|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$577.15
|
| Rate for Payer: BCN Commercial |
$577.15
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$577.15
|
| Rate for Payer: BCN Commercial |
$577.15
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,951.48
|
| Rate for Payer: BCN Commercial |
$4,951.48
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$3,864.33
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$5,317.36
|
| Rate for Payer: BCN Commercial |
$5,317.36
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$3,864.33
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,091.68 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,091.68
|
| Rate for Payer: BCN Commercial |
$1,091.68
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 57455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$157.18 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$163.65
|
| Rate for Payer: BCCCP Commercial |
$157.18
|
| Rate for Payer: BCN Commercial |
$163.65
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$172.94
|
| Rate for Payer: BCCCP Commercial |
$164.88
|
| Rate for Payer: BCN Commercial |
$172.94
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 57456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$154.52
|
| Rate for Payer: BCCCP Commercial |
$146.69
|
| Rate for Payer: BCN Commercial |
$154.52
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$158.80
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$295.08 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,331.22
|
| Rate for Payer: BCCCP Commercial |
$295.08
|
| Rate for Payer: BCN Commercial |
$2,331.22
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,331.22
|
| Rate for Payer: BCCCP Commercial |
$331.06
|
| Rate for Payer: BCN Commercial |
$2,331.22
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S) OF VAGINA/CERVIX
|
Facility
|
OP
|
$2,967.88
|
|
|
Service Code
|
CPT 57421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.98 |
| Max. Negotiated Rate |
$2,967.88 |
| Rate for Payer: Aetna Medicare |
$954.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$580.01
|
| Rate for Payer: BCN Commercial |
$580.01
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Mclaren Medicaid |
$479.98
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$963.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Nomi Health Commercial |
$2,753.22
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,967.88
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,374.30
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$917.74
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: VA VA |
$917.74
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$146,856.48
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$66,696.87 |
| Max. Negotiated Rate |
$146,856.48 |
| Rate for Payer: Aetna Medicare |
$73,015.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87,759.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87,759.04
|
| Rate for Payer: BCBS MAPPO |
$70,207.23
|
| Rate for Payer: BCBS Trust/PPO |
$133,177.48
|
| Rate for Payer: BCN Commercial |
$133,177.48
|
| Rate for Payer: BCN Medicare Advantage |
$70,207.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70,207.23
|
| Rate for Payer: Mclaren Medicare |
$70,207.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73,717.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80,738.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$77,227.95
|
| Rate for Payer: Nomi Health Commercial |
$116,223.84
|
| Rate for Payer: PACE Medicare |
$66,696.87
|
| Rate for Payer: PACE SWMI |
$70,207.23
|
| Rate for Payer: PHP Medicare Advantage |
$70,207.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145,254.03
|
| Rate for Payer: Priority Health Medicare |
$70,207.23
|
| Rate for Payer: Priority Health Tiered Network |
$116,203.21
|
| Rate for Payer: Railroad Medicare Medicare |
$70,207.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146,856.48
|
| Rate for Payer: UHC Core |
$122,863.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70,207.23
|
| Rate for Payer: UHC Exchange |
$100,339.92
|
| Rate for Payer: VA VA |
$70,207.23
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$94,003.73
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$42,891.03 |
| Max. Negotiated Rate |
$94,003.73 |
| Rate for Payer: Railroad Medicare Medicare |
$45,148.45
|
| Rate for Payer: Aetna Medicare |
$46,954.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56,435.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56,435.56
|
| Rate for Payer: BCBS MAPPO |
$45,148.45
|
| Rate for Payer: BCBS Trust/PPO |
$93,610.93
|
| Rate for Payer: BCN Commercial |
$93,610.93
|
| Rate for Payer: BCN Medicare Advantage |
$45,148.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45,148.45
|
| Rate for Payer: Mclaren Medicare |
$45,148.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47,405.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,920.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$49,663.29
|
| Rate for Payer: Nomi Health Commercial |
$74,395.59
|
| Rate for Payer: PACE Medicare |
$42,891.03
|
| Rate for Payer: PACE SWMI |
$45,148.45
|
| Rate for Payer: PHP Medicare Advantage |
$45,148.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92,977.99
|
| Rate for Payer: Priority Health Medicare |
$45,148.45
|
| Rate for Payer: Priority Health Tiered Network |
$74,382.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,003.73
|
| Rate for Payer: UHC Core |
$78,645.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45,148.45
|
| Rate for Payer: UHC Exchange |
$64,228.19
|
| Rate for Payer: VA VA |
$45,148.45
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,477.36
|
| Rate for Payer: BCN Commercial |
$4,477.36
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$2,606.87
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
COMPLEX AORTIC ARCH PROCEDURES
|
Facility
|
IP
|
$225,004.72
|
|
|
Service Code
|
MSDRG 209
|
| Min. Negotiated Rate |
$83,650.60 |
| Max. Negotiated Rate |
$225,004.72 |
| Rate for Payer: Aetna Medicare |
$91,575.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110,066.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110,066.57
|
| Rate for Payer: BCBS MAPPO |
$88,053.26
|
| Rate for Payer: BCBS Trust/PPO |
$225,004.72
|
| Rate for Payer: BCN Commercial |
$225,004.72
|
| Rate for Payer: BCN Medicare Advantage |
$88,053.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88,053.26
|
| Rate for Payer: Mclaren Medicare |
$88,053.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92,455.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101,261.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$96,858.59
|
| Rate for Payer: Nomi Health Commercial |
$146,012.52
|
| Rate for Payer: PACE Medicare |
$83,650.60
|
| Rate for Payer: PACE SWMI |
$88,053.26
|
| Rate for Payer: PHP Medicare Advantage |
$88,053.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$182,483.28
|
| Rate for Payer: Priority Health Medicare |
$88,053.26
|
| Rate for Payer: Priority Health Tiered Network |
$145,986.60
|
| Rate for Payer: Railroad Medicare Medicare |
$88,053.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184,496.44
|
| Rate for Payer: UHC Core |
$154,354.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$88,053.26
|
| Rate for Payer: UHC Exchange |
$126,057.48
|
| Rate for Payer: VA VA |
$88,053.26
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$17,661.05
|
|
|
Service Code
|
MSDRG 381
|
| Min. Negotiated Rate |
$8,504.90 |
| Max. Negotiated Rate |
$17,661.05 |
| Rate for Payer: Aetna Medicare |
$9,310.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,190.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,190.66
|
| Rate for Payer: BCBS MAPPO |
$8,952.53
|
| Rate for Payer: BCBS Trust/PPO |
$17,167.43
|
| Rate for Payer: BCN Commercial |
$17,167.43
|
| Rate for Payer: BCN Medicare Advantage |
$8,952.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,952.53
|
| Rate for Payer: Mclaren Medicare |
$8,952.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,400.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,295.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,847.78
|
| Rate for Payer: Nomi Health Commercial |
$13,977.15
|
| Rate for Payer: PACE Medicare |
$8,504.90
|
| Rate for Payer: PACE SWMI |
$8,952.53
|
| Rate for Payer: PHP Medicare Advantage |
$8,952.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,468.34
|
| Rate for Payer: Priority Health Medicare |
$8,952.53
|
| Rate for Payer: Priority Health Tiered Network |
$13,974.67
|
| Rate for Payer: Railroad Medicare Medicare |
$8,952.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,661.05
|
| Rate for Payer: UHC Core |
$14,775.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,952.53
|
| Rate for Payer: UHC Exchange |
$12,066.94
|
| Rate for Payer: VA VA |
$8,952.53
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$37,363.85
|
|
|
Service Code
|
MSDRG 380
|
| Min. Negotiated Rate |
$14,956.15 |
| Max. Negotiated Rate |
$37,363.85 |
| Rate for Payer: Aetna Medicare |
$16,373.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,679.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,679.15
|
| Rate for Payer: BCBS MAPPO |
$15,743.32
|
| Rate for Payer: BCBS Trust/PPO |
$37,363.85
|
| Rate for Payer: BCN Commercial |
$37,363.85
|
| Rate for Payer: BCN Medicare Advantage |
$15,743.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,743.32
|
| Rate for Payer: Mclaren Medicare |
$15,743.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,530.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,104.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,317.65
|
| Rate for Payer: Nomi Health Commercial |
$25,312.38
|
| Rate for Payer: PACE Medicare |
$14,956.15
|
| Rate for Payer: PACE SWMI |
$15,743.32
|
| Rate for Payer: PHP Medicare Advantage |
$15,743.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,634.86
|
| Rate for Payer: Priority Health Medicare |
$15,743.32
|
| Rate for Payer: Priority Health Tiered Network |
$25,307.89
|
| Rate for Payer: Railroad Medicare Medicare |
$15,743.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,983.86
|
| Rate for Payer: UHC Core |
$26,758.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,743.32
|
| Rate for Payer: UHC Exchange |
$21,853.02
|
| Rate for Payer: VA VA |
$15,743.32
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$14,019.05
|
|
|
Service Code
|
MSDRG 382
|
| Min. Negotiated Rate |
$6,427.91 |
| Max. Negotiated Rate |
$14,019.05 |
| Rate for Payer: Aetna Medicare |
$7,036.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,457.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,457.77
|
| Rate for Payer: BCBS MAPPO |
$6,766.22
|
| Rate for Payer: BCBS Trust/PPO |
$14,019.05
|
| Rate for Payer: BCN Commercial |
$14,019.05
|
| Rate for Payer: BCN Medicare Advantage |
$6,766.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,766.22
|
| Rate for Payer: Mclaren Medicare |
$6,766.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,104.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,781.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,442.84
|
| Rate for Payer: Nomi Health Commercial |
$10,327.74
|
| Rate for Payer: PACE Medicare |
$6,427.91
|
| Rate for Payer: PACE SWMI |
$6,766.22
|
| Rate for Payer: PHP Medicare Advantage |
$6,766.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,907.39
|
| Rate for Payer: Priority Health Medicare |
$6,766.22
|
| Rate for Payer: Priority Health Tiered Network |
$10,325.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,766.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,049.78
|
| Rate for Payer: UHC Core |
$10,917.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,766.22
|
| Rate for Payer: UHC Exchange |
$8,916.28
|
| Rate for Payer: VA VA |
$6,766.22
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$18,988.57
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$7,908.77 |
| Max. Negotiated Rate |
$18,988.57 |
| Rate for Payer: Aetna Medicare |
$8,658.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,406.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,406.27
|
| Rate for Payer: BCBS MAPPO |
$8,325.02
|
| Rate for Payer: BCBS Trust/PPO |
$18,988.57
|
| Rate for Payer: BCN Commercial |
$18,988.57
|
| Rate for Payer: BCN Medicare Advantage |
$8,325.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,325.02
|
| Rate for Payer: Mclaren Medicare |
$8,325.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,741.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,573.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,157.52
|
| Rate for Payer: Nomi Health Commercial |
$12,929.67
|
| Rate for Payer: PACE Medicare |
$7,908.77
|
| Rate for Payer: PACE SWMI |
$8,325.02
|
| Rate for Payer: PHP Medicare Advantage |
$8,325.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,159.22
|
| Rate for Payer: Priority Health Medicare |
$8,325.02
|
| Rate for Payer: Priority Health Tiered Network |
$12,927.37
|
| Rate for Payer: Railroad Medicare Medicare |
$8,325.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,337.49
|
| Rate for Payer: UHC Core |
$13,668.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,325.02
|
| Rate for Payer: UHC Exchange |
$11,162.62
|
| Rate for Payer: VA VA |
$8,325.02
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$33,585.80
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$13,991.44 |
| Max. Negotiated Rate |
$33,585.80 |
| Rate for Payer: Aetna Medicare |
$15,316.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,409.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,409.79
|
| Rate for Payer: BCBS MAPPO |
$14,727.83
|
| Rate for Payer: BCBS Trust/PPO |
$33,585.80
|
| Rate for Payer: BCN Commercial |
$33,585.80
|
| Rate for Payer: BCN Medicare Advantage |
$14,727.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,727.83
|
| Rate for Payer: Mclaren Medicare |
$14,727.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,464.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,937.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,200.61
|
| Rate for Payer: Nomi Health Commercial |
$23,617.32
|
| Rate for Payer: PACE Medicare |
$13,991.44
|
| Rate for Payer: PACE SWMI |
$14,727.83
|
| Rate for Payer: PHP Medicare Advantage |
$14,727.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,516.41
|
| Rate for Payer: Priority Health Medicare |
$14,727.83
|
| Rate for Payer: Priority Health Tiered Network |
$23,613.13
|
| Rate for Payer: Railroad Medicare Medicare |
$14,727.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,842.04
|
| Rate for Payer: UHC Core |
$24,966.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,727.83
|
| Rate for Payer: UHC Exchange |
$20,389.62
|
| Rate for Payer: VA VA |
$14,727.83
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$14,051.82
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$5,604.15 |
| Max. Negotiated Rate |
$14,051.82 |
| Rate for Payer: Aetna Medicare |
$6,135.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.89
|
| Rate for Payer: BCBS MAPPO |
$5,899.11
|
| Rate for Payer: BCBS Trust/PPO |
$14,051.82
|
| Rate for Payer: BCN Commercial |
$14,051.82
|
| Rate for Payer: BCN Medicare Advantage |
$5,899.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,899.11
|
| Rate for Payer: Mclaren Medicare |
$5,899.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,194.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,489.02
|
| Rate for Payer: Nomi Health Commercial |
$8,880.36
|
| Rate for Payer: PACE Medicare |
$5,604.15
|
| Rate for Payer: PACE SWMI |
$5,899.11
|
| Rate for Payer: PHP Medicare Advantage |
$5,899.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,098.48
|
| Rate for Payer: Priority Health Medicare |
$5,899.11
|
| Rate for Payer: Priority Health Tiered Network |
$8,878.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,899.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,220.92
|
| Rate for Payer: UHC Core |
$9,387.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,899.11
|
| Rate for Payer: UHC Exchange |
$7,666.71
|
| Rate for Payer: VA VA |
$5,899.11
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 00574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Advantage |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health SBD |
$125.16
|
|
|
COMPOUNDING VEHICLE SUSPENSION NO.7 ORAL
|
Facility
|
OP
|
$198.66
|
|
|
Service Code
|
NDC 00574030316
|
| Hospital Charge Code |
118921
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.07 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: BCBS Complete |
$79.46
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Advantage |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health SBD |
$125.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.13
|
| Rate for Payer: UHC Core |
$103.50
|
| Rate for Payer: UHC Exchange |
$78.07
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
IP
|
$181.64
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.43 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
|
|
COMPOUNDING VEHICLE SUSPENSION SUGAR-FREE NO.20 ORAL
|
Facility
|
OP
|
$181.64
|
|
|
Service Code
|
NDC 39328001416
|
| Hospital Charge Code |
176500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.38 |
| Max. Negotiated Rate |
$163.48 |
| Rate for Payer: Aetna Commercial |
$154.39
|
| Rate for Payer: Aetna Medicare |
$90.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.07
|
| Rate for Payer: BCBS Complete |
$72.66
|
| Rate for Payer: Cash Price |
$145.31
|
| Rate for Payer: Cofinity Advantage |
$127.15
|
| Rate for Payer: Cofinity Commercial |
$156.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.31
|
| Rate for Payer: Healthscope Commercial |
$163.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.23
|
| Rate for Payer: PHP Commercial |
$154.39
|
| Rate for Payer: Priority Health SBD |
$114.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.07
|
| Rate for Payer: UHC Core |
$94.63
|
| Rate for Payer: UHC Exchange |
$71.38
|
|
