|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$14,148.73
|
|
|
Service Code
|
NDC 00085432402
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,225.44 |
| Max. Negotiated Rate |
$12,733.86 |
| Rate for Payer: Aetna American Axle |
$9,196.67
|
| Rate for Payer: Aetna Commercial |
$12,026.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,196.67
|
| Rate for Payer: Cash Price |
$11,318.98
|
| Rate for Payer: Cofinity Advantage |
$9,904.11
|
| Rate for Payer: Cofinity Commercial |
$12,167.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,318.98
|
| Rate for Payer: Healthscope Commercial |
$12,733.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,904.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,611.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,026.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10,611.55
|
| Rate for Payer: PHP Commercial |
$12,026.42
|
| Rate for Payer: Priority Health SBD |
$8,913.70
|
| Rate for Payer: UMR Bronson Commercial |
$6,225.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,611.55
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,761.06
|
|
|
Service Code
|
NDC 00904714910
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$651.59 |
| Max. Negotiated Rate |
$1,584.95 |
| Rate for Payer: Aetna American Axle |
$1,144.69
|
| Rate for Payer: Aetna Commercial |
$1,496.90
|
| Rate for Payer: Aetna Medicare |
$880.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.69
|
| Rate for Payer: BCBS Complete |
$704.42
|
| Rate for Payer: Cash Price |
$1,408.85
|
| Rate for Payer: Cofinity Advantage |
$1,232.74
|
| Rate for Payer: Cofinity Commercial |
$1,514.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.85
|
| Rate for Payer: Healthscope Commercial |
$1,584.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,408.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,320.80
|
| Rate for Payer: PHP Commercial |
$1,496.90
|
| Rate for Payer: Priority Health SBD |
$1,109.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.69
|
| Rate for Payer: UHC Core |
$917.51
|
| Rate for Payer: UHC Exchange |
$692.10
|
| Rate for Payer: UMR Bronson Commercial |
$651.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.80
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$138.69
|
|
|
Service Code
|
NDC 60687052311
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.02 |
| Max. Negotiated Rate |
$124.82 |
| Rate for Payer: Aetna American Axle |
$90.15
|
| Rate for Payer: Aetna Commercial |
$117.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.15
|
| Rate for Payer: Cash Price |
$110.95
|
| Rate for Payer: Cofinity Advantage |
$97.08
|
| Rate for Payer: Cofinity Commercial |
$119.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.95
|
| Rate for Payer: Healthscope Commercial |
$124.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.02
|
| Rate for Payer: PHP Commercial |
$117.89
|
| Rate for Payer: Priority Health SBD |
$87.37
|
| Rate for Payer: UMR Bronson Commercial |
$61.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.02
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,337.77
|
|
|
Service Code
|
NDC 00254204502
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,234.97 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna American Axle |
$2,169.55
|
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna Medicare |
$1,668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: BCBS Complete |
$1,335.11
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Advantage |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,336.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,503.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,670.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,503.33
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,169.55
|
| Rate for Payer: UHC Core |
$1,738.98
|
| Rate for Payer: UHC Exchange |
$1,311.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,503.33
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4,953.38
|
|
|
Service Code
|
NDC 00085132801
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,179.49 |
| Max. Negotiated Rate |
$4,458.04 |
| Rate for Payer: Aetna American Axle |
$3,219.70
|
| Rate for Payer: Aetna Commercial |
$4,210.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,219.70
|
| Rate for Payer: Cash Price |
$3,962.70
|
| Rate for Payer: Cofinity Advantage |
$3,467.37
|
| Rate for Payer: Cofinity Commercial |
$4,259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,962.70
|
| Rate for Payer: Healthscope Commercial |
$4,458.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,467.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,715.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,210.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,715.03
|
| Rate for Payer: PHP Commercial |
$4,210.37
|
| Rate for Payer: Priority Health SBD |
$3,120.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,179.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,715.03
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,809.25
|
|
|
Service Code
|
NDC 00254101636
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,039.42 |
| Max. Negotiated Rate |
$2,528.32 |
| Rate for Payer: Aetna American Axle |
$1,826.01
|
| Rate for Payer: Aetna Commercial |
$2,387.86
|
| Rate for Payer: Aetna Medicare |
$1,404.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.01
|
| Rate for Payer: BCBS Complete |
$1,123.70
|
| Rate for Payer: Cash Price |
$2,247.40
|
| Rate for Payer: Cofinity Advantage |
$1,966.47
|
| Rate for Payer: Cofinity Commercial |
$2,415.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.40
|
| Rate for Payer: Healthscope Commercial |
$2,528.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,966.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,106.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,247.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,387.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,106.94
|
| Rate for Payer: PHP Commercial |
$2,387.86
|
| Rate for Payer: Priority Health SBD |
$1,769.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,826.01
|
| Rate for Payer: UHC Core |
$1,463.62
|
| Rate for Payer: UHC Exchange |
$1,104.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,106.94
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4,953.38
|
|
|
Service Code
|
NDC 00085132801
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,832.75 |
| Max. Negotiated Rate |
$4,458.04 |
| Rate for Payer: Aetna American Axle |
$3,219.70
|
| Rate for Payer: Aetna Commercial |
$4,210.37
|
| Rate for Payer: Aetna Medicare |
$2,476.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,219.70
|
| Rate for Payer: BCBS Complete |
$1,981.35
|
| Rate for Payer: Cash Price |
$3,962.70
|
| Rate for Payer: Cofinity Advantage |
$3,467.37
|
| Rate for Payer: Cofinity Commercial |
$4,259.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,962.70
|
| Rate for Payer: Healthscope Commercial |
$4,458.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,467.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,715.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,962.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,210.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,715.03
|
| Rate for Payer: PHP Commercial |
$4,210.37
|
| Rate for Payer: Priority Health SBD |
$3,120.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,219.70
|
| Rate for Payer: UHC Core |
$2,580.71
|
| Rate for Payer: UHC Exchange |
$1,946.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,832.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,715.03
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,809.25
|
|
|
Service Code
|
NDC 00254101636
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,236.07 |
| Max. Negotiated Rate |
$2,528.32 |
| Rate for Payer: Aetna American Axle |
$1,826.01
|
| Rate for Payer: Aetna Commercial |
$2,387.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.01
|
| Rate for Payer: Cash Price |
$2,247.40
|
| Rate for Payer: Cofinity Advantage |
$1,966.47
|
| Rate for Payer: Cofinity Commercial |
$2,415.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,247.40
|
| Rate for Payer: Healthscope Commercial |
$2,528.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,966.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,106.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,387.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,106.94
|
| Rate for Payer: PHP Commercial |
$2,387.86
|
| Rate for Payer: Priority Health SBD |
$1,769.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,106.94
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$358.68
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
170121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$322.81 |
| Rate for Payer: Aetna American Axle |
$233.14
|
| Rate for Payer: Aetna Commercial |
$304.88
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.44
|
| Rate for Payer: BCBS Complete |
$0.19
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$286.94
|
| Rate for Payer: Cash Price |
$286.94
|
| Rate for Payer: Cofinity Advantage |
$251.08
|
| Rate for Payer: Cofinity Commercial |
$308.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$322.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.01
|
| Rate for Payer: Mclaren Medicaid |
$0.35
|
| Rate for Payer: Mclaren Medicare |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.37
|
| Rate for Payer: Meridian Medicaid |
$0.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.88
|
| Rate for Payer: Nomi Health Commercial |
$1.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.01
|
| Rate for Payer: PACE Medicare |
$0.33
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Commercial |
$304.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$0.66
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: Priority Health SBD |
$225.97
|
| Rate for Payer: Priority Health Tiered Network |
$0.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.58
|
| Rate for Payer: UHC Core |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.58
|
| Rate for Payer: UHC Medicaid |
$0.18
|
| Rate for Payer: UHCCP Medicaid |
$0.18
|
| Rate for Payer: UMR Bronson Commercial |
$132.71
|
| Rate for Payer: VA VA |
$0.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.01
|
|
|
POSACONAZOLE 300 MG/16.7 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$358.68
|
|
|
Service Code
|
HCPCS J1837
|
| Hospital Charge Code |
170121
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$322.81 |
| Rate for Payer: Aetna American Axle |
$233.14
|
| Rate for Payer: Aetna Commercial |
$304.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.14
|
| Rate for Payer: Cash Price |
$286.94
|
| Rate for Payer: Cofinity Advantage |
$251.08
|
| Rate for Payer: Cofinity Commercial |
$308.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$286.94
|
| Rate for Payer: Healthscope Commercial |
$322.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$304.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.01
|
| Rate for Payer: PHP Commercial |
$304.88
|
| Rate for Payer: Priority Health SBD |
$225.97
|
| Rate for Payer: UMR Bronson Commercial |
$157.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.01
|
|
|
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,659.96
|
| Rate for Payer: BCN Commercial |
$5,659.96
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$3,397.77
|
|
|
Service Code
|
CPT 22840
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,397.77 |
| Max. Negotiated Rate |
$3,397.77 |
| Rate for Payer: BCBS Trust/PPO |
$3,397.77
|
| Rate for Payer: BCN Commercial |
$3,397.77
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$3,411.47
|
|
|
Service Code
|
CPT 22842
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,411.47 |
| Max. Negotiated Rate |
$3,411.47 |
| Rate for Payer: BCBS Trust/PPO |
$3,411.47
|
| Rate for Payer: BCN Commercial |
$3,411.47
|
|
|
POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES); 7 TO 12 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$3,649.62
|
|
|
Service Code
|
CPT 22843
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,649.62 |
| Max. Negotiated Rate |
$3,649.62 |
| Rate for Payer: BCBS Trust/PPO |
$3,649.62
|
| Rate for Payer: BCN Commercial |
$3,649.62
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$29,726.31
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$15,051.82 |
| Max. Negotiated Rate |
$29,726.31 |
| Rate for Payer: Aetna Medicare |
$16,477.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,805.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,805.03
|
| Rate for Payer: BCBS MAPPO |
$15,844.02
|
| Rate for Payer: BCBS Trust/PPO |
$25,554.14
|
| Rate for Payer: BCN Commercial |
$25,554.14
|
| Rate for Payer: BCN Medicare Advantage |
$15,844.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,844.02
|
| Rate for Payer: Mclaren Medicare |
$15,844.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,636.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,220.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,428.42
|
| Rate for Payer: Nomi Health Commercial |
$23,525.73
|
| Rate for Payer: PACE Medicare |
$15,051.82
|
| Rate for Payer: PACE SWMI |
$15,844.02
|
| Rate for Payer: PHP Medicare Advantage |
$15,844.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,401.95
|
| Rate for Payer: Priority Health Medicare |
$15,844.02
|
| Rate for Payer: Priority Health Tiered Network |
$23,521.55
|
| Rate for Payer: Railroad Medicare Medicare |
$15,844.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,726.31
|
| Rate for Payer: UHC Core |
$24,869.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,844.02
|
| Rate for Payer: UHC Exchange |
$20,310.55
|
| Rate for Payer: VA VA |
$15,844.02
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$17,598.84
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$8,491.19 |
| Max. Negotiated Rate |
$17,598.84 |
| Rate for Payer: Aetna Medicare |
$9,295.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,172.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,172.62
|
| Rate for Payer: BCBS MAPPO |
$8,938.10
|
| Rate for Payer: BCBS Trust/PPO |
$17,598.84
|
| Rate for Payer: BCN Commercial |
$17,598.84
|
| Rate for Payer: BCN Medicare Advantage |
$8,938.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,938.10
|
| Rate for Payer: Mclaren Medicare |
$8,938.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,385.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,278.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,831.91
|
| Rate for Payer: Nomi Health Commercial |
$12,872.91
|
| Rate for Payer: PACE Medicare |
$8,491.19
|
| Rate for Payer: PACE SWMI |
$8,938.10
|
| Rate for Payer: PHP Medicare Advantage |
$8,938.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,088.28
|
| Rate for Payer: Priority Health Medicare |
$8,938.10
|
| Rate for Payer: Priority Health Tiered Network |
$12,870.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8,938.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,265.77
|
| Rate for Payer: UHC Core |
$13,608.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,938.10
|
| Rate for Payer: UHC Exchange |
$11,113.61
|
| Rate for Payer: VA VA |
$8,938.10
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$36,185.91
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$17,576.59 |
| Max. Negotiated Rate |
$36,185.91 |
| Rate for Payer: Aetna Medicare |
$19,241.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,127.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,127.09
|
| Rate for Payer: BCBS MAPPO |
$18,501.67
|
| Rate for Payer: BCBS Trust/PPO |
$36,185.91
|
| Rate for Payer: BCN Commercial |
$36,185.91
|
| Rate for Payer: BCN Medicare Advantage |
$18,501.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,501.67
|
| Rate for Payer: Mclaren Medicare |
$18,501.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,426.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,276.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,351.84
|
| Rate for Payer: Nomi Health Commercial |
$27,625.35
|
| Rate for Payer: PACE Medicare |
$17,576.59
|
| Rate for Payer: PACE SWMI |
$18,501.67
|
| Rate for Payer: PHP Medicare Advantage |
$18,501.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$34,525.56
|
| Rate for Payer: Priority Health Medicare |
$18,501.67
|
| Rate for Payer: Priority Health Tiered Network |
$27,620.45
|
| Rate for Payer: Railroad Medicare Medicare |
$18,501.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,906.45
|
| Rate for Payer: UHC Core |
$29,203.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,501.67
|
| Rate for Payer: UHC Exchange |
$23,849.89
|
| Rate for Payer: VA VA |
$18,501.67
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,237.71
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$36,700.73 |
| Max. Negotiated Rate |
$89,237.71 |
| Rate for Payer: Aetna Medicare |
$40,177.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48,290.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48,290.44
|
| Rate for Payer: BCBS MAPPO |
$38,632.35
|
| Rate for Payer: BCBS Trust/PPO |
$89,237.71
|
| Rate for Payer: BCN Commercial |
$89,237.71
|
| Rate for Payer: BCN Medicare Advantage |
$38,632.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,632.35
|
| Rate for Payer: Mclaren Medicare |
$38,632.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40,563.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,427.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$42,495.58
|
| Rate for Payer: Nomi Health Commercial |
$58,678.23
|
| Rate for Payer: PACE Medicare |
$36,700.73
|
| Rate for Payer: PACE SWMI |
$38,632.35
|
| Rate for Payer: PHP Medicare Advantage |
$38,632.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73,334.78
|
| Rate for Payer: Priority Health Medicare |
$38,632.35
|
| Rate for Payer: Priority Health Tiered Network |
$58,667.81
|
| Rate for Payer: Railroad Medicare Medicare |
$38,632.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74,143.81
|
| Rate for Payer: UHC Core |
$62,030.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38,632.35
|
| Rate for Payer: UHC Exchange |
$50,658.87
|
| Rate for Payer: VA VA |
$38,632.35
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,208.25
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$11,629.30 |
| Max. Negotiated Rate |
$25,208.25 |
| Rate for Payer: Aetna Medicare |
$12,731.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,301.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,301.71
|
| Rate for Payer: BCBS MAPPO |
$12,241.37
|
| Rate for Payer: BCBS Trust/PPO |
$25,208.25
|
| Rate for Payer: BCN Commercial |
$25,208.25
|
| Rate for Payer: BCN Medicare Advantage |
$12,241.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,241.37
|
| Rate for Payer: Mclaren Medicare |
$12,241.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,853.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,077.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,465.51
|
| Rate for Payer: Nomi Health Commercial |
$17,968.41
|
| Rate for Payer: PACE Medicare |
$11,629.30
|
| Rate for Payer: PACE SWMI |
$12,241.37
|
| Rate for Payer: PHP Medicare Advantage |
$12,241.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,456.53
|
| Rate for Payer: Priority Health Medicare |
$12,241.37
|
| Rate for Payer: Priority Health Tiered Network |
$17,965.22
|
| Rate for Payer: Railroad Medicare Medicare |
$12,241.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,704.27
|
| Rate for Payer: UHC Core |
$18,994.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,241.37
|
| Rate for Payer: UHC Exchange |
$15,512.73
|
| Rate for Payer: VA VA |
$12,241.37
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$14,133.73
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$13,460.70 |
| Max. Negotiated Rate |
$14,133.73 |
| Rate for Payer: BCBS Complete |
$14,133.73
|
| Rate for Payer: Mclaren Medicaid |
$13,460.70
|
| Rate for Payer: Meridian Medicaid |
$14,133.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,460.70
|
| Rate for Payer: UHC Medicaid |
$13,460.70
|
| Rate for Payer: UHCCP Medicaid |
$13,460.70
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$11,177.93
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$10,645.65 |
| Max. Negotiated Rate |
$11,177.93 |
| Rate for Payer: BCBS Complete |
$11,177.93
|
| Rate for Payer: Mclaren Medicaid |
$10,645.65
|
| Rate for Payer: Meridian Medicaid |
$11,177.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,645.65
|
| Rate for Payer: UHC Medicaid |
$10,645.65
|
| Rate for Payer: UHCCP Medicaid |
$10,645.65
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$8,694.28
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$8,280.27 |
| Max. Negotiated Rate |
$8,694.28 |
| Rate for Payer: BCBS Complete |
$8,694.28
|
| Rate for Payer: Mclaren Medicaid |
$8,280.27
|
| Rate for Payer: Meridian Medicaid |
$8,694.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,280.27
|
| Rate for Payer: UHC Medicaid |
$8,280.27
|
| Rate for Payer: UHCCP Medicaid |
$8,280.27
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$26,906.09
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$25,624.85 |
| Max. Negotiated Rate |
$26,906.09 |
| Rate for Payer: BCBS Complete |
$26,906.09
|
| Rate for Payer: Mclaren Medicaid |
$25,624.85
|
| Rate for Payer: Meridian Medicaid |
$26,906.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,624.85
|
| Rate for Payer: UHC Medicaid |
$25,624.85
|
| Rate for Payer: UHCCP Medicaid |
$25,624.85
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$14,738.45
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$14,036.62 |
| Max. Negotiated Rate |
$14,738.45 |
| Rate for Payer: BCBS Complete |
$14,738.45
|
| Rate for Payer: Mclaren Medicaid |
$14,036.62
|
| Rate for Payer: Meridian Medicaid |
$14,738.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,036.62
|
| Rate for Payer: UHC Medicaid |
$14,036.62
|
| Rate for Payer: UHCCP Medicaid |
$14,036.62
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$4,219.72
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$4,018.78 |
| Max. Negotiated Rate |
$4,219.72 |
| Rate for Payer: BCBS Complete |
$4,219.72
|
| Rate for Payer: Mclaren Medicaid |
$4,018.78
|
| Rate for Payer: Meridian Medicaid |
$4,219.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,018.78
|
| Rate for Payer: UHC Medicaid |
$4,018.78
|
| Rate for Payer: UHCCP Medicaid |
$4,018.78
|
|
