.21
|
| Rate for Payer: Priority Health Medicare |
$9,932.43
|
| Rate for Payer: Priority Health Tiered Network |
$14,404.16
|
| Rate for Payer: Railroad Medicare Medicare |
$9,932.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,203.84
|
| Rate for Payer: UHC Core |
$15,229.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,932.43
|
| Rate for Payer: UHC Exchange |
$12,437.80
|
| Rate for Payer: VA VA |
$9,932.43
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC
|
Facility
|
IP
|
$36,965.52
|
|
|
Service Code
|
MSDRG 486
|
| Min. Negotiated Rate |
$17,176.19 |
| Max. Negotiated Rate |
$36,965.52 |
| Rate for Payer: Aetna Medicare |
$18,803.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,600.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,600.25
|
| Rate for Payer: BCBS MAPPO |
$18,080.20
|
| Rate for Payer: BCBS Trust/PPO |
$36,965.52
|
| Rate for Payer: BCN Commercial |
$36,965.52
|
| Rate for Payer: BCN Medicare Advantage |
$18,080.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,080.20
|
| Rate for Payer: Mclaren Medicare |
$18,080.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,984.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,792.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,888.22
|
| Rate for Payer: Nomi Health Commercial |
$26,975.19
|
| Rate for Payer: PACE Medicare |
$17,176.19
|
| Rate for Payer: PACE SWMI |
$18,080.20
|
| Rate for Payer: PHP Medicare Advantage |
$18,080.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33,713.01
|
| Rate for Payer: Priority Health Medicare |
$18,080.20
|
| Rate for Payer: Priority Health Tiered Network |
$26,970.40
|
| Rate for Payer: Railroad Medicare Medicare |
$18,080.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,084.93
|
| Rate for Payer: UHC Core |
$28,516.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,080.20
|
| Rate for Payer: UHC Exchange |
$23,288.58
|
| Rate for Payer: VA VA |
$18,080.20
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC
|
Facility
|
IP
|
$55,659.65
|
|
|
Service Code
|
MSDRG 485
|
| Min. Negotiated Rate |
$26,201.21 |
| Max. Negotiated Rate |
$55,659.65 |
| Rate for Payer: Aetna Medicare |
$28,683.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,475.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,475.28
|
| Rate for Payer: BCBS MAPPO |
$27,580.22
|
| Rate for Payer: BCBS Trust/PPO |
$55,659.65
|
| Rate for Payer: BCN Commercial |
$55,659.65
|
| Rate for Payer: BCN Medicare Advantage |
$27,580.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,580.22
|
| Rate for Payer: Mclaren Medicare |
$27,580.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,959.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,717.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,338.24
|
| Rate for Payer: Nomi Health Commercial |
$41,629.59
|
| Rate for Payer: PACE Medicare |
$26,201.21
|
| Rate for Payer: PACE SWMI |
$27,580.22
|
| Rate for Payer: PHP Medicare Advantage |
$27,580.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$52,027.76
|
| Rate for Payer: Priority Health Medicare |
$27,580.22
|
| Rate for Payer: Priority Health Tiered Network |
$41,622.20
|
| Rate for Payer: Railroad Medicare Medicare |
$27,580.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,601.73
|
| Rate for Payer: UHC Core |
$44,007.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,580.22
|
| Rate for Payer: UHC Exchange |
$35,940.21
|
| Rate for Payer: VA VA |
$27,580.22
|
|
|
KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$28,840.02
|
|
|
Service Code
|
MSDRG 487
|
| Min. Negotiated Rate |
$13,006.10 |
| Max. Negotiated Rate |
$28,840.02 |
| Rate for Payer: Aetna Medicare |
$14,238.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,113.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,113.29
|
| Rate for Payer: BCBS MAPPO |
$13,690.63
|
| Rate for Payer: BCBS Trust/PPO |
$28,840.02
|
| Rate for Payer: BCN Commercial |
$28,840.02
|
| Rate for Payer: BCN Medicare Advantage |
$13,690.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,690.63
|
| Rate for Payer: Mclaren Medicare |
$13,690.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,375.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,744.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,059.69
|
| Rate for Payer: Nomi Health Commercial |
$20,203.98
|
| Rate for Payer: PACE Medicare |
$13,006.10
|
| Rate for Payer: PACE SWMI |
$13,690.63
|
| Rate for Payer: PHP Medicare Advantage |
$13,690.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25,250.50
|
| Rate for Payer: Priority Health Medicare |
$13,690.63
|
| Rate for Payer: Priority Health Tiered Network |
$20,200.39
|
| Rate for Payer: Railroad Medicare Medicare |
$13,690.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,529.06
|
| Rate for Payer: UHC Core |
$21,358.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,690.63
|
| Rate for Payer: UHC Exchange |
$17,442.77
|
| Rate for Payer: VA VA |
$13,690.63
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$221.35
|
|
|
Service Code
|
NDC 00904710961
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.39 |
| Max. Negotiated Rate |
$199.22 |
| Rate for Payer: Aetna American Axle |
$143.88
|
| Rate for Payer: Aetna Commercial |
$188.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.88
|
| Rate for Payer: Cash Price |
$177.08
|
| Rate for Payer: Cofinity Advantage |
$154.94
|
| Rate for Payer: Cofinity Commercial |
$190.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.08
|
| Rate for Payer: Healthscope Commercial |
$199.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.01
|
| Rate for Payer: PHP Commercial |
$188.15
|
| Rate for Payer: Priority Health SBD |
$139.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.01
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 00904745161
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UMR Bronson Commercial |
$149.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.07
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$373.35
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.14 |
| Max. Negotiated Rate |
$336.01 |
| Rate for Payer: Aetna American Axle |
$242.68
|
| Rate for Payer: Aetna Commercial |
$317.35
|
| Rate for Payer: Aetna Medicare |
$186.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.68
|
| Rate for Payer: BCBS Complete |
$149.34
|
| Rate for Payer: Cash Price |
$298.68
|
| Rate for Payer: Cofinity Advantage |
$261.35
|
| Rate for Payer: Cofinity Commercial |
$321.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.68
|
| Rate for Payer: Healthscope Commercial |
$336.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$298.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.01
|
| Rate for Payer: PHP Commercial |
$317.35
|
| Rate for Payer: Priority Health SBD |
$235.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.68
|
| Rate for Payer: UHC Core |
$194.52
|
| Rate for Payer: UHC Exchange |
$146.73
|
| Rate for Payer: UMR Bronson Commercial |
$138.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.01
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$362.90
|
|
|
Service Code
|
NDC 49884012201
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.27 |
| Max. Negotiated Rate |
$326.61 |
| Rate for Payer: Aetna American Axle |
$235.88
|
| Rate for Payer: Aetna Commercial |
$308.46
|
| Rate for Payer: Aetna Medicare |
$181.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.88
|
| Rate for Payer: BCBS Complete |
$145.16
|
| Rate for Payer: Cash Price |
$290.32
|
| Rate for Payer: Cofinity Advantage |
$254.03
|
| Rate for Payer: Cofinity Commercial |
$312.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.32
|
| Rate for Payer: Healthscope Commercial |
$326.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.18
|
| Rate for Payer: PHP Commercial |
$308.46
|
| Rate for Payer: Priority Health SBD |
$228.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.88
|
| Rate for Payer: UHC Core |
$189.07
|
| Rate for Payer: UHC Exchange |
$142.62
|
| Rate for Payer: UMR Bronson Commercial |
$134.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.18
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
NDC 51079092801
|
| 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 Advantage |
$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 |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.43
|
| 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 |
$2.15
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
NDC 51079092801
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Aetna American Axle |
$1.86
|
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.86
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: Cash Price |
$2.29
|
| Rate for Payer: Cofinity Advantage |
$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 |
$2.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.43
|
| Rate for Payer: Priority Health SBD |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.86
|
| Rate for Payer: UHC Core |
$1.49
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UMR Bronson Commercial |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
IP
|
$373.35
|
|
|
Service Code
|
NDC 60687043901
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.27 |
| Max. Negotiated Rate |
$336.01 |
| Rate for Payer: Aetna American Axle |
$242.68
|
| Rate for Payer: Aetna Commercial |
$317.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.68
|
| Rate for Payer: Cash Price |
$298.68
|
| Rate for Payer: Cofinity Advantage |
$261.35
|
| Rate for Payer: Cofinity Commercial |
$321.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$298.68
|
| Rate for Payer: Healthscope Commercial |
$336.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$261.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$280.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$280.01
|
| Rate for Payer: PHP Commercial |
$317.35
|
| Rate for Payer: Priority Health SBD |
$235.21
|
| Rate for Payer: UMR Bronson Commercial |
$164.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$280.01
|
|
|
LABETALOL 100 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 00904745161
|
| Hospital Charge Code |
10373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna Medicare |
$170.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: BCBS Complete |
$136.04
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.06
|
| Rate for Payer: UHC Core |
$177.19
|
| Rate for Payer: UHC Exchange |
$133.66
|
| Rate for Payer: UMR Bronson Commercial |
$125.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.07
|
|
