|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
NDC 45802086800
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna Commercial |
$6.31
|
| Rate for Payer: Aetna Medicare |
$2.59
|
| Rate for Payer: ASR ASR |
$6.80
|
| Rate for Payer: BCBS Complete |
$2.81
|
| Rate for Payer: BCBS Trust/PPO |
$5.78
|
| Rate for Payer: BCN Commercial |
$5.78
|
| Rate for Payer: Cash Price |
$5.61
|
| Rate for Payer: Cofinity Commercial |
$6.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.61
|
| Rate for Payer: Healthscope Commercial |
$6.80
|
| Rate for Payer: Healthscope Whirlpool |
$7.01
|
| Rate for Payer: Mclaren Commercial |
$6.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.96
|
| Rate for Payer: Nomi Health Commercial |
$5.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.14
|
| Rate for Payer: Priority Health Narrow Network |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.17
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.38
|
|
|
Service Code
|
NDC 904693186
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna Commercial |
$5.74
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$6.18
|
| Rate for Payer: BCBS Complete |
$2.55
|
| Rate for Payer: BCBS Trust/PPO |
$5.26
|
| Rate for Payer: BCN Commercial |
$5.26
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cofinity Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.10
|
| Rate for Payer: Healthscope Commercial |
$6.18
|
| Rate for Payer: Healthscope Whirlpool |
$6.38
|
| Rate for Payer: Mclaren Commercial |
$5.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.42
|
| Rate for Payer: Nomi Health Commercial |
$5.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.59
|
| Rate for Payer: Priority Health Narrow Network |
$4.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.61
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna Commercial |
$5.77
|
| Rate for Payer: ASR ASR |
$6.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.27
|
| Rate for Payer: BCN Commercial |
$5.27
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$6.22
|
| Rate for Payer: Healthscope Whirlpool |
$6.41
|
| Rate for Payer: Mclaren Commercial |
$5.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.64
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$69.89
|
|
|
Service Code
|
NDC 68084043098
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$25.86
|
| Rate for Payer: ASR ASR |
$67.79
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$57.62
|
| Rate for Payer: BCN Commercial |
$57.62
|
| Rate for Payer: Cash Price |
$55.91
|
| Rate for Payer: Cofinity Commercial |
$65.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.91
|
| Rate for Payer: Healthscope Commercial |
$67.79
|
| Rate for Payer: Healthscope Whirlpool |
$69.89
|
| Rate for Payer: Mclaren Commercial |
$62.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.40
|
| Rate for Payer: Nomi Health Commercial |
$57.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.24
|
| Rate for Payer: Priority Health Narrow Network |
$48.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.50
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$520.80
|
|
|
Service Code
|
NDC 904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: ASR ASR |
$505.18
|
| Rate for Payer: BCBS Complete |
$208.32
|
| Rate for Payer: BCBS Trust/PPO |
$429.40
|
| Rate for Payer: BCN Commercial |
$429.40
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Healthscope Commercial |
$505.18
|
| Rate for Payer: Healthscope Whirlpool |
$520.80
|
| Rate for Payer: Mclaren Commercial |
$468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$456.32
|
| Rate for Payer: Priority Health Narrow Network |
$365.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.30
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
NDC 51079030601
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$6.41 |
| Rate for Payer: Aetna Commercial |
$5.77
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: ASR ASR |
$6.22
|
| Rate for Payer: BCBS Complete |
$2.57
|
| Rate for Payer: BCBS Trust/PPO |
$5.29
|
| Rate for Payer: BCN Commercial |
$5.29
|
| Rate for Payer: Cash Price |
$5.13
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.13
|
| Rate for Payer: Healthscope Commercial |
$6.22
|
| Rate for Payer: Healthscope Whirlpool |
$6.41
|
| Rate for Payer: Mclaren Commercial |
$5.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.45
|
| Rate for Payer: Nomi Health Commercial |
$5.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.62
|
| Rate for Payer: Priority Health Narrow Network |
$4.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.64
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$520.80
|
|
|
Service Code
|
NDC 904693181
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$390.60 |
| Max. Negotiated Rate |
$520.80 |
| Rate for Payer: Aetna Commercial |
$468.72
|
| Rate for Payer: ASR ASR |
$505.18
|
| Rate for Payer: BCBS Trust/PPO |
$427.68
|
| Rate for Payer: BCN Commercial |
$427.68
|
| Rate for Payer: Cash Price |
$416.64
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$416.64
|
| Rate for Payer: Healthscope Commercial |
$505.18
|
| Rate for Payer: Healthscope Whirlpool |
$520.80
|
| Rate for Payer: Mclaren Commercial |
$468.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$442.68
|
| Rate for Payer: Nomi Health Commercial |
$427.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.30
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
IP
|
$54.19
|
|
|
Service Code
|
NDC 41100080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: ASR ASR |
$52.57
|
| Rate for Payer: BCBS Trust/PPO |
$44.50
|
| Rate for Payer: BCN Commercial |
$44.50
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$52.57
|
| Rate for Payer: Healthscope Whirlpool |
$54.19
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$54.19
|
|
|
Service Code
|
NDC 41100080676
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$54.19 |
| Rate for Payer: Aetna Commercial |
$48.77
|
| Rate for Payer: Aetna Medicare |
$20.05
|
| Rate for Payer: ASR ASR |
$52.57
|
| Rate for Payer: BCBS Complete |
$21.68
|
| Rate for Payer: BCBS Trust/PPO |
$44.68
|
| Rate for Payer: BCN Commercial |
$44.68
|
| Rate for Payer: Cash Price |
$43.35
|
| Rate for Payer: Cofinity Commercial |
$50.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.35
|
| Rate for Payer: Healthscope Commercial |
$52.57
|
| Rate for Payer: Healthscope Whirlpool |
$54.19
|
| Rate for Payer: Mclaren Commercial |
$48.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.06
|
| Rate for Payer: Nomi Health Commercial |
$44.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$47.48
|
| Rate for Payer: Priority Health Narrow Network |
$37.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.69
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM ORAL POWDER PACKET
|
Facility
|
OP
|
$691.20
|
|
|
Service Code
|
NDC 17856031201
|
| Hospital Charge Code |
25424
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.74 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$622.08
|
| Rate for Payer: Aetna Medicare |
$255.74
|
| Rate for Payer: ASR ASR |
$670.46
|
| Rate for Payer: BCBS Complete |
$276.48
|
| Rate for Payer: BCBS Trust/PPO |
$569.89
|
| Rate for Payer: BCN Commercial |
$569.89
|
| Rate for Payer: Cash Price |
$552.96
|
| Rate for Payer: Cofinity Commercial |
$649.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$552.96
|
| Rate for Payer: Healthscope Commercial |
$670.46
|
| Rate for Payer: Healthscope Whirlpool |
$691.20
|
| Rate for Payer: Mclaren Commercial |
$622.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$552.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$587.52
|
| Rate for Payer: Nomi Health Commercial |
$566.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$518.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$605.63
|
| Rate for Payer: Priority Health Narrow Network |
$484.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$608.26
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$25,055.45
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$14,143.00 |
| Max. Negotiated Rate |
$25,055.45 |
| Rate for Payer: Aetna Medicare |
$14,887.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,609.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,609.21
|
| Rate for Payer: BCBS MAPPO |
$14,887.37
|
| Rate for Payer: BCN Medicare Advantage |
$14,887.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,887.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,887.37
|
| Rate for Payer: Mclaren Medicare |
$14,887.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,631.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,120.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,376.11
|
| Rate for Payer: PACE Medicare |
$14,143.00
|
| Rate for Payer: PACE SWMI |
$14,887.37
|
| Rate for Payer: PHP Commercial |
$16,376.11
|
| Rate for Payer: PHP Medicare Advantage |
$14,887.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,055.45
|
| Rate for Payer: Priority Health Medicare |
$14,887.37
|
| Rate for Payer: Priority Health Narrow Network |
$20,044.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14,887.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,887.37
|
| Rate for Payer: UHC Exchange |
$23,075.42
|
| Rate for Payer: UHCCP DNSP |
$14,887.37
|
| Rate for Payer: VA VA |
$14,887.37
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC
|
Facility
|
IP
|
$13,857.90
|
|
|
Service Code
|
MSDRG 863
|
| Min. Negotiated Rate |
$8,493.55 |
| Max. Negotiated Rate |
$13,857.90 |
| Rate for Payer: Aetna Medicare |
$8,940.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,175.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,175.73
|
| Rate for Payer: BCBS MAPPO |
$8,940.58
|
| Rate for Payer: BCN Medicare Advantage |
$8,940.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,940.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,940.58
|
| Rate for Payer: Mclaren Medicare |
$8,940.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,387.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,281.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,834.64
|
| Rate for Payer: PACE Medicare |
$8,493.55
|
| Rate for Payer: PACE SWMI |
$8,940.58
|
| Rate for Payer: PHP Commercial |
$9,834.64
|
| Rate for Payer: PHP Medicare Advantage |
$8,940.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13,709.95
|
| Rate for Payer: Priority Health Medicare |
$8,940.58
|
| Rate for Payer: Priority Health Narrow Network |
$10,967.96
|
| Rate for Payer: Railroad Medicare Medicare |
$8,940.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,940.58
|
| Rate for Payer: UHC Exchange |
$13,857.90
|
| Rate for Payer: UHCCP DNSP |
$8,940.58
|
| Rate for Payer: VA VA |
$8,940.58
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$29,421.64
|
|
|
Service Code
|
MSDRG 857
|
| Min. Negotiated Rate |
$16,317.12 |
| Max. Negotiated Rate |
$29,421.64 |
| Rate for Payer: Aetna Medicare |
$17,175.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,469.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,469.90
|
| Rate for Payer: BCBS MAPPO |
$17,175.92
|
| Rate for Payer: BCN Medicare Advantage |
$17,175.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,175.92
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,175.92
|
| Rate for Payer: Mclaren Medicare |
$17,175.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,034.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,752.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,893.51
|
| Rate for Payer: PACE Medicare |
$16,317.12
|
| Rate for Payer: PACE SWMI |
$17,175.92
|
| Rate for Payer: PHP Commercial |
$18,893.51
|
| Rate for Payer: PHP Medicare Advantage |
$17,175.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29,421.64
|
| Rate for Payer: Priority Health Medicare |
$17,175.92
|
| Rate for Payer: Priority Health Narrow Network |
$23,537.31
|
| Rate for Payer: Railroad Medicare Medicare |
$17,175.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,175.92
|
| Rate for Payer: UHC Exchange |
$26,622.68
|
| Rate for Payer: UHCCP DNSP |
$17,175.92
|
| Rate for Payer: VA VA |
$17,175.92
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$62,493.68
|
|
|
Service Code
|
MSDRG 856
|
| Min. Negotiated Rate |
$32,785.22 |
| Max. Negotiated Rate |
$62,493.68 |
| Rate for Payer: Aetna Medicare |
$34,510.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,138.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,138.45
|
| Rate for Payer: BCBS MAPPO |
$34,510.76
|
| Rate for Payer: BCN Medicare Advantage |
$34,510.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,510.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$34,510.76
|
| Rate for Payer: Mclaren Medicare |
$34,510.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,236.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39,687.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$37,961.84
|
| Rate for Payer: PACE Medicare |
$32,785.22
|
| Rate for Payer: PACE SWMI |
$34,510.76
|
| Rate for Payer: PHP Commercial |
$37,961.84
|
| Rate for Payer: PHP Medicare Advantage |
$34,510.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$62,493.68
|
| Rate for Payer: Priority Health Medicare |
$34,510.76
|
| Rate for Payer: Priority Health Narrow Network |
$49,994.94
|
| Rate for Payer: Railroad Medicare Medicare |
$34,510.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34,510.76
|
| Rate for Payer: UHC Exchange |
$53,491.68
|
| Rate for Payer: UHCCP DNSP |
$34,510.76
|
| Rate for Payer: VA VA |
$34,510.76
|
|
|
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,136.77
|
|
|
Service Code
|
MSDRG 858
|
| Min. Negotiated Rate |
$11,195.82 |
| Max. Negotiated Rate |
$19,136.77 |
| Rate for Payer: Aetna Medicare |
$11,785.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,731.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,731.34
|
| Rate for Payer: BCBS MAPPO |
$11,785.07
|
| Rate for Payer: BCN Medicare Advantage |
$11,785.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,785.07
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,785.07
|
| Rate for Payer: Mclaren Medicare |
$11,785.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,374.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,552.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,963.58
|
| Rate for Payer: PACE Medicare |
$11,195.82
|
| Rate for Payer: PACE SWMI |
$11,785.07
|
| Rate for Payer: PHP Commercial |
$12,963.58
|
| Rate for Payer: PHP Medicare Advantage |
$11,785.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19,136.77
|
| Rate for Payer: Priority Health Medicare |
$11,785.07
|
| Rate for Payer: Priority Health Narrow Network |
$15,309.42
|
| Rate for Payer: Railroad Medicare Medicare |
$11,785.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,785.07
|
| Rate for Payer: UHC Exchange |
$18,266.86
|
| Rate for Payer: UHCCP DNSP |
$11,785.07
|
| Rate for Payer: VA VA |
$11,785.07
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$12,724.04
|
|
|
Service Code
|
APR-DRG 7113
|
| Min. Negotiated Rate |
$11,504.05 |
| Max. Negotiated Rate |
$12,724.04 |
| Rate for Payer: BCBS Complete |
$12,724.04
|
| Rate for Payer: Mclaren Medicaid |
$12,118.13
|
| Rate for Payer: Meridian Medicaid |
$12,724.04
|
| Rate for Payer: PHP Medicaid |
$11,504.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,118.13
|
| Rate for Payer: UHC Medicaid |
$12,118.13
|
| Rate for Payer: UHCCP Medicaid |
$12,118.13
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$24,222.48
|
|
|
Service Code
|
APR-DRG 7114
|
| Min. Negotiated Rate |
$21,900.02 |
| Max. Negotiated Rate |
$24,222.48 |
| Rate for Payer: BCBS Complete |
$24,222.48
|
| Rate for Payer: Mclaren Medicaid |
$23,069.03
|
| Rate for Payer: Meridian Medicaid |
$24,222.48
|
| Rate for Payer: PHP Medicaid |
$21,900.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,069.03
|
| Rate for Payer: UHC Medicaid |
$23,069.03
|
| Rate for Payer: UHCCP Medicaid |
$23,069.03
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$7,827.12
|
|
|
Service Code
|
APR-DRG 7111
|
| Min. Negotiated Rate |
$7,076.65 |
| Max. Negotiated Rate |
$7,827.12 |
| Rate for Payer: BCBS Complete |
$7,827.12
|
| Rate for Payer: Mclaren Medicaid |
$7,454.40
|
| Rate for Payer: Meridian Medicaid |
$7,827.12
|
| Rate for Payer: PHP Medicaid |
$7,076.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,454.40
|
| Rate for Payer: UHC Medicaid |
$7,454.40
|
| Rate for Payer: UHCCP Medicaid |
$7,454.40
|
|
|
POST-OPERATIVE, POST-TRAUMA, OTHER DEVICE INFECTIONS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$10,063.05
|
|
|
Service Code
|
APR-DRG 7112
|
| Min. Negotiated Rate |
$9,098.20 |
| Max. Negotiated Rate |
$10,063.05 |
| Rate for Payer: BCBS Complete |
$10,063.05
|
| Rate for Payer: Mclaren Medicaid |
$9,583.85
|
| Rate for Payer: Meridian Medicaid |
$10,063.05
|
| Rate for Payer: PHP Medicaid |
$9,098.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,583.85
|
| Rate for Payer: UHC Medicaid |
$9,583.85
|
| Rate for Payer: UHCCP Medicaid |
$9,583.85
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$8,904.48
|
|
|
Service Code
|
APR-DRG 7213
|
| Min. Negotiated Rate |
$8,050.72 |
| Max. Negotiated Rate |
$8,904.48 |
| Rate for Payer: BCBS Complete |
$8,904.48
|
| Rate for Payer: Mclaren Medicaid |
$8,480.46
|
| Rate for Payer: Meridian Medicaid |
$8,904.48
|
| Rate for Payer: PHP Medicaid |
$8,050.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,480.46
|
| Rate for Payer: UHC Medicaid |
$8,480.46
|
| Rate for Payer: UHCCP Medicaid |
$8,480.46
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$13,268.44
|
|
|
Service Code
|
APR-DRG 7214
|
| Min. Negotiated Rate |
$11,996.26 |
| Max. Negotiated Rate |
$13,268.44 |
| Rate for Payer: BCBS Complete |
$13,268.44
|
| Rate for Payer: Mclaren Medicaid |
$12,636.61
|
| Rate for Payer: Meridian Medicaid |
$13,268.44
|
| Rate for Payer: PHP Medicaid |
$11,996.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,636.61
|
| Rate for Payer: UHC Medicaid |
$12,636.61
|
| Rate for Payer: UHCCP Medicaid |
$12,636.61
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$5,232.61
|
|
|
Service Code
|
APR-DRG 7212
|
| Min. Negotiated Rate |
$4,730.91 |
| Max. Negotiated Rate |
$5,232.61 |
| Rate for Payer: BCBS Complete |
$5,232.61
|
| Rate for Payer: Mclaren Medicaid |
$4,983.44
|
| Rate for Payer: Meridian Medicaid |
$5,232.61
|
| Rate for Payer: PHP Medicaid |
$4,730.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,983.44
|
| Rate for Payer: UHC Medicaid |
$4,983.44
|
| Rate for Payer: UHCCP Medicaid |
$4,983.44
|
|
|
POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS
|
Facility
|
IP
|
$3,798.85
|
|
|
Service Code
|
APR-DRG 7211
|
| Min. Negotiated Rate |
$3,434.61 |
| Max. Negotiated Rate |
$3,798.85 |
| Rate for Payer: BCBS Complete |
$3,798.85
|
| Rate for Payer: Mclaren Medicaid |
$3,617.95
|
| Rate for Payer: Meridian Medicaid |
$3,798.85
|
| Rate for Payer: PHP Medicaid |
$3,434.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,617.95
|
| Rate for Payer: UHC Medicaid |
$3,617.95
|
| Rate for Payer: UHCCP Medicaid |
$3,617.95
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$21,580.84
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$13,226.96 |
| Max. Negotiated Rate |
$21,580.84 |
| Rate for Payer: Aetna Medicare |
$13,923.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,403.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,403.90
|
| Rate for Payer: BCBS MAPPO |
$13,923.12
|
| Rate for Payer: BCN Medicare Advantage |
$13,923.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,923.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,923.12
|
| Rate for Payer: Mclaren Medicare |
$13,923.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,619.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,011.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,315.43
|
| Rate for Payer: PACE Medicare |
$13,226.96
|
| Rate for Payer: PACE SWMI |
$13,923.12
|
| Rate for Payer: PHP Commercial |
$15,315.43
|
| Rate for Payer: PHP Medicare Advantage |
$13,923.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,754.65
|
| Rate for Payer: Priority Health Medicare |
$13,923.12
|
| Rate for Payer: Priority Health Narrow Network |
$14,203.72
|
| Rate for Payer: Railroad Medicare Medicare |
$13,923.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,923.12
|
| Rate for Payer: UHC Exchange |
$21,580.84
|
| Rate for Payer: UHCCP DNSP |
$13,923.12
|
| Rate for Payer: VA VA |
$13,923.12
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$10,027.14
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$6,145.66 |
| Max. Negotiated Rate |
$10,027.14 |
| Rate for Payer: Aetna Medicare |
$6,469.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,086.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,086.40
|
| Rate for Payer: BCBS MAPPO |
$6,469.12
|
| Rate for Payer: BCN Medicare Advantage |
$6,469.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,469.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,469.12
|
| Rate for Payer: Mclaren Medicare |
$6,469.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,792.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,439.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,116.03
|
| Rate for Payer: PACE Medicare |
$6,145.66
|
| Rate for Payer: PACE SWMI |
$6,469.12
|
| Rate for Payer: PHP Commercial |
$7,116.03
|
| Rate for Payer: PHP Medicare Advantage |
$6,469.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8,507.06
|
| Rate for Payer: Priority Health Medicare |
$6,469.12
|
| Rate for Payer: Priority Health Narrow Network |
$6,805.65
|
| Rate for Payer: Railroad Medicare Medicare |
$6,469.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,469.12
|
| Rate for Payer: UHC Exchange |
$10,027.14
|
| Rate for Payer: UHCCP DNSP |
$6,469.12
|
| Rate for Payer: VA VA |
$6,469.12
|
|
