|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.87 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Advantage |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.41
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: UMR Bronson Commercial |
$95.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$657.83
|
|
|
Service Code
|
NDC 00078093926
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$592.05 |
| Rate for Payer: Aetna American Axle |
$427.59
|
| Rate for Payer: Aetna Commercial |
$559.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.59
|
| Rate for Payer: Cash Price |
$526.26
|
| Rate for Payer: Cofinity Advantage |
$460.48
|
| Rate for Payer: Cofinity Commercial |
$565.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.26
|
| Rate for Payer: Healthscope Commercial |
$592.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.37
|
| Rate for Payer: PHP Commercial |
$559.16
|
| Rate for Payer: Priority Health SBD |
$414.43
|
| Rate for Payer: UMR Bronson Commercial |
$289.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.37
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$217.88
|
|
|
Service Code
|
NDC 60505058204
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.62 |
| Max. Negotiated Rate |
$196.09 |
| Rate for Payer: Aetna American Axle |
$141.62
|
| Rate for Payer: Aetna Commercial |
$185.20
|
| Rate for Payer: Aetna Medicare |
$108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.62
|
| Rate for Payer: BCBS Complete |
$87.15
|
| Rate for Payer: Cash Price |
$174.30
|
| Rate for Payer: Cofinity Advantage |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$187.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.30
|
| Rate for Payer: Healthscope Commercial |
$196.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.41
|
| Rate for Payer: PHP Commercial |
$185.20
|
| Rate for Payer: Priority Health SBD |
$137.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.62
|
| Rate for Payer: UHC Core |
$113.52
|
| Rate for Payer: UHC Exchange |
$85.63
|
| Rate for Payer: UMR Bronson Commercial |
$80.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.41
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$37.77
|
|
|
Service Code
|
NDC 72266015801
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$33.99 |
| Rate for Payer: Aetna American Axle |
$24.55
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna Medicare |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.55
|
| Rate for Payer: BCBS Complete |
$15.11
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Advantage |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$32.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$33.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.33
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$19.68
|
| Rate for Payer: UHC Exchange |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.33
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$37.77
|
|
|
Service Code
|
NDC 72266015801
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.62 |
| Max. Negotiated Rate |
$33.99 |
| Rate for Payer: Aetna American Axle |
$24.55
|
| Rate for Payer: Aetna Commercial |
$32.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.55
|
| Rate for Payer: Cash Price |
$30.22
|
| Rate for Payer: Cofinity Advantage |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$32.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.22
|
| Rate for Payer: Healthscope Commercial |
$33.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.33
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: Priority Health SBD |
$23.80
|
| Rate for Payer: UMR Bronson Commercial |
$16.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.33
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$38.99
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cofinity Advantage |
$27.29
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.24
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.34
|
| Rate for Payer: UHC Core |
$20.31
|
| Rate for Payer: UHC Exchange |
$15.32
|
| Rate for Payer: UMR Bronson Commercial |
$14.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.24
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Aetna American Axle |
$70.82
|
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna Medicare |
$54.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.82
|
| Rate for Payer: BCBS Complete |
$43.58
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Advantage |
$76.27
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.72
|
| Rate for Payer: PHP Commercial |
$92.62
|
| Rate for Payer: Priority Health SBD |
$68.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.82
|
| Rate for Payer: UHC Core |
$56.77
|
| Rate for Payer: UHC Exchange |
$42.82
|
| Rate for Payer: UMR Bronson Commercial |
$40.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.72
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$91.91
|
|
|
Service Code
|
NDC 00781713593
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$82.72 |
| Rate for Payer: Aetna American Axle |
$59.74
|
| Rate for Payer: Aetna Commercial |
$78.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.74
|
| Rate for Payer: Cash Price |
$73.53
|
| Rate for Payer: Cofinity Advantage |
$64.34
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.53
|
| Rate for Payer: Healthscope Commercial |
$82.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.93
|
| Rate for Payer: PHP Commercial |
$78.12
|
| Rate for Payer: Priority Health SBD |
$57.90
|
| Rate for Payer: UMR Bronson Commercial |
$40.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.93
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$108.96
|
|
|
Service Code
|
NDC 65862084003
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.94 |
| Max. Negotiated Rate |
$98.06 |
| Rate for Payer: Aetna American Axle |
$70.82
|
| Rate for Payer: Aetna Commercial |
$92.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.82
|
| Rate for Payer: Cash Price |
$87.17
|
| Rate for Payer: Cofinity Advantage |
$76.27
|
| Rate for Payer: Cofinity Commercial |
$93.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.17
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.72
|
| Rate for Payer: PHP Commercial |
$92.62
|
| Rate for Payer: Priority Health SBD |
$68.64
|
| Rate for Payer: UMR Bronson Commercial |
$47.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.72
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
IP
|
$38.99
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$35.09 |
| Rate for Payer: Aetna American Axle |
$25.34
|
| Rate for Payer: Aetna Commercial |
$33.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.34
|
| Rate for Payer: Cash Price |
$31.19
|
| Rate for Payer: Cofinity Advantage |
$27.29
|
| Rate for Payer: Cofinity Commercial |
$33.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.19
|
| Rate for Payer: Healthscope Commercial |
$35.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.24
|
| Rate for Payer: PHP Commercial |
$33.14
|
| Rate for Payer: Priority Health SBD |
$24.56
|
| Rate for Payer: UMR Bronson Commercial |
$17.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.24
|
|
|
MOXIFLOXACIN 0.5 % EYE DROPS
|
Facility
|
OP
|
$657.83
|
|
|
Service Code
|
NDC 00078093926
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.40 |
| Max. Negotiated Rate |
$592.05 |
| Rate for Payer: Aetna American Axle |
$427.59
|
| Rate for Payer: Aetna Commercial |
$559.16
|
| Rate for Payer: Aetna Medicare |
$328.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.59
|
| Rate for Payer: BCBS Complete |
$263.13
|
| Rate for Payer: Cash Price |
$526.26
|
| Rate for Payer: Cofinity Advantage |
$460.48
|
| Rate for Payer: Cofinity Commercial |
$565.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.26
|
| Rate for Payer: Healthscope Commercial |
$592.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$526.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$493.37
|
| Rate for Payer: PHP Commercial |
$559.16
|
| Rate for Payer: Priority Health SBD |
$414.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.59
|
| Rate for Payer: UHC Core |
$342.73
|
| Rate for Payer: UHC Exchange |
$258.53
|
| Rate for Payer: UMR Bronson Commercial |
$243.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.37
|
|
|
MOXIFLOXACIN 400 MG TABLET
|
Facility
|
OP
|
$248.53
|
|
|
Service Code
|
NDC 72205000130
|
| Hospital Charge Code |
26854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.96 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna American Axle |
$161.54
|
| Rate for Payer: Aetna Commercial |
$211.25
|
| Rate for Payer: Aetna Medicare |
$124.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.54
|
| Rate for Payer: BCBS Complete |
$99.41
|
| Rate for Payer: Cash Price |
$198.82
|
| Rate for Payer: Cofinity Advantage |
$173.97
|
| Rate for Payer: Cofinity Commercial |
$213.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.82
|
| Rate for Payer: Healthscope Commercial |
$223.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$198.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.40
|
| Rate for Payer: PHP Commercial |
$211.25
|
| Rate for Payer: Priority Health SBD |
$156.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.54
|
| Rate for Payer: UHC Core |
$129.48
|
| Rate for Payer: UHC Exchange |
$97.67
|
| Rate for Payer: UMR Bronson Commercial |
$91.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.40
|
|
|
MOXIFLOXACIN 400 MG TABLET
|
Facility
|
IP
|
$248.53
|
|
|
Service Code
|
NDC 72205000130
|
| Hospital Charge Code |
26854
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.35 |
| Max. Negotiated Rate |
$223.68 |
| Rate for Payer: Aetna American Axle |
$161.54
|
| Rate for Payer: Aetna Commercial |
$211.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.54
|
| Rate for Payer: Cash Price |
$198.82
|
| Rate for Payer: Cofinity Advantage |
$173.97
|
| Rate for Payer: Cofinity Commercial |
$213.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.82
|
| Rate for Payer: Healthscope Commercial |
$223.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$173.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.40
|
| Rate for Payer: PHP Commercial |
$211.25
|
| Rate for Payer: Priority Health SBD |
$156.57
|
| Rate for Payer: UMR Bronson Commercial |
$109.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.40
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$19,451.51
|
|
|
Service Code
|
APR-DRG 2991
|
| Min. Negotiated Rate |
$18,525.25 |
| Max. Negotiated Rate |
$19,451.51 |
| Rate for Payer: BCBS Complete |
$19,451.51
|
| Rate for Payer: Mclaren Medicaid |
$18,525.25
|
| Rate for Payer: Meridian Medicaid |
$19,451.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,525.25
|
| Rate for Payer: UHC Medicaid |
$18,525.25
|
| Rate for Payer: UHCCP Medicaid |
$18,525.25
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$23,484.79
|
|
|
Service Code
|
APR-DRG 2992
|
| Min. Negotiated Rate |
$22,366.47 |
| Max. Negotiated Rate |
$23,484.79 |
| Rate for Payer: BCBS Complete |
$23,484.79
|
| Rate for Payer: Mclaren Medicaid |
$22,366.47
|
| Rate for Payer: Meridian Medicaid |
$23,484.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,366.47
|
| Rate for Payer: UHC Medicaid |
$22,366.47
|
| Rate for Payer: UHCCP Medicaid |
$22,366.47
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$32,413.94
|
|
|
Service Code
|
APR-DRG 2993
|
| Min. Negotiated Rate |
$30,870.42 |
| Max. Negotiated Rate |
$32,413.94 |
| Rate for Payer: BCBS Complete |
$32,413.94
|
| Rate for Payer: Mclaren Medicaid |
$30,870.42
|
| Rate for Payer: Meridian Medicaid |
$32,413.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$30,870.42
|
| Rate for Payer: UHC Medicaid |
$30,870.42
|
| Rate for Payer: UHCCP Medicaid |
$30,870.42
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL
|
Facility
|
IP
|
$42,686.31
|
|
|
Service Code
|
APR-DRG 2994
|
| Min. Negotiated Rate |
$40,653.63 |
| Max. Negotiated Rate |
$42,686.31 |
| Rate for Payer: BCBS Complete |
$42,686.31
|
| Rate for Payer: Mclaren Medicaid |
$40,653.63
|
| Rate for Payer: Meridian Medicaid |
$42,686.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$40,653.63
|
| Rate for Payer: UHC Medicaid |
$40,653.63
|
| Rate for Payer: UHCCP Medicaid |
$40,653.63
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH CC
|
Facility
|
IP
|
$117,663.18
|
|
|
Service Code
|
MSDRG 427
|
| Min. Negotiated Rate |
$57,911.90 |
| Max. Negotiated Rate |
$117,663.18 |
| Rate for Payer: Aetna Medicare |
$63,398.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76,199.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76,199.88
|
| Rate for Payer: BCBS MAPPO |
$60,959.90
|
| Rate for Payer: BCBS Trust/PPO |
$106,207.92
|
| Rate for Payer: BCN Commercial |
$106,207.92
|
| Rate for Payer: BCN Medicare Advantage |
$60,959.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60,959.90
|
| Rate for Payer: Mclaren Medicare |
$60,959.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64,007.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70,103.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$67,055.89
|
| Rate for Payer: Nomi Health Commercial |
$93,119.94
|
| Rate for Payer: PACE Medicare |
$57,911.90
|
| Rate for Payer: PACE SWMI |
$60,959.90
|
| Rate for Payer: PHP Medicare Advantage |
$60,959.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$116,379.28
|
| Rate for Payer: Priority Health Medicare |
$60,959.90
|
| Rate for Payer: Priority Health Tiered Network |
$93,103.41
|
| Rate for Payer: Railroad Medicare Medicare |
$60,959.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117,663.18
|
| Rate for Payer: UHC Core |
$98,440.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60,959.90
|
| Rate for Payer: UHC Exchange |
$80,393.55
|
| Rate for Payer: VA VA |
$60,959.90
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$179,645.56
|
|
|
Service Code
|
MSDRG 426
|
| Min. Negotiated Rate |
$88,121.90 |
| Max. Negotiated Rate |
$179,645.56 |
| Rate for Payer: Aetna Medicare |
$96,470.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$115,949.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$115,949.86
|
| Rate for Payer: BCBS MAPPO |
$92,759.89
|
| Rate for Payer: BCBS Trust/PPO |
$158,864.43
|
| Rate for Payer: BCN Commercial |
$158,864.43
|
| Rate for Payer: BCN Medicare Advantage |
$92,759.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92,759.89
|
| Rate for Payer: Mclaren Medicare |
$92,759.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97,397.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$106,673.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$102,035.88
|
| Rate for Payer: Nomi Health Commercial |
$142,173.48
|
| Rate for Payer: PACE Medicare |
$88,121.90
|
| Rate for Payer: PACE SWMI |
$92,759.89
|
| Rate for Payer: PHP Medicare Advantage |
$92,759.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177,685.33
|
| Rate for Payer: Priority Health Medicare |
$92,759.89
|
| Rate for Payer: Priority Health Tiered Network |
$142,148.24
|
| Rate for Payer: Railroad Medicare Medicare |
$92,759.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179,645.56
|
| Rate for Payer: UHC Core |
$150,296.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92,759.89
|
| Rate for Payer: UHC Exchange |
$122,743.10
|
| Rate for Payer: VA VA |
$92,759.89
|
|
|
MULTIPLE LEVEL COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION EXCEPT CERVICAL WITHOUT CC/MCC
|
Facility
|
IP
|
$91,638.60
|
|
|
Service Code
|
MSDRG 428
|
| Min. Negotiated Rate |
$45,227.62 |
| Max. Negotiated Rate |
$91,638.60 |
| Rate for Payer: Aetna Medicare |
$49,512.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,510.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,510.03
|
| Rate for Payer: BCBS MAPPO |
$47,608.02
|
| Rate for Payer: BCBS Trust/PPO |
$89,361.24
|
| Rate for Payer: BCN Commercial |
$89,361.24
|
| Rate for Payer: BCN Medicare Advantage |
$47,608.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,608.02
|
| Rate for Payer: Mclaren Medicare |
$47,608.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,988.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,749.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$52,368.82
|
| Rate for Payer: Nomi Health Commercial |
$72,523.80
|
| Rate for Payer: PACE Medicare |
$45,227.62
|
| Rate for Payer: PACE SWMI |
$47,608.02
|
| Rate for Payer: PHP Medicare Advantage |
$47,608.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90,638.67
|
| Rate for Payer: Priority Health Medicare |
$47,608.02
|
| Rate for Payer: Priority Health Tiered Network |
$72,510.93
|
| Rate for Payer: Railroad Medicare Medicare |
$47,608.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91,638.60
|
| Rate for Payer: UHC Core |
$76,667.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47,608.02
|
| Rate for Payer: UHC Exchange |
$62,612.21
|
| Rate for Payer: VA VA |
$47,608.02
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITH MCC OR CUSTOM-MADE ANATOMICALLY DESIGNED INTERBODY FUSION DEVICE
|
Facility
|
IP
|
$113,987.53
|
|
|
Service Code
|
MSDRG 447
|
| Min. Negotiated Rate |
$53,645.68 |
| Max. Negotiated Rate |
$113,987.53 |
| Rate for Payer: Aetna Medicare |
$58,727.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,586.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,586.43
|
| Rate for Payer: BCBS MAPPO |
$56,469.14
|
| Rate for Payer: BCBS Trust/PPO |
$113,987.53
|
| Rate for Payer: BCN Commercial |
$113,987.53
|
| Rate for Payer: BCN Medicare Advantage |
$56,469.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,469.14
|
| Rate for Payer: Mclaren Medicare |
$56,469.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,292.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,939.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$62,116.05
|
| Rate for Payer: Nomi Health Commercial |
$86,192.64
|
| Rate for Payer: PACE Medicare |
$53,645.68
|
| Rate for Payer: PACE SWMI |
$56,469.14
|
| Rate for Payer: PHP Medicare Advantage |
$56,469.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107,721.69
|
| Rate for Payer: Priority Health Medicare |
$56,469.14
|
| Rate for Payer: Priority Health Tiered Network |
$86,177.34
|
| Rate for Payer: Railroad Medicare Medicare |
$56,469.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108,910.08
|
| Rate for Payer: UHC Core |
$91,116.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,469.14
|
| Rate for Payer: UHC Exchange |
$74,412.98
|
| Rate for Payer: VA VA |
$56,469.14
|
|
|
MULTIPLE LEVEL SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC
|
Facility
|
IP
|
$72,355.35
|
|
|
Service Code
|
MSDRG 448
|
| Min. Negotiated Rate |
$34,254.61 |
| Max. Negotiated Rate |
$72,355.35 |
| Rate for Payer: Aetna Medicare |
$37,499.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,071.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,071.85
|
| Rate for Payer: BCBS MAPPO |
$36,057.48
|
| Rate for Payer: BCBS Trust/PPO |
$72,355.35
|
| Rate for Payer: BCN Commercial |
$72,355.35
|
| Rate for Payer: BCN Medicare Advantage |
$36,057.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,057.48
|
| Rate for Payer: Mclaren Medicare |
$36,057.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37,860.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,466.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$39,663.23
|
| Rate for Payer: Nomi Health Commercial |
$54,706.32
|
| Rate for Payer: PACE Medicare |
$34,254.61
|
| Rate for Payer: PACE SWMI |
$36,057.48
|
| Rate for Payer: PHP Medicare Advantage |
$36,057.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$68,370.77
|
| Rate for Payer: Priority Health Medicare |
$36,057.48
|
| Rate for Payer: Priority Health Tiered Network |
$54,696.61
|
| Rate for Payer: Railroad Medicare Medicare |
$36,057.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,125.04
|
| Rate for Payer: UHC Core |
$57,831.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$36,057.48
|
| Rate for Payer: UHC Exchange |
$47,229.79
|
| Rate for Payer: VA VA |
$36,057.48
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$31,826.69
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$10,421.73 |
| Max. Negotiated Rate |
$31,826.69 |
| Rate for Payer: Aetna Medicare |
$11,409.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,712.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,712.80
|
| Rate for Payer: BCBS MAPPO |
$10,970.24
|
| Rate for Payer: BCBS Trust/PPO |
$31,826.69
|
| Rate for Payer: BCN Commercial |
$31,826.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,970.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,970.24
|
| Rate for Payer: Mclaren Medicare |
$10,970.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,518.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,615.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,067.26
|
| Rate for Payer: Nomi Health Commercial |
$16,007.61
|
| Rate for Payer: PACE Medicare |
$10,421.73
|
| Rate for Payer: PACE SWMI |
$10,970.24
|
| Rate for Payer: PHP Medicare Advantage |
$10,970.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,005.96
|
| Rate for Payer: Priority Health Medicare |
$10,970.24
|
| Rate for Payer: Priority Health Tiered Network |
$16,004.77
|
| Rate for Payer: Railroad Medicare Medicare |
$10,970.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,226.67
|
| Rate for Payer: UHC Core |
$16,922.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,970.24
|
| Rate for Payer: UHC Exchange |
$13,819.90
|
| Rate for Payer: VA VA |
$10,970.24
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$33,215.71
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$14,144.55 |
| Max. Negotiated Rate |
$33,215.71 |
| Rate for Payer: Aetna Medicare |
$15,484.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,611.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,611.25
|
| Rate for Payer: BCBS MAPPO |
$14,889.00
|
| Rate for Payer: BCBS Trust/PPO |
$33,215.71
|
| Rate for Payer: BCN Commercial |
$33,215.71
|
| Rate for Payer: BCN Medicare Advantage |
$14,889.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,889.00
|
| Rate for Payer: Mclaren Medicare |
$14,889.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,633.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,122.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,377.90
|
| Rate for Payer: Nomi Health Commercial |
$22,052.55
|
| Rate for Payer: PACE Medicare |
$14,144.55
|
| Rate for Payer: PACE SWMI |
$14,889.00
|
| Rate for Payer: PHP Medicare Advantage |
$14,889.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,560.80
|
| Rate for Payer: Priority Health Medicare |
$14,889.00
|
| Rate for Payer: Priority Health Tiered Network |
$22,048.64
|
| Rate for Payer: Railroad Medicare Medicare |
$14,889.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,864.85
|
| Rate for Payer: UHC Core |
$23,312.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,889.00
|
| Rate for Payer: UHC Exchange |
$19,038.70
|
| Rate for Payer: VA VA |
$14,889.00
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$20,986.29
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$7,870.73 |
| Max. Negotiated Rate |
$20,986.29 |
| Rate for Payer: Aetna Medicare |
$8,616.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,356.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,356.23
|
| Rate for Payer: BCBS MAPPO |
$8,284.98
|
| Rate for Payer: BCBS Trust/PPO |
$20,986.29
|
| Rate for Payer: BCN Commercial |
$20,986.29
|
| Rate for Payer: BCN Medicare Advantage |
$8,284.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,284.98
|
| Rate for Payer: Mclaren Medicare |
$8,284.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,699.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,527.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,113.48
|
| Rate for Payer: Nomi Health Commercial |
$11,865.42
|
| Rate for Payer: PACE Medicare |
$7,870.73
|
| Rate for Payer: PACE SWMI |
$8,284.98
|
| Rate for Payer: PHP Medicare Advantage |
$8,284.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,829.14
|
| Rate for Payer: Priority Health Medicare |
$8,284.98
|
| Rate for Payer: Priority Health Tiered Network |
$11,863.31
|
| Rate for Payer: Railroad Medicare Medicare |
$8,284.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,992.74
|
| Rate for Payer: UHC Core |
$12,543.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,284.98
|
| Rate for Payer: UHC Exchange |
$10,243.81
|
| Rate for Payer: VA VA |
$8,284.98
|
|
