|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$7,809.68
|
|
|
Service Code
|
APR-DRG 3843
|
| Min. Negotiated Rate |
$7,060.88 |
| Max. Negotiated Rate |
$7,809.68 |
| Rate for Payer: BCBS Complete |
$7,809.68
|
| Rate for Payer: Mclaren Medicaid |
$7,437.79
|
| Rate for Payer: Meridian Medicaid |
$7,809.68
|
| Rate for Payer: PHP Medicaid |
$7,060.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,437.79
|
| Rate for Payer: UHC Medicaid |
$7,437.79
|
| Rate for Payer: UHCCP Medicaid |
$7,437.79
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$4,856.59
|
|
|
Service Code
|
APR-DRG 3842
|
| Min. Negotiated Rate |
$4,390.94 |
| Max. Negotiated Rate |
$4,856.59 |
| Rate for Payer: BCBS Complete |
$4,856.59
|
| Rate for Payer: Mclaren Medicaid |
$4,625.33
|
| Rate for Payer: Meridian Medicaid |
$4,856.59
|
| Rate for Payer: PHP Medicaid |
$4,390.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,625.33
|
| Rate for Payer: UHC Medicaid |
$4,625.33
|
| Rate for Payer: UHCCP Medicaid |
$4,625.33
|
|
|
CONTUSION, OPEN WOUND AND OTHER TRAUMA TO SKIN AND SUBCUTANEOUS TISSUE
|
Facility
|
IP
|
$3,864.24
|
|
|
Service Code
|
APR-DRG 3841
|
| Min. Negotiated Rate |
$3,493.74 |
| Max. Negotiated Rate |
$3,864.24 |
| Rate for Payer: BCBS Complete |
$3,864.24
|
| Rate for Payer: Mclaren Medicaid |
$3,680.23
|
| Rate for Payer: Meridian Medicaid |
$3,864.24
|
| Rate for Payer: PHP Medicaid |
$3,493.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,680.23
|
| Rate for Payer: UHC Medicaid |
$3,680.23
|
| Rate for Payer: UHCCP Medicaid |
$3,680.23
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,876.47
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$19,778.95 |
| Max. Negotiated Rate |
$21,876.47 |
| Rate for Payer: BCBS Complete |
$21,876.47
|
| Rate for Payer: Mclaren Medicaid |
$20,834.74
|
| Rate for Payer: Meridian Medicaid |
$21,876.47
|
| Rate for Payer: PHP Medicaid |
$19,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,834.74
|
| Rate for Payer: UHC Medicaid |
$20,834.74
|
| Rate for Payer: UHCCP Medicaid |
$20,834.74
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$30,124.29
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$27,235.96 |
| Max. Negotiated Rate |
$30,124.29 |
| Rate for Payer: BCBS Complete |
$30,124.29
|
| Rate for Payer: Mclaren Medicaid |
$28,689.80
|
| Rate for Payer: Meridian Medicaid |
$30,124.29
|
| Rate for Payer: PHP Medicaid |
$27,235.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$28,689.80
|
| Rate for Payer: UHC Medicaid |
$28,689.80
|
| Rate for Payer: UHCCP Medicaid |
$28,689.80
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$34,057.74
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$30,792.27 |
| Max. Negotiated Rate |
$34,057.74 |
| Rate for Payer: BCBS Complete |
$34,057.74
|
| Rate for Payer: Mclaren Medicaid |
$32,435.94
|
| Rate for Payer: Meridian Medicaid |
$34,057.74
|
| Rate for Payer: PHP Medicaid |
$30,792.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,435.94
|
| Rate for Payer: UHC Medicaid |
$32,435.94
|
| Rate for Payer: UHCCP Medicaid |
$32,435.94
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$25,125.46
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$22,716.43 |
| Max. Negotiated Rate |
$25,125.46 |
| Rate for Payer: BCBS Complete |
$25,125.46
|
| Rate for Payer: Mclaren Medicaid |
$23,929.01
|
| Rate for Payer: Meridian Medicaid |
$25,125.46
|
| Rate for Payer: PHP Medicaid |
$22,716.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,929.01
|
| Rate for Payer: UHC Medicaid |
$23,929.01
|
| Rate for Payer: UHCCP Medicaid |
$23,929.01
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$105,035.87
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$53,968.93 |
| Max. Negotiated Rate |
$105,035.87 |
| Rate for Payer: Aetna Medicare |
$56,809.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71,011.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71,011.75
|
| Rate for Payer: BCBS MAPPO |
$56,809.40
|
| Rate for Payer: BCN Medicare Advantage |
$56,809.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,809.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$56,809.40
|
| Rate for Payer: Mclaren Medicare |
$56,809.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59,649.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65,330.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$62,490.34
|
| Rate for Payer: PACE Medicare |
$53,968.93
|
| Rate for Payer: PACE SWMI |
$56,809.40
|
| Rate for Payer: PHP Commercial |
$62,490.34
|
| Rate for Payer: PHP Medicare Advantage |
$56,809.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105,035.87
|
| Rate for Payer: Priority Health Medicare |
$56,809.40
|
| Rate for Payer: Priority Health Narrow Network |
$84,028.70
|
| Rate for Payer: Railroad Medicare Medicare |
$56,809.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,809.40
|
| Rate for Payer: UHC Exchange |
$88,054.57
|
| Rate for Payer: UHCCP DNSP |
$56,809.40
|
| Rate for Payer: VA VA |
$56,809.40
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$75,050.94
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$39,038.06 |
| Max. Negotiated Rate |
$75,050.94 |
| Rate for Payer: Aetna Medicare |
$41,092.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51,365.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51,365.86
|
| Rate for Payer: BCBS MAPPO |
$41,092.69
|
| Rate for Payer: BCN Medicare Advantage |
$41,092.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,092.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,092.69
|
| Rate for Payer: Mclaren Medicare |
$41,092.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,147.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47,256.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$45,201.96
|
| Rate for Payer: PACE Medicare |
$39,038.06
|
| Rate for Payer: PACE SWMI |
$41,092.69
|
| Rate for Payer: PHP Commercial |
$45,201.96
|
| Rate for Payer: PHP Medicare Advantage |
$41,092.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75,050.94
|
| Rate for Payer: Priority Health Medicare |
$41,092.69
|
| Rate for Payer: Priority Health Narrow Network |
$60,040.75
|
| Rate for Payer: Railroad Medicare Medicare |
$41,092.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,092.69
|
| Rate for Payer: UHC Exchange |
$63,693.67
|
| Rate for Payer: UHCCP DNSP |
$41,092.69
|
| Rate for Payer: VA VA |
$41,092.69
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$17,714.14
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$16,015.71 |
| Max. Negotiated Rate |
$17,714.14 |
| Rate for Payer: BCBS Complete |
$17,714.14
|
| Rate for Payer: Mclaren Medicaid |
$16,870.61
|
| Rate for Payer: Meridian Medicaid |
$17,714.14
|
| Rate for Payer: PHP Medicaid |
$16,015.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,870.61
|
| Rate for Payer: UHC Medicaid |
$16,870.61
|
| Rate for Payer: UHCCP Medicaid |
$16,870.61
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$21,259.04
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$19,220.72 |
| Max. Negotiated Rate |
$21,259.04 |
| Rate for Payer: BCBS Complete |
$21,259.04
|
| Rate for Payer: Mclaren Medicaid |
$20,246.71
|
| Rate for Payer: Meridian Medicaid |
$21,259.04
|
| Rate for Payer: PHP Medicaid |
$19,220.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$20,246.71
|
| Rate for Payer: UHC Medicaid |
$20,246.71
|
| Rate for Payer: UHCCP Medicaid |
$20,246.71
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$22,419.24
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$20,269.68 |
| Max. Negotiated Rate |
$22,419.24 |
| Rate for Payer: BCBS Complete |
$22,419.24
|
| Rate for Payer: Mclaren Medicaid |
$21,351.66
|
| Rate for Payer: Meridian Medicaid |
$22,419.24
|
| Rate for Payer: PHP Medicaid |
$20,269.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,351.66
|
| Rate for Payer: UHC Medicaid |
$21,351.66
|
| Rate for Payer: UHCCP Medicaid |
$21,351.66
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$33,937.85
|
|
|
Service Code
|
APR-DRG 1664
|
| Min. Negotiated Rate |
$30,683.88 |
| Max. Negotiated Rate |
$33,937.85 |
| Rate for Payer: BCBS Complete |
$33,937.85
|
| Rate for Payer: Mclaren Medicaid |
$32,321.76
|
| Rate for Payer: Meridian Medicaid |
$33,937.85
|
| Rate for Payer: PHP Medicaid |
$30,683.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$32,321.76
|
| Rate for Payer: UHC Medicaid |
$32,321.76
|
| Rate for Payer: UHCCP Medicaid |
$32,321.76
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
|
IP
|
$80,627.52
|
|
|
Service Code
|
MSDRG 235
|
| Min. Negotiated Rate |
$41,814.89 |
| Max. Negotiated Rate |
$80,627.52 |
| Rate for Payer: Aetna Medicare |
$44,015.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,019.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,019.59
|
| Rate for Payer: BCBS MAPPO |
$44,015.67
|
| Rate for Payer: BCN Medicare Advantage |
$44,015.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,015.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$44,015.67
|
| Rate for Payer: Mclaren Medicare |
$44,015.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,216.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,618.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,417.24
|
| Rate for Payer: PACE Medicare |
$41,814.89
|
| Rate for Payer: PACE SWMI |
$44,015.67
|
| Rate for Payer: PHP Commercial |
$48,417.24
|
| Rate for Payer: PHP Medicare Advantage |
$44,015.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$80,627.52
|
| Rate for Payer: Priority Health Medicare |
$44,015.67
|
| Rate for Payer: Priority Health Narrow Network |
$64,502.02
|
| Rate for Payer: Railroad Medicare Medicare |
$44,015.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44,015.67
|
| Rate for Payer: UHC Exchange |
$68,224.29
|
| Rate for Payer: UHCCP DNSP |
$44,015.67
|
| Rate for Payer: VA VA |
$44,015.67
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
|
IP
|
$57,549.09
|
|
|
Service Code
|
MSDRG 236
|
| Min. Negotiated Rate |
$30,323.08 |
| Max. Negotiated Rate |
$57,549.09 |
| Rate for Payer: Aetna Medicare |
$31,919.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,898.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,898.79
|
| Rate for Payer: BCBS MAPPO |
$31,919.03
|
| Rate for Payer: BCN Medicare Advantage |
$31,919.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,919.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,919.03
|
| Rate for Payer: Mclaren Medicare |
$31,919.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,514.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,706.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,110.93
|
| Rate for Payer: PACE Medicare |
$30,323.08
|
| Rate for Payer: PACE SWMI |
$31,919.03
|
| Rate for Payer: PHP Commercial |
$35,110.93
|
| Rate for Payer: PHP Medicare Advantage |
$31,919.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57,549.09
|
| Rate for Payer: Priority Health Medicare |
$31,919.03
|
| Rate for Payer: Priority Health Narrow Network |
$46,039.27
|
| Rate for Payer: Railroad Medicare Medicare |
$31,919.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,919.03
|
| Rate for Payer: UHC Exchange |
$49,474.50
|
| Rate for Payer: UHCCP DNSP |
$31,919.03
|
| Rate for Payer: VA VA |
$31,919.03
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
|
IP
|
$115,816.71
|
|
|
Service Code
|
MSDRG 231
|
| Min. Negotiated Rate |
$59,337.21 |
| Max. Negotiated Rate |
$115,816.71 |
| Rate for Payer: Aetna Medicare |
$62,460.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78,075.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78,075.27
|
| Rate for Payer: BCBS MAPPO |
$62,460.22
|
| Rate for Payer: BCN Medicare Advantage |
$62,460.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62,460.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$62,460.22
|
| Rate for Payer: Mclaren Medicare |
$62,460.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65,583.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71,829.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$68,706.24
|
| Rate for Payer: PACE Medicare |
$59,337.21
|
| Rate for Payer: PACE SWMI |
$62,460.22
|
| Rate for Payer: PHP Commercial |
$68,706.24
|
| Rate for Payer: PHP Medicare Advantage |
$62,460.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$115,816.71
|
| Rate for Payer: Priority Health Medicare |
$62,460.22
|
| Rate for Payer: Priority Health Narrow Network |
$92,653.37
|
| Rate for Payer: Railroad Medicare Medicare |
$62,460.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62,460.22
|
| Rate for Payer: UHC Exchange |
$96,813.34
|
| Rate for Payer: UHCCP DNSP |
$62,460.22
|
| Rate for Payer: VA VA |
$62,460.22
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
|
IP
|
$83,292.85
|
|
|
Service Code
|
MSDRG 232
|
| Min. Negotiated Rate |
$43,142.07 |
| Max. Negotiated Rate |
$83,292.85 |
| Rate for Payer: Aetna Medicare |
$45,412.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,765.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,765.89
|
| Rate for Payer: BCBS MAPPO |
$45,412.71
|
| Rate for Payer: BCN Medicare Advantage |
$45,412.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,412.71
|
| Rate for Payer: Humana Choice PPO Medicare |
$45,412.71
|
| Rate for Payer: Mclaren Medicare |
$45,412.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,683.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52,224.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$49,953.98
|
| Rate for Payer: PACE Medicare |
$43,142.07
|
| Rate for Payer: PACE SWMI |
$45,412.71
|
| Rate for Payer: PHP Commercial |
$49,953.98
|
| Rate for Payer: PHP Medicare Advantage |
$45,412.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$83,292.85
|
| Rate for Payer: Priority Health Medicare |
$45,412.71
|
| Rate for Payer: Priority Health Narrow Network |
$66,634.28
|
| Rate for Payer: Railroad Medicare Medicare |
$45,412.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45,412.71
|
| Rate for Payer: UHC Exchange |
$70,389.70
|
| Rate for Payer: UHCCP DNSP |
$45,412.71
|
| Rate for Payer: VA VA |
$45,412.71
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$59,453.28
|
|
|
Service Code
|
MSDRG 323
|
| Min. Negotiated Rate |
$31,271.26 |
| Max. Negotiated Rate |
$59,453.28 |
| Rate for Payer: Aetna Medicare |
$32,917.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,146.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,146.40
|
| Rate for Payer: BCBS MAPPO |
$32,917.12
|
| Rate for Payer: BCN Medicare Advantage |
$32,917.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,917.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$32,917.12
|
| Rate for Payer: Mclaren Medicare |
$32,917.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,562.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,854.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,208.83
|
| Rate for Payer: PACE Medicare |
$31,271.26
|
| Rate for Payer: PACE SWMI |
$32,917.12
|
| Rate for Payer: PHP Commercial |
$36,208.83
|
| Rate for Payer: PHP Medicare Advantage |
$32,917.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$59,453.28
|
| Rate for Payer: Priority Health Medicare |
$32,917.12
|
| Rate for Payer: Priority Health Narrow Network |
$47,562.63
|
| Rate for Payer: Railroad Medicare Medicare |
$32,917.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,917.12
|
| Rate for Payer: UHC Exchange |
$51,021.54
|
| Rate for Payer: UHCCP DNSP |
$32,917.12
|
| Rate for Payer: VA VA |
$32,917.12
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$43,290.96
|
|
|
Service Code
|
MSDRG 324
|
| Min. Negotiated Rate |
$23,223.30 |
| Max. Negotiated Rate |
$43,290.96 |
| Rate for Payer: Aetna Medicare |
$24,445.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,556.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,556.97
|
| Rate for Payer: BCBS MAPPO |
$24,445.58
|
| Rate for Payer: BCN Medicare Advantage |
$24,445.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,445.58
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,445.58
|
| Rate for Payer: Mclaren Medicare |
$24,445.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,667.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,112.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,890.14
|
| Rate for Payer: PACE Medicare |
$23,223.30
|
| Rate for Payer: PACE SWMI |
$24,445.58
|
| Rate for Payer: PHP Commercial |
$26,890.14
|
| Rate for Payer: PHP Medicare Advantage |
$24,445.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$43,290.96
|
| Rate for Payer: Priority Health Medicare |
$24,445.58
|
| Rate for Payer: Priority Health Narrow Network |
$34,632.77
|
| Rate for Payer: Railroad Medicare Medicare |
$24,445.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,445.58
|
| Rate for Payer: UHC Exchange |
$37,890.65
|
| Rate for Payer: UHCCP DNSP |
$24,445.58
|
| Rate for Payer: VA VA |
$24,445.58
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$44,107.04
|
|
|
Service Code
|
MSDRG 325
|
| Min. Negotiated Rate |
$23,629.66 |
| Max. Negotiated Rate |
$44,107.04 |
| Rate for Payer: Aetna Medicare |
$24,873.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,091.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,091.66
|
| Rate for Payer: BCBS MAPPO |
$24,873.33
|
| Rate for Payer: BCN Medicare Advantage |
$24,873.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,873.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,873.33
|
| Rate for Payer: Mclaren Medicare |
$24,873.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,117.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,604.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,360.66
|
| Rate for Payer: PACE Medicare |
$23,629.66
|
| Rate for Payer: PACE SWMI |
$24,873.33
|
| Rate for Payer: PHP Commercial |
$27,360.66
|
| Rate for Payer: PHP Medicare Advantage |
$24,873.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,107.04
|
| Rate for Payer: Priority Health Medicare |
$24,873.33
|
| Rate for Payer: Priority Health Narrow Network |
$35,285.63
|
| Rate for Payer: Railroad Medicare Medicare |
$24,873.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,873.33
|
| Rate for Payer: UHC Exchange |
$38,553.66
|
| Rate for Payer: UHCCP DNSP |
$24,873.33
|
| Rate for Payer: VA VA |
$24,873.33
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$134.50
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$134.50 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Medicare |
$107.70
|
| Rate for Payer: Aetna Medicare |
$49.77
|
| Rate for Payer: Aetna Medicare |
$30.62
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR ASR |
$130.47
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: BCBS Complete |
$53.80
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Trust/PPO |
$110.90
|
| Rate for Payer: BCBS Trust/PPO |
$240.00
|
| Rate for Payer: BCBS Trust/PPO |
$68.24
|
| Rate for Payer: BCN Commercial |
$110.90
|
| Rate for Payer: BCN Commercial |
$240.00
|
| Rate for Payer: BCN Commercial |
$68.24
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$107.60
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$107.60
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Cofinity Commercial |
$126.43
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Healthscope Commercial |
$80.29
|
| Rate for Payer: Healthscope Commercial |
$130.47
|
| Rate for Payer: Healthscope Commercial |
$282.36
|
| Rate for Payer: Healthscope Whirlpool |
$291.09
|
| Rate for Payer: Healthscope Whirlpool |
$134.50
|
| Rate for Payer: Healthscope Whirlpool |
$82.77
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$121.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$232.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.33
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Nomi Health Commercial |
$110.29
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$21.43
|
| Rate for Payer: Priority Health Narrow Network |
$17.14
|
| Rate for Payer: Priority Health Narrow Network |
$17.14
|
| Rate for Payer: Priority Health Narrow Network |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.36
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$134.50
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$134.50 |
| Rate for Payer: Aetna Commercial |
$121.05
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Commercial |
$261.98
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR ASR |
$130.47
|
| Rate for Payer: ASR ASR |
$282.36
|
| Rate for Payer: BCBS Trust/PPO |
$67.97
|
| Rate for Payer: BCBS Trust/PPO |
$110.45
|
| Rate for Payer: BCBS Trust/PPO |
$239.04
|
| Rate for Payer: BCN Commercial |
$239.04
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Commercial |
$67.97
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$107.60
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cofinity Commercial |
$126.43
|
| Rate for Payer: Cofinity Commercial |
$273.62
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Healthscope Commercial |
$282.36
|
| Rate for Payer: Healthscope Commercial |
$130.47
|
| Rate for Payer: Healthscope Commercial |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$291.09
|
| Rate for Payer: Healthscope Whirlpool |
$82.77
|
| Rate for Payer: Healthscope Whirlpool |
$134.50
|
| Rate for Payer: Mclaren Commercial |
$261.98
|
| Rate for Payer: Mclaren Commercial |
$121.05
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.33
|
| Rate for Payer: Nomi Health Commercial |
$238.69
|
| Rate for Payer: Nomi Health Commercial |
$110.29
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.36
|
|
|
CPT 0255T
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: BCBS Complete |
$187.60
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.75
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC
|
Facility
|
IP
|
$22,041.16
|
|
|
Service Code
|
MSDRG 073
|
| Min. Negotiated Rate |
$12,642.05 |
| Max. Negotiated Rate |
$22,041.16 |
| Rate for Payer: Aetna Medicare |
$13,307.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,634.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,634.28
|
| Rate for Payer: BCBS MAPPO |
$13,307.42
|
| Rate for Payer: BCN Medicare Advantage |
$13,307.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,307.42
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,307.42
|
| Rate for Payer: Mclaren Medicare |
$13,307.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,972.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,303.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,638.16
|
| Rate for Payer: PACE Medicare |
$12,642.05
|
| Rate for Payer: PACE SWMI |
$13,307.42
|
| Rate for Payer: PHP Commercial |
$14,638.16
|
| Rate for Payer: PHP Medicare Advantage |
$13,307.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22,041.16
|
| Rate for Payer: Priority Health Medicare |
$13,307.42
|
| Rate for Payer: Priority Health Narrow Network |
$17,632.93
|
| Rate for Payer: Railroad Medicare Medicare |
$13,307.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,307.42
|
| Rate for Payer: UHC Exchange |
$20,626.50
|
| Rate for Payer: UHCCP DNSP |
$13,307.42
|
| Rate for Payer: VA VA |
$13,307.42
|
|
|
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,225.14
|
|
|
Service Code
|
MSDRG 074
|
| Min. Negotiated Rate |
$8,718.63 |
| Max. Negotiated Rate |
$14,225.14 |
| Rate for Payer: Aetna Medicare |
$9,177.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,471.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,471.89
|
| Rate for Payer: BCBS MAPPO |
$9,177.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,177.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,177.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,177.51
|
| Rate for Payer: Mclaren Medicare |
$9,177.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,636.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,554.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,095.26
|
| Rate for Payer: PACE Medicare |
$8,718.63
|
| Rate for Payer: PACE SWMI |
$9,177.51
|
| Rate for Payer: PHP Commercial |
$10,095.26
|
| Rate for Payer: PHP Medicare Advantage |
$9,177.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,161.96
|
| Rate for Payer: Priority Health Medicare |
$9,177.51
|
| Rate for Payer: Priority Health Narrow Network |
$11,329.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9,177.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,177.51
|
| Rate for Payer: UHC Exchange |
$14,225.14
|
| Rate for Payer: UHCCP DNSP |
$9,177.51
|
| Rate for Payer: VA VA |
$9,177.51
|
|
