|
MS-DRG 42.00: VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$15,138.78
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$5,943.00 |
| Max. Negotiated Rate |
$15,138.78 |
| Rate for Payer: Aetna Medicare |
$8,613.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,352.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,352.84
|
| Rate for Payer: BCBS MAPPO |
$8,282.27
|
| Rate for Payer: BCBS Trust/PPO |
$14,691.28
|
| Rate for Payer: BCN Commercial |
$14,691.28
|
| Rate for Payer: BCN Medicare Advantage |
$8,282.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,282.27
|
| Rate for Payer: Mclaren Medicare |
$8,282.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,696.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,524.61
|
| Rate for Payer: Nomi Health Commercial |
$12,489.78
|
| Rate for Payer: PACE Medicare |
$7,868.16
|
| Rate for Payer: PACE SWMI |
$8,282.27
|
| Rate for Payer: PHP Medicare Advantage |
$8,282.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,087.17
|
| Rate for Payer: Priority Health Medicare |
$8,282.27
|
| Rate for Payer: Priority Health Narrow Network |
$6,469.74
|
| Rate for Payer: Railroad Medicare Medicare |
$8,282.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,138.78
|
| Rate for Payer: UHC Core |
$12,110.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,282.27
|
| Rate for Payer: UHC Exchange |
$5,943.00
|
| Rate for Payer: UHC Medicare Advantage |
$8,282.27
|
| Rate for Payer: VA VA |
$8,282.27
|
|
|
MS-DRG 42.00: VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$53,469.26
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$21,055.20 |
| Max. Negotiated Rate |
$53,469.26 |
| Rate for Payer: Aetna Medicare |
$23,049.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,704.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,704.21
|
| Rate for Payer: BCBS MAPPO |
$22,163.37
|
| Rate for Payer: BCBS Trust/PPO |
$53,469.26
|
| Rate for Payer: BCN Commercial |
$53,469.26
|
| Rate for Payer: BCN Medicare Advantage |
$22,163.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,163.37
|
| Rate for Payer: Mclaren Medicare |
$22,163.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23,271.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,487.88
|
| Rate for Payer: Nomi Health Commercial |
$34,599.09
|
| Rate for Payer: PACE Medicare |
$21,055.20
|
| Rate for Payer: PACE SWMI |
$22,163.37
|
| Rate for Payer: PHP Medicare Advantage |
$22,163.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,178.99
|
| Rate for Payer: Priority Health Medicare |
$22,163.37
|
| Rate for Payer: Priority Health Narrow Network |
$32,943.20
|
| Rate for Payer: Railroad Medicare Medicare |
$22,163.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,937.32
|
| Rate for Payer: UHC Core |
$33,547.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,163.37
|
| Rate for Payer: UHC Exchange |
$26,670.80
|
| Rate for Payer: UHC Medicare Advantage |
$22,163.37
|
| Rate for Payer: VA VA |
$22,163.37
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$44,986.91
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$16,850.35 |
| Max. Negotiated Rate |
$44,986.91 |
| Rate for Payer: Aetna Medicare |
$18,446.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,171.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,171.51
|
| Rate for Payer: BCBS MAPPO |
$17,737.21
|
| Rate for Payer: BCBS Trust/PPO |
$44,986.91
|
| Rate for Payer: BCN Commercial |
$44,986.91
|
| Rate for Payer: BCN Medicare Advantage |
$17,737.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,737.21
|
| Rate for Payer: Mclaren Medicare |
$17,737.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,624.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,397.79
|
| Rate for Payer: Nomi Health Commercial |
$27,549.24
|
| Rate for Payer: PACE Medicare |
$16,850.35
|
| Rate for Payer: PACE SWMI |
$17,737.21
|
| Rate for Payer: PHP Medicare Advantage |
$17,737.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,789.34
|
| Rate for Payer: Priority Health Medicare |
$17,737.21
|
| Rate for Payer: Priority Health Narrow Network |
$26,231.48
|
| Rate for Payer: Railroad Medicare Medicare |
$17,737.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33,392.24
|
| Rate for Payer: UHC Core |
$26,712.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,737.21
|
| Rate for Payer: UHC Exchange |
$21,236.41
|
| Rate for Payer: UHC Medicare Advantage |
$17,737.21
|
| Rate for Payer: VA VA |
$17,737.21
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$104,858.29
|
|
|
Service Code
|
MSDRG 031
|
| Min. Negotiated Rate |
$32,661.87 |
| Max. Negotiated Rate |
$104,858.29 |
| Rate for Payer: Aetna Medicare |
$35,756.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,976.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,976.15
|
| Rate for Payer: BCBS MAPPO |
$34,380.92
|
| Rate for Payer: BCBS Trust/PPO |
$104,858.29
|
| Rate for Payer: BCN Commercial |
$104,858.29
|
| Rate for Payer: BCN Medicare Advantage |
$34,380.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,380.92
|
| Rate for Payer: Mclaren Medicare |
$34,380.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,099.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,538.06
|
| Rate for Payer: Nomi Health Commercial |
$54,058.74
|
| Rate for Payer: PACE Medicare |
$32,661.87
|
| Rate for Payer: PACE SWMI |
$34,380.92
|
| Rate for Payer: PHP Medicare Advantage |
$34,380.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64,339.58
|
| Rate for Payer: Priority Health Medicare |
$34,380.92
|
| Rate for Payer: Priority Health Narrow Network |
$51,471.68
|
| Rate for Payer: Railroad Medicare Medicare |
$34,380.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65,524.22
|
| Rate for Payer: UHC Core |
$52,416.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,380.92
|
| Rate for Payer: UHC Exchange |
$41,671.33
|
| Rate for Payer: UHC Medicare Advantage |
$34,380.92
|
| Rate for Payer: VA VA |
$34,380.92
|
|
|
MS-DRG 42.00: VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$41,133.46
|
|
|
Service Code
|
MSDRG 033
|
| Min. Negotiated Rate |
$12,694.71 |
| Max. Negotiated Rate |
$41,133.46 |
| Rate for Payer: Aetna Medicare |
$13,897.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,703.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,703.56
|
| Rate for Payer: BCBS MAPPO |
$13,362.85
|
| Rate for Payer: BCBS Trust/PPO |
$41,133.46
|
| Rate for Payer: BCN Commercial |
$41,133.46
|
| Rate for Payer: BCN Medicare Advantage |
$13,362.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,362.85
|
| Rate for Payer: Mclaren Medicare |
$13,362.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,030.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,367.28
|
| Rate for Payer: Nomi Health Commercial |
$20,581.95
|
| Rate for Payer: PACE Medicare |
$12,694.71
|
| Rate for Payer: PACE SWMI |
$13,362.85
|
| Rate for Payer: PHP Medicare Advantage |
$13,362.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,496.43
|
| Rate for Payer: Priority Health Medicare |
$13,362.85
|
| Rate for Payer: Priority Health Narrow Network |
$19,597.14
|
| Rate for Payer: Railroad Medicare Medicare |
$13,362.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,947.24
|
| Rate for Payer: UHC Core |
$19,956.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,362.85
|
| Rate for Payer: UHC Exchange |
$15,865.65
|
| Rate for Payer: UHC Medicare Advantage |
$13,362.85
|
| Rate for Payer: VA VA |
$13,362.85
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITH MCC
|
Facility
|
IP
|
$26,907.98
|
|
|
Service Code
|
MSDRG 865
|
| Min. Negotiated Rate |
$11,774.49 |
| Max. Negotiated Rate |
$26,907.98 |
| Rate for Payer: Aetna Medicare |
$12,889.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,492.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,492.75
|
| Rate for Payer: BCBS MAPPO |
$12,394.20
|
| Rate for Payer: BCBS Trust/PPO |
$26,907.98
|
| Rate for Payer: BCN Commercial |
$26,907.98
|
| Rate for Payer: BCN Medicare Advantage |
$12,394.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,394.20
|
| Rate for Payer: Mclaren Medicare |
$12,394.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,013.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,253.33
|
| Rate for Payer: Nomi Health Commercial |
$19,039.11
|
| Rate for Payer: PACE Medicare |
$11,774.49
|
| Rate for Payer: PACE SWMI |
$12,394.20
|
| Rate for Payer: PHP Medicare Advantage |
$12,394.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,661.57
|
| Rate for Payer: Priority Health Medicare |
$12,394.20
|
| Rate for Payer: Priority Health Narrow Network |
$18,129.26
|
| Rate for Payer: Railroad Medicare Medicare |
$12,394.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,077.17
|
| Rate for Payer: UHC Core |
$18,460.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,394.20
|
| Rate for Payer: UHC Exchange |
$14,676.35
|
| Rate for Payer: UHC Medicare Advantage |
$12,394.20
|
| Rate for Payer: VA VA |
$12,394.20
|
|
|
MS-DRG 42.00: VIRAL ILLNESS WITHOUT MCC
|
Facility
|
IP
|
$13,834.73
|
|
|
Service Code
|
MSDRG 866
|
| Min. Negotiated Rate |
$7,226.46 |
| Max. Negotiated Rate |
$13,834.73 |
| Rate for Payer: Aetna Medicare |
$7,911.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,508.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,508.50
|
| Rate for Payer: BCBS MAPPO |
$7,606.80
|
| Rate for Payer: BCBS Trust/PPO |
$12,124.07
|
| Rate for Payer: BCN Commercial |
$12,124.07
|
| Rate for Payer: BCN Medicare Advantage |
$7,606.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,606.80
|
| Rate for Payer: Mclaren Medicare |
$7,606.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,987.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,747.82
|
| Rate for Payer: Nomi Health Commercial |
$11,413.92
|
| Rate for Payer: PACE Medicare |
$7,226.46
|
| Rate for Payer: PACE SWMI |
$7,606.80
|
| Rate for Payer: PHP Medicare Advantage |
$7,606.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,584.05
|
| Rate for Payer: Priority Health Medicare |
$7,606.80
|
| Rate for Payer: Priority Health Narrow Network |
$10,867.24
|
| Rate for Payer: Railroad Medicare Medicare |
$7,606.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,834.73
|
| Rate for Payer: UHC Core |
$11,067.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,606.80
|
| Rate for Payer: UHC Exchange |
$8,798.45
|
| Rate for Payer: UHC Medicare Advantage |
$7,606.80
|
| Rate for Payer: VA VA |
$7,606.80
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITH CC/MCC
|
Facility
|
IP
|
$26,931.45
|
|
|
Service Code
|
MSDRG 075
|
| Min. Negotiated Rate |
$13,671.11 |
| Max. Negotiated Rate |
$26,931.45 |
| Rate for Payer: Aetna Medicare |
$14,966.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,988.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,988.30
|
| Rate for Payer: BCBS MAPPO |
$14,390.64
|
| Rate for Payer: BCBS Trust/PPO |
$20,302.07
|
| Rate for Payer: BCN Commercial |
$20,302.07
|
| Rate for Payer: BCN Medicare Advantage |
$14,390.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,390.64
|
| Rate for Payer: Mclaren Medicare |
$14,390.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,110.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,549.24
|
| Rate for Payer: Nomi Health Commercial |
$22,218.96
|
| Rate for Payer: PACE Medicare |
$13,671.11
|
| Rate for Payer: PACE SWMI |
$14,390.64
|
| Rate for Payer: PHP Medicare Advantage |
$14,390.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,446.44
|
| Rate for Payer: Priority Health Medicare |
$14,390.64
|
| Rate for Payer: Priority Health Narrow Network |
$21,157.15
|
| Rate for Payer: Railroad Medicare Medicare |
$14,390.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,931.45
|
| Rate for Payer: UHC Core |
$21,543.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,390.64
|
| Rate for Payer: UHC Exchange |
$17,127.55
|
| Rate for Payer: UHC Medicare Advantage |
$14,390.64
|
| Rate for Payer: VA VA |
$14,390.64
|
|
|
MS-DRG 42.00: VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,336.65
|
|
|
Service Code
|
MSDRG 076
|
| Min. Negotiated Rate |
$7,473.46 |
| Max. Negotiated Rate |
$14,336.65 |
| Rate for Payer: Aetna Medicare |
$8,181.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,833.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,833.50
|
| Rate for Payer: BCBS MAPPO |
$7,866.80
|
| Rate for Payer: BCBS Trust/PPO |
$11,745.61
|
| Rate for Payer: BCN Commercial |
$11,745.61
|
| Rate for Payer: BCN Medicare Advantage |
$7,866.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,866.80
|
| Rate for Payer: Mclaren Medicare |
$7,866.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,260.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,046.82
|
| Rate for Payer: Nomi Health Commercial |
$11,828.01
|
| Rate for Payer: PACE Medicare |
$7,473.46
|
| Rate for Payer: PACE SWMI |
$7,866.80
|
| Rate for Payer: PHP Medicare Advantage |
$7,866.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,078.46
|
| Rate for Payer: Priority Health Medicare |
$7,866.80
|
| Rate for Payer: Priority Health Narrow Network |
$11,262.77
|
| Rate for Payer: Railroad Medicare Medicare |
$7,866.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,336.65
|
| Rate for Payer: UHC Core |
$11,468.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,866.80
|
| Rate for Payer: UHC Exchange |
$9,117.65
|
| Rate for Payer: UHC Medicare Advantage |
$7,866.80
|
| Rate for Payer: VA VA |
$7,866.80
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$63,073.77
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$23,105.70 |
| Max. Negotiated Rate |
$63,073.77 |
| Rate for Payer: Aetna Medicare |
$25,294.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,402.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,402.24
|
| Rate for Payer: BCBS MAPPO |
$24,321.79
|
| Rate for Payer: BCBS Trust/PPO |
$63,073.77
|
| Rate for Payer: BCN Commercial |
$63,073.77
|
| Rate for Payer: BCN Medicare Advantage |
$24,321.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,321.79
|
| Rate for Payer: Mclaren Medicare |
$24,321.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,537.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,970.06
|
| Rate for Payer: Nomi Health Commercial |
$38,036.94
|
| Rate for Payer: PACE Medicare |
$23,105.70
|
| Rate for Payer: PACE SWMI |
$24,321.79
|
| Rate for Payer: PHP Medicare Advantage |
$24,321.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,274.01
|
| Rate for Payer: Priority Health Medicare |
$24,321.79
|
| Rate for Payer: Priority Health Narrow Network |
$36,219.22
|
| Rate for Payer: Railroad Medicare Medicare |
$24,321.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,104.31
|
| Rate for Payer: UHC Core |
$36,881.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,321.79
|
| Rate for Payer: UHC Exchange |
$29,320.88
|
| Rate for Payer: UHC Medicare Advantage |
$24,321.79
|
| Rate for Payer: VA VA |
$24,321.79
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$115,079.46
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$41,974.89 |
| Max. Negotiated Rate |
$115,079.46 |
| Rate for Payer: Aetna Medicare |
$45,951.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,230.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,230.11
|
| Rate for Payer: BCBS MAPPO |
$44,184.09
|
| Rate for Payer: BCBS Trust/PPO |
$115,079.46
|
| Rate for Payer: BCN Commercial |
$115,079.46
|
| Rate for Payer: BCN Medicare Advantage |
$44,184.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,184.09
|
| Rate for Payer: Mclaren Medicare |
$44,184.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,393.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,811.70
|
| Rate for Payer: Nomi Health Commercial |
$69,672.90
|
| Rate for Payer: PACE Medicare |
$41,974.89
|
| Rate for Payer: PACE SWMI |
$44,184.09
|
| Rate for Payer: PHP Medicare Advantage |
$44,184.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82,924.56
|
| Rate for Payer: Priority Health Medicare |
$44,184.09
|
| Rate for Payer: Priority Health Narrow Network |
$66,339.66
|
| Rate for Payer: Railroad Medicare Medicare |
$44,184.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84,450.04
|
| Rate for Payer: UHC Core |
$67,555.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,184.09
|
| Rate for Payer: UHC Exchange |
$53,707.54
|
| Rate for Payer: UHC Medicare Advantage |
$44,184.09
|
| Rate for Payer: VA VA |
$44,184.09
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,869.37
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$13,776.51 |
| Max. Negotiated Rate |
$35,869.37 |
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,653.72
|
| Rate for Payer: Aetna Medicare |
$15,081.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,126.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,126.99
|
| Rate for Payer: BCBS MAPPO |
$14,501.59
|
| Rate for Payer: BCBS Trust/PPO |
$35,869.37
|
| Rate for Payer: BCN Commercial |
$35,869.37
|
| Rate for Payer: BCN Medicare Advantage |
$14,501.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,501.59
|
| Rate for Payer: Mclaren Medicare |
$14,501.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,226.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,676.83
|
| Rate for Payer: Nomi Health Commercial |
$22,395.69
|
| Rate for Payer: PACE Medicare |
$13,776.51
|
| Rate for Payer: PACE SWMI |
$14,501.59
|
| Rate for Payer: PHP Medicare Advantage |
$14,501.59
|
| Rate for Payer: Priority Health Medicare |
$14,501.59
|
| Rate for Payer: Priority Health Narrow Network |
$21,322.98
|
| Rate for Payer: Railroad Medicare Medicare |
$14,501.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,145.66
|
| Rate for Payer: UHC Core |
$21,715.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,501.59
|
| Rate for Payer: UHC Exchange |
$17,263.78
|
| Rate for Payer: UHC Medicare Advantage |
$14,501.59
|
| Rate for Payer: VA VA |
$14,501.59
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$48,663.03
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$15,019.13 |
| Max. Negotiated Rate |
$48,663.03 |
| Rate for Payer: Aetna Medicare |
$16,441.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,762.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,762.01
|
| Rate for Payer: BCBS MAPPO |
$15,809.61
|
| Rate for Payer: BCBS Trust/PPO |
$48,663.03
|
| Rate for Payer: BCN Commercial |
$48,663.03
|
| Rate for Payer: BCN Medicare Advantage |
$15,809.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,809.61
|
| Rate for Payer: Mclaren Medicare |
$15,809.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,600.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,181.05
|
| Rate for Payer: Nomi Health Commercial |
$24,479.04
|
| Rate for Payer: PACE Medicare |
$15,019.13
|
| Rate for Payer: PACE SWMI |
$15,809.61
|
| Rate for Payer: PHP Medicare Advantage |
$15,809.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,133.46
|
| Rate for Payer: Priority Health Medicare |
$15,809.61
|
| Rate for Payer: Priority Health Narrow Network |
$23,306.77
|
| Rate for Payer: Railroad Medicare Medicare |
$15,809.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,670.87
|
| Rate for Payer: UHC Core |
$23,735.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,809.61
|
| Rate for Payer: UHC Exchange |
$18,869.73
|
| Rate for Payer: UHC Medicare Advantage |
$15,809.61
|
| Rate for Payer: VA VA |
$15,809.61
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$74,734.69
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$34,507.69 |
| Max. Negotiated Rate |
$74,734.69 |
| Rate for Payer: Aetna Medicare |
$37,776.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,404.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,404.85
|
| Rate for Payer: BCBS MAPPO |
$36,323.88
|
| Rate for Payer: BCBS Trust/PPO |
$74,734.69
|
| Rate for Payer: BCN Commercial |
$74,734.69
|
| Rate for Payer: BCN Medicare Advantage |
$36,323.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,323.88
|
| Rate for Payer: Mclaren Medicare |
$36,323.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38,140.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,772.46
|
| Rate for Payer: Nomi Health Commercial |
$57,153.45
|
| Rate for Payer: PACE Medicare |
$34,507.69
|
| Rate for Payer: PACE SWMI |
$36,323.88
|
| Rate for Payer: PHP Medicare Advantage |
$36,323.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68,023.11
|
| Rate for Payer: Priority Health Medicare |
$36,323.88
|
| Rate for Payer: Priority Health Narrow Network |
$54,418.49
|
| Rate for Payer: Railroad Medicare Medicare |
$36,323.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69,275.30
|
| Rate for Payer: UHC Core |
$55,416.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$36,323.88
|
| Rate for Payer: UHC Exchange |
$44,056.89
|
| Rate for Payer: UHC Medicare Advantage |
$36,323.88
|
| Rate for Payer: VA VA |
$36,323.88
|
|
|
MS-DRG 42.00: WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$27,037.67
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,798.63 |
| Max. Negotiated Rate |
$27,037.67 |
| Rate for Payer: Aetna Medicare |
$10,726.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,892.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,892.94
|
| Rate for Payer: BCBS MAPPO |
$10,314.35
|
| Rate for Payer: BCBS Trust/PPO |
$27,037.67
|
| Rate for Payer: BCN Commercial |
$27,037.67
|
| Rate for Payer: BCN Medicare Advantage |
$10,314.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,314.35
|
| Rate for Payer: Mclaren Medicare |
$10,314.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,830.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,861.50
|
| Rate for Payer: Nomi Health Commercial |
$15,726.39
|
| Rate for Payer: PACE Medicare |
$9,798.63
|
| Rate for Payer: PACE SWMI |
$10,314.35
|
| Rate for Payer: PHP Medicare Advantage |
$10,314.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,717.03
|
| Rate for Payer: Priority Health Medicare |
$10,314.35
|
| Rate for Payer: Priority Health Narrow Network |
$14,973.62
|
| Rate for Payer: Railroad Medicare Medicare |
$10,314.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,061.85
|
| Rate for Payer: UHC Core |
$15,248.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,314.35
|
| Rate for Payer: UHC Exchange |
$12,122.73
|
| Rate for Payer: UHC Medicare Advantage |
$10,314.35
|
| Rate for Payer: VA VA |
$10,314.35
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.97 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna American Axle |
$179.14
|
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna Medicare |
$137.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.14
|
| Rate for Payer: BCBS Complete |
$110.24
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health SBD |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$101.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
OP
|
$1,240.00
|
|
|
Service Code
|
NDC 00536466110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$458.80 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna American Axle |
$806.00
|
| Rate for Payer: Aetna Commercial |
$1,054.00
|
| Rate for Payer: Aetna Medicare |
$620.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.00
|
| Rate for Payer: BCBS Complete |
$496.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$868.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$868.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.00
|
| Rate for Payer: Healthscope Commercial |
$1,116.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$868.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.00
|
| Rate for Payer: PHP Commercial |
$1,054.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.00
|
| Rate for Payer: Priority Health SBD |
$781.20
|
| Rate for Payer: UMR Bronson Commercial |
$458.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$1,240.00
|
|
|
Service Code
|
NDC 00536466110
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$545.60 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna American Axle |
$806.00
|
| Rate for Payer: Aetna Commercial |
$1,054.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.00
|
| Rate for Payer: Cash Price |
$992.00
|
| Rate for Payer: Cofinity Commercial |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$868.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$868.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$992.00
|
| Rate for Payer: Healthscope Commercial |
$1,116.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$868.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$930.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.00
|
| Rate for Payer: PHP Commercial |
$1,054.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.00
|
| Rate for Payer: Priority Health SBD |
$781.20
|
| Rate for Payer: UMR Bronson Commercial |
$545.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$930.00
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$275.60
|
|
|
Service Code
|
NDC 40985022368
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.26 |
| Max. Negotiated Rate |
$248.04 |
| Rate for Payer: Aetna American Axle |
$179.14
|
| Rate for Payer: Aetna Commercial |
$234.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.14
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$237.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.48
|
| Rate for Payer: Healthscope Commercial |
$248.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.26
|
| Rate for Payer: PHP Commercial |
$234.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.14
|
| Rate for Payer: Priority Health SBD |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$121.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.70
|
|
|
MULTIVITAMIN-IRON 9 MG-FOLIC ACID 400 MCG-CALCIUM AND MINERALS TABLET
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
NDC 00904549261
|
| Hospital Charge Code |
118929
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
NDC 96295012782
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$104.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$145.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
NDC 57896062101
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$59.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
|
MULTIVITAMIN-MINERALS-IRON FUMARATE 19 MG-FOLIC ACID 400 MCG TABLET
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
NDC 57896062101
|
| Hospital Charge Code |
196928
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna American Axle |
$104.00
|
| Rate for Payer: Aetna Commercial |
$136.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$137.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$112.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$144.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$112.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.00
|
| Rate for Payer: PHP Commercial |
$136.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health SBD |
$100.80
|
| Rate for Payer: UMR Bronson Commercial |
$70.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$120.00
|
|
