|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$22,038.41
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$12,640.67 |
| Max. Negotiated Rate |
$22,038.41 |
| Rate for Payer: Aetna Medicare |
$13,305.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,632.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,632.46
|
| Rate for Payer: BCBS MAPPO |
$13,305.97
|
| Rate for Payer: BCN Medicare Advantage |
$13,305.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,305.97
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,305.97
|
| Rate for Payer: Mclaren Medicare |
$13,305.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,971.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,301.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,636.57
|
| Rate for Payer: PACE Medicare |
$12,640.67
|
| Rate for Payer: PACE SWMI |
$13,305.97
|
| Rate for Payer: PHP Commercial |
$14,636.57
|
| Rate for Payer: PHP Medicare Advantage |
$13,305.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,038.41
|
| Rate for Payer: Priority Health Medicare |
$13,305.97
|
| Rate for Payer: Priority Health Narrow Network |
$17,630.73
|
| Rate for Payer: Railroad Medicare Medicare |
$13,305.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,305.97
|
| Rate for Payer: UHC Exchange |
$20,624.25
|
| Rate for Payer: UHCCP DNSP |
$13,305.97
|
| Rate for Payer: VA VA |
$13,305.97
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$10,790.62
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$6,613.61 |
| Max. Negotiated Rate |
$10,790.62 |
| Rate for Payer: Aetna Medicare |
$6,961.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,702.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,702.11
|
| Rate for Payer: BCBS MAPPO |
$6,961.69
|
| Rate for Payer: BCN Medicare Advantage |
$6,961.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,961.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,961.69
|
| Rate for Payer: Mclaren Medicare |
$6,961.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,309.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,005.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,657.86
|
| Rate for Payer: PACE Medicare |
$6,613.61
|
| Rate for Payer: PACE SWMI |
$6,961.69
|
| Rate for Payer: PHP Commercial |
$7,657.86
|
| Rate for Payer: PHP Medicare Advantage |
$6,961.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,934.53
|
| Rate for Payer: Priority Health Medicare |
$6,961.69
|
| Rate for Payer: Priority Health Narrow Network |
$7,947.62
|
| Rate for Payer: Railroad Medicare Medicare |
$6,961.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,961.69
|
| Rate for Payer: UHC Exchange |
$10,790.62
|
| Rate for Payer: UHCCP DNSP |
$6,961.69
|
| Rate for Payer: VA VA |
$6,961.69
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC
|
Facility
|
IP
|
$10,445.70
|
|
|
Service Code
|
MSDRG 284
|
| Min. Negotiated Rate |
$6,402.20 |
| Max. Negotiated Rate |
$10,445.70 |
| Rate for Payer: Aetna Medicare |
$6,739.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,423.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,423.95
|
| Rate for Payer: BCBS MAPPO |
$6,739.16
|
| Rate for Payer: BCN Medicare Advantage |
$6,739.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,739.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,739.16
|
| Rate for Payer: Mclaren Medicare |
$6,739.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,076.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,750.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,413.08
|
| Rate for Payer: PACE Medicare |
$6,402.20
|
| Rate for Payer: PACE SWMI |
$6,739.16
|
| Rate for Payer: PHP Commercial |
$7,413.08
|
| Rate for Payer: PHP Medicare Advantage |
$6,739.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,510.00
|
| Rate for Payer: Priority Health Medicare |
$6,739.16
|
| Rate for Payer: Priority Health Narrow Network |
$7,608.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,739.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,739.16
|
| Rate for Payer: UHC Exchange |
$10,445.70
|
| Rate for Payer: UHCCP DNSP |
$6,739.16
|
| Rate for Payer: VA VA |
$6,739.16
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC
|
Facility
|
IP
|
$27,213.82
|
|
|
Service Code
|
MSDRG 283
|
| Min. Negotiated Rate |
$15,217.75 |
| Max. Negotiated Rate |
$27,213.82 |
| Rate for Payer: Aetna Medicare |
$16,018.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,023.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,023.35
|
| Rate for Payer: BCBS MAPPO |
$16,018.68
|
| Rate for Payer: BCN Medicare Advantage |
$16,018.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,018.68
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,018.68
|
| Rate for Payer: Mclaren Medicare |
$16,018.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,819.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,421.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,620.55
|
| Rate for Payer: PACE Medicare |
$15,217.75
|
| Rate for Payer: PACE SWMI |
$16,018.68
|
| Rate for Payer: PHP Commercial |
$17,620.55
|
| Rate for Payer: PHP Medicare Advantage |
$16,018.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$27,213.82
|
| Rate for Payer: Priority Health Medicare |
$16,018.68
|
| Rate for Payer: Priority Health Narrow Network |
$21,771.05
|
| Rate for Payer: Railroad Medicare Medicare |
$16,018.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16,018.68
|
| Rate for Payer: UHC Exchange |
$24,828.95
|
| Rate for Payer: UHCCP DNSP |
$16,018.68
|
| Rate for Payer: VA VA |
$16,018.68
|
|
|
ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC
|
Facility
|
IP
|
$9,404.28
|
|
|
Service Code
|
MSDRG 285
|
| Min. Negotiated Rate |
$5,763.92 |
| Max. Negotiated Rate |
$9,404.28 |
| Rate for Payer: Aetna Medicare |
$6,067.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,584.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,584.10
|
| Rate for Payer: BCBS MAPPO |
$6,067.28
|
| Rate for Payer: BCN Medicare Advantage |
$6,067.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,067.28
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,067.28
|
| Rate for Payer: Mclaren Medicare |
$6,067.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,370.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,977.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,674.01
|
| Rate for Payer: PACE Medicare |
$5,763.92
|
| Rate for Payer: PACE SWMI |
$6,067.28
|
| Rate for Payer: PHP Commercial |
$6,674.01
|
| Rate for Payer: PHP Medicare Advantage |
$6,067.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,228.17
|
| Rate for Payer: Priority Health Medicare |
$6,067.28
|
| Rate for Payer: Priority Health Narrow Network |
$6,582.53
|
| Rate for Payer: Railroad Medicare Medicare |
$6,067.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,067.28
|
| Rate for Payer: UHC Exchange |
$9,404.28
|
| Rate for Payer: UHCCP DNSP |
$6,067.28
|
| Rate for Payer: VA VA |
$6,067.28
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 904578961
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: Aetna Medicare |
$110.43
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: BCBS Trust/PPO |
$246.07
|
| Rate for Payer: BCN Commercial |
$246.07
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$289.50
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$261.50
|
| Rate for Payer: Priority Health Narrow Network |
$209.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
ACYCLOVIR 200 MG CAPSULE
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 904578961
|
| Hospital Charge Code |
8969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: BCBS Trust/PPO |
$245.09
|
| Rate for Payer: BCN Commercial |
$245.09
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$289.50
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.86
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$24.86 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$24.12
|
| Rate for Payer: ASR ASR |
$21.96
|
| Rate for Payer: ASR ASR |
$19.52
|
| Rate for Payer: BCBS Trust/PPO |
$20.42
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.22
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: BCN Commercial |
$22.22
|
| Rate for Payer: BCN Commercial |
$18.60
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$21.96
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Whirlpool |
$24.86
|
| Rate for Payer: Healthscope Whirlpool |
$27.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.13
|
| Rate for Payer: Healthscope Whirlpool |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$24.35
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$22.19
|
| Rate for Payer: Nomi Health Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$16.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.81
|
|
|
ACYCLOVIR SODIUM 50 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.06
|
|
|
Service Code
|
HCPCS J0133
|
| Hospital Charge Code |
23128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$27.06 |
| Rate for Payer: Aetna Commercial |
$24.35
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Commercial |
$18.12
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Aetna Medicare |
$9.20
|
| Rate for Payer: Aetna Medicare |
$8.38
|
| Rate for Payer: ASR ASR |
$24.12
|
| Rate for Payer: ASR ASR |
$21.96
|
| Rate for Payer: ASR ASR |
$19.52
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: BCBS Complete |
$9.95
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$9.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.67
|
| Rate for Payer: BCBS Trust/PPO |
$22.31
|
| Rate for Payer: BCBS Trust/PPO |
$20.50
|
| Rate for Payer: BCBS Trust/PPO |
$16.60
|
| Rate for Payer: BCN Commercial |
$22.31
|
| Rate for Payer: BCN Commercial |
$20.50
|
| Rate for Payer: BCN Commercial |
$16.60
|
| Rate for Payer: BCN Commercial |
$18.67
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$18.12
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Cofinity Commercial |
$18.92
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Cofinity Commercial |
$21.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.89
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$21.96
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Healthscope Whirlpool |
$20.13
|
| Rate for Payer: Healthscope Whirlpool |
$24.86
|
| Rate for Payer: Healthscope Whirlpool |
$27.06
|
| Rate for Payer: Healthscope Whirlpool |
$22.64
|
| Rate for Payer: Mclaren Commercial |
$22.38
|
| Rate for Payer: Mclaren Commercial |
$20.38
|
| Rate for Payer: Mclaren Commercial |
$18.12
|
| Rate for Payer: Mclaren Commercial |
$24.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.00
|
| Rate for Payer: Nomi Health Commercial |
$16.50
|
| Rate for Payer: Nomi Health Commercial |
$20.39
|
| Rate for Payer: Nomi Health Commercial |
$22.19
|
| Rate for Payer: Nomi Health Commercial |
$18.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.93
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.04
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.04 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$22.76
|
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: ASR ASR |
$24.53
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$23.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.77
|
| Rate for Payer: BCBS Trust/PPO |
$14.82
|
| Rate for Payer: BCBS Trust/PPO |
$20.31
|
| Rate for Payer: BCN Commercial |
$20.31
|
| Rate for Payer: BCN Commercial |
$14.82
|
| Rate for Payer: BCN Commercial |
$20.77
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$23.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Healthscope Commercial |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Healthscope Whirlpool |
$25.29
|
| Rate for Payer: Healthscope Whirlpool |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$22.26
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Mclaren Commercial |
$22.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$20.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
|
|
ADENOSINE 3 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.04
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
8975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$18.04 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$22.26
|
| Rate for Payer: Aetna Commercial |
$22.76
|
| Rate for Payer: Aetna Medicare |
$9.15
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$24.53
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: ASR ASR |
$23.99
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Complete |
$10.12
|
| Rate for Payer: BCBS Complete |
$9.89
|
| Rate for Payer: BCBS Trust/PPO |
$14.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$20.85
|
| Rate for Payer: BCN Commercial |
$14.88
|
| Rate for Payer: BCN Commercial |
$20.40
|
| Rate for Payer: BCN Commercial |
$20.85
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$20.23
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$23.25
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$23.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.79
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$23.99
|
| Rate for Payer: Healthscope Whirlpool |
$24.74
|
| Rate for Payer: Healthscope Whirlpool |
$18.04
|
| Rate for Payer: Healthscope Whirlpool |
$25.29
|
| Rate for Payer: Mclaren Commercial |
$22.76
|
| Rate for Payer: Mclaren Commercial |
$22.26
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$20.74
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$20.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
IP
|
$18.04
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$18.04 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$18.68
|
| Rate for Payer: BCBS Trust/PPO |
$14.82
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: BCN Commercial |
$14.82
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$22.07
|
| Rate for Payer: Healthscope Whirlpool |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
ADENOSINE 3 MG/ML IV (CODE)
|
Facility
|
OP
|
$22.75
|
|
|
Service Code
|
HCPCS J0153
|
| Hospital Charge Code |
163702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$20.47
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Medicare |
$6.68
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: ASR ASR |
$22.07
|
| Rate for Payer: ASR ASR |
$17.50
|
| Rate for Payer: BCBS Complete |
$7.22
|
| Rate for Payer: BCBS Complete |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.88
|
| Rate for Payer: BCN Commercial |
$14.88
|
| Rate for Payer: BCN Commercial |
$18.76
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$18.20
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cofinity Commercial |
$16.96
|
| Rate for Payer: Cofinity Commercial |
$21.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.43
|
| Rate for Payer: Healthscope Commercial |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$17.50
|
| Rate for Payer: Healthscope Whirlpool |
$22.75
|
| Rate for Payer: Healthscope Whirlpool |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$20.47
|
| Rate for Payer: Mclaren Commercial |
$16.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.34
|
| Rate for Payer: Nomi Health Commercial |
$14.79
|
| Rate for Payer: Nomi Health Commercial |
$18.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.55
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: Priority Health Narrow Network |
$0.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.02
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$6,361.20
|
|
|
Service Code
|
APR-DRG 7554
|
| Min. Negotiated Rate |
$5,751.29 |
| Max. Negotiated Rate |
$6,361.20 |
| Rate for Payer: BCBS Complete |
$6,361.20
|
| Rate for Payer: Mclaren Medicaid |
$6,058.29
|
| Rate for Payer: Meridian Medicaid |
$6,361.20
|
| Rate for Payer: PHP Medicaid |
$5,751.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,058.29
|
| Rate for Payer: UHC Medicaid |
$6,058.29
|
| Rate for Payer: UHCCP Medicaid |
$6,058.29
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$2,866.44
|
|
|
Service Code
|
APR-DRG 7551
|
| Min. Negotiated Rate |
$2,591.60 |
| Max. Negotiated Rate |
$2,866.44 |
| Rate for Payer: BCBS Complete |
$2,866.44
|
| Rate for Payer: Mclaren Medicaid |
$2,729.94
|
| Rate for Payer: Meridian Medicaid |
$2,866.44
|
| Rate for Payer: PHP Medicaid |
$2,591.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,729.94
|
| Rate for Payer: UHC Medicaid |
$2,729.94
|
| Rate for Payer: UHCCP Medicaid |
$2,729.94
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$6,210.80
|
|
|
Service Code
|
APR-DRG 7553
|
| Min. Negotiated Rate |
$5,615.30 |
| Max. Negotiated Rate |
$6,210.80 |
| Rate for Payer: BCBS Complete |
$6,210.80
|
| Rate for Payer: Mclaren Medicaid |
$5,915.04
|
| Rate for Payer: Meridian Medicaid |
$6,210.80
|
| Rate for Payer: PHP Medicaid |
$5,615.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,915.04
|
| Rate for Payer: UHC Medicaid |
$5,915.04
|
| Rate for Payer: UHCCP Medicaid |
$5,915.04
|
|
|
ADJUSTMENT DISORDERS
|
Facility
|
IP
|
$3,453.35
|
|
|
Service Code
|
APR-DRG 7552
|
| Min. Negotiated Rate |
$3,122.24 |
| Max. Negotiated Rate |
$3,453.35 |
| Rate for Payer: BCBS Complete |
$3,453.35
|
| Rate for Payer: Mclaren Medicaid |
$3,288.90
|
| Rate for Payer: Meridian Medicaid |
$3,453.35
|
| Rate for Payer: PHP Medicaid |
$3,122.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,288.90
|
| Rate for Payer: UHC Medicaid |
$3,288.90
|
| Rate for Payer: UHCCP Medicaid |
$3,288.90
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$30,112.70
|
|
|
Service Code
|
MSDRG 614
|
| Min. Negotiated Rate |
$16,661.24 |
| Max. Negotiated Rate |
$30,112.70 |
| Rate for Payer: Aetna Medicare |
$17,538.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,922.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,922.69
|
| Rate for Payer: BCBS MAPPO |
$17,538.15
|
| Rate for Payer: BCN Medicare Advantage |
$17,538.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,538.15
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,538.15
|
| Rate for Payer: Mclaren Medicare |
$17,538.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,415.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,168.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,291.97
|
| Rate for Payer: PACE Medicare |
$16,661.24
|
| Rate for Payer: PACE SWMI |
$17,538.15
|
| Rate for Payer: PHP Commercial |
$19,291.97
|
| Rate for Payer: PHP Medicare Advantage |
$17,538.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30,112.70
|
| Rate for Payer: Priority Health Medicare |
$17,538.15
|
| Rate for Payer: Priority Health Narrow Network |
$24,090.16
|
| Rate for Payer: Railroad Medicare Medicare |
$17,538.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,538.15
|
| Rate for Payer: UHC Exchange |
$27,184.13
|
| Rate for Payer: UHCCP DNSP |
$17,538.15
|
| Rate for Payer: VA VA |
$17,538.15
|
|
|
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,224.70
|
|
|
Service Code
|
MSDRG 615
|
| Min. Negotiated Rate |
$11,239.60 |
| Max. Negotiated Rate |
$19,224.70 |
| Rate for Payer: Aetna Medicare |
$11,831.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,788.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,788.95
|
| Rate for Payer: BCBS MAPPO |
$11,831.16
|
| Rate for Payer: BCN Medicare Advantage |
$11,831.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,831.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,831.16
|
| Rate for Payer: Mclaren Medicare |
$11,831.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,422.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,605.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,014.28
|
| Rate for Payer: PACE Medicare |
$11,239.60
|
| Rate for Payer: PACE SWMI |
$11,831.16
|
| Rate for Payer: PHP Commercial |
$13,014.28
|
| Rate for Payer: PHP Medicare Advantage |
$11,831.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,224.70
|
| Rate for Payer: Priority Health Medicare |
$11,831.16
|
| Rate for Payer: Priority Health Narrow Network |
$15,379.76
|
| Rate for Payer: Railroad Medicare Medicare |
$11,831.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,831.16
|
| Rate for Payer: UHC Exchange |
$18,338.30
|
| Rate for Payer: UHCCP DNSP |
$11,831.16
|
| Rate for Payer: VA VA |
$11,831.16
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$16,844.40
|
|
|
Service Code
|
APR-DRG 4013
|
| Min. Negotiated Rate |
$15,229.36 |
| Max. Negotiated Rate |
$16,844.40 |
| Rate for Payer: BCBS Complete |
$16,844.40
|
| Rate for Payer: Mclaren Medicaid |
$16,042.29
|
| Rate for Payer: Meridian Medicaid |
$16,844.40
|
| Rate for Payer: PHP Medicaid |
$15,229.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,042.29
|
| Rate for Payer: UHC Medicaid |
$16,042.29
|
| Rate for Payer: UHCCP Medicaid |
$16,042.29
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$11,867.92
|
|
|
Service Code
|
APR-DRG 4012
|
| Min. Negotiated Rate |
$10,730.02 |
| Max. Negotiated Rate |
$11,867.92 |
| Rate for Payer: BCBS Complete |
$11,867.92
|
| Rate for Payer: Mclaren Medicaid |
$11,302.78
|
| Rate for Payer: Meridian Medicaid |
$11,867.92
|
| Rate for Payer: PHP Medicaid |
$10,730.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,302.78
|
| Rate for Payer: UHC Medicaid |
$11,302.78
|
| Rate for Payer: UHCCP Medicaid |
$11,302.78
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$8,192.23
|
|
|
Service Code
|
APR-DRG 4011
|
| Min. Negotiated Rate |
$7,406.76 |
| Max. Negotiated Rate |
$8,192.23 |
| Rate for Payer: BCBS Complete |
$8,192.23
|
| Rate for Payer: Mclaren Medicaid |
$7,802.13
|
| Rate for Payer: Meridian Medicaid |
$8,192.23
|
| Rate for Payer: PHP Medicaid |
$7,406.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,802.13
|
| Rate for Payer: UHC Medicaid |
$7,802.13
|
| Rate for Payer: UHCCP Medicaid |
$7,802.13
|
|
|
ADRENAL PROCEDURES
|
Facility
|
IP
|
$27,768.47
|
|
|
Service Code
|
APR-DRG 4014
|
| Min. Negotiated Rate |
$25,106.02 |
| Max. Negotiated Rate |
$27,768.47 |
| Rate for Payer: BCBS Complete |
$27,768.47
|
| Rate for Payer: Mclaren Medicaid |
$26,446.16
|
| Rate for Payer: Meridian Medicaid |
$27,768.47
|
| Rate for Payer: PHP Medicaid |
$25,106.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$26,446.16
|
| Rate for Payer: UHC Medicaid |
$26,446.16
|
| Rate for Payer: UHCCP Medicaid |
$26,446.16
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$15,471.26
|
|
|
Service Code
|
MSDRG 560
|
| Min. Negotiated Rate |
$9,370.59 |
| Max. Negotiated Rate |
$15,471.26 |
| Rate for Payer: Aetna Medicare |
$9,863.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,329.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,329.73
|
| Rate for Payer: BCBS MAPPO |
$9,863.78
|
| Rate for Payer: BCN Medicare Advantage |
$9,863.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,863.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,863.78
|
| Rate for Payer: Mclaren Medicare |
$9,863.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,356.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,343.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,850.16
|
| Rate for Payer: PACE Medicare |
$9,370.59
|
| Rate for Payer: PACE SWMI |
$9,863.78
|
| Rate for Payer: PHP Commercial |
$10,850.16
|
| Rate for Payer: PHP Medicare Advantage |
$9,863.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,471.26
|
| Rate for Payer: Priority Health Medicare |
$9,863.78
|
| Rate for Payer: Priority Health Narrow Network |
$12,377.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,863.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,863.78
|
| Rate for Payer: UHC Exchange |
$15,288.86
|
| Rate for Payer: UHCCP DNSP |
$9,863.78
|
| Rate for Payer: VA VA |
$9,863.78
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$25,621.49
|
|
|
Service Code
|
MSDRG 559
|
| Min. Negotiated Rate |
$14,424.86 |
| Max. Negotiated Rate |
$25,621.49 |
| Rate for Payer: Aetna Medicare |
$15,184.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,980.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,980.08
|
| Rate for Payer: BCBS MAPPO |
$15,184.06
|
| Rate for Payer: BCN Medicare Advantage |
$15,184.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,184.06
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,184.06
|
| Rate for Payer: Mclaren Medicare |
$15,184.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,943.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,461.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,702.47
|
| Rate for Payer: PACE Medicare |
$14,424.86
|
| Rate for Payer: PACE SWMI |
$15,184.06
|
| Rate for Payer: PHP Commercial |
$16,702.47
|
| Rate for Payer: PHP Medicare Advantage |
$15,184.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,621.49
|
| Rate for Payer: Priority Health Medicare |
$15,184.06
|
| Rate for Payer: Priority Health Narrow Network |
$20,497.19
|
| Rate for Payer: Railroad Medicare Medicare |
$15,184.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,184.06
|
| Rate for Payer: UHC Exchange |
$23,535.29
|
| Rate for Payer: UHCCP DNSP |
$15,184.06
|
| Rate for Payer: VA VA |
$15,184.06
|
|
