|
UNLISTED PROCEDURE, NOSE
|
Facility
|
OP
|
$763.21
|
|
|
Service Code
|
CPT 30999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.59 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$121.59
|
| Rate for Payer: BCN Commercial |
$121.59
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Mclaren Medicaid |
$123.43
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
|
Facility
|
OP
|
$794.84
|
|
|
Service Code
|
CPT 27299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$137.20
|
| Rate for Payer: BCN Commercial |
$137.20
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Mclaren Medicaid |
$128.54
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
UNLISTED PROCEDURE, URINARY SYSTEM
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 53899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$148.34
|
| Rate for Payer: BCN Commercial |
$148.34
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
UNLISTED PROCEDURE, VASCULAR SURGERY
|
Facility
|
OP
|
$2,021.35
|
|
|
Service Code
|
CPT 37799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$469.70
|
| Rate for Payer: BCN Commercial |
$469.70
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Mclaren Medicaid |
$326.90
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$36,181.75
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$13,015.72 |
| Max. Negotiated Rate |
$36,181.75 |
| Rate for Payer: Aetna Medicare |
$14,248.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,125.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,125.95
|
| Rate for Payer: BCBS MAPPO |
$13,700.76
|
| Rate for Payer: BCBS Trust/PPO |
$36,181.75
|
| Rate for Payer: BCN Commercial |
$36,181.75
|
| Rate for Payer: BCN Medicare Advantage |
$13,700.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,700.76
|
| Rate for Payer: Mclaren Medicare |
$13,700.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,385.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,755.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,070.84
|
| Rate for Payer: Nomi Health Commercial |
$21,902.91
|
| Rate for Payer: PACE Medicare |
$13,015.72
|
| Rate for Payer: PACE SWMI |
$13,700.76
|
| Rate for Payer: PHP Medicare Advantage |
$13,700.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,373.78
|
| Rate for Payer: Priority Health Medicare |
$13,700.76
|
| Rate for Payer: Priority Health Tiered Network |
$21,899.02
|
| Rate for Payer: Railroad Medicare Medicare |
$13,700.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,675.77
|
| Rate for Payer: UHC Core |
$23,154.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,700.76
|
| Rate for Payer: UHC Exchange |
$18,909.51
|
| Rate for Payer: VA VA |
$13,700.76
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$43,967.62
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$20,353.86 |
| Max. Negotiated Rate |
$43,967.62 |
| Rate for Payer: Aetna Medicare |
$22,282.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,781.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,781.40
|
| Rate for Payer: BCBS MAPPO |
$21,425.12
|
| Rate for Payer: BCBS Trust/PPO |
$40,034.70
|
| Rate for Payer: BCN Commercial |
$40,034.70
|
| Rate for Payer: BCN Medicare Advantage |
$21,425.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,425.12
|
| Rate for Payer: Mclaren Medicare |
$21,425.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,496.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,638.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,567.63
|
| Rate for Payer: Nomi Health Commercial |
$34,796.46
|
| Rate for Payer: PACE Medicare |
$20,353.86
|
| Rate for Payer: PACE SWMI |
$21,425.12
|
| Rate for Payer: PHP Medicare Advantage |
$21,425.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,487.86
|
| Rate for Payer: Priority Health Medicare |
$21,425.12
|
| Rate for Payer: Priority Health Tiered Network |
$34,790.28
|
| Rate for Payer: Railroad Medicare Medicare |
$21,425.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,967.62
|
| Rate for Payer: UHC Core |
$36,784.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,425.12
|
| Rate for Payer: UHC Exchange |
$30,040.94
|
| Rate for Payer: VA VA |
$21,425.12
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,604.68
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$8,568.79 |
| Max. Negotiated Rate |
$18,604.68 |
| Rate for Payer: Aetna Medicare |
$9,380.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,274.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,274.73
|
| Rate for Payer: BCBS MAPPO |
$9,019.78
|
| Rate for Payer: BCBS Trust/PPO |
$18,604.68
|
| Rate for Payer: BCN Commercial |
$18,604.68
|
| Rate for Payer: BCN Medicare Advantage |
$9,019.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,019.78
|
| Rate for Payer: Mclaren Medicare |
$9,019.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,470.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,372.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,921.76
|
| Rate for Payer: Nomi Health Commercial |
$14,089.38
|
| Rate for Payer: PACE Medicare |
$8,568.79
|
| Rate for Payer: PACE SWMI |
$9,019.78
|
| Rate for Payer: PHP Medicare Advantage |
$9,019.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,608.60
|
| Rate for Payer: Priority Health Medicare |
$9,019.78
|
| Rate for Payer: Priority Health Tiered Network |
$14,086.88
|
| Rate for Payer: Railroad Medicare Medicare |
$9,019.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,802.86
|
| Rate for Payer: UHC Core |
$14,894.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,019.78
|
| Rate for Payer: UHC Exchange |
$12,163.83
|
| Rate for Payer: VA VA |
$9,019.78
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$11,143.81
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$10,613.15 |
| Max. Negotiated Rate |
$11,143.81 |
| Rate for Payer: BCBS Complete |
$11,143.81
|
| Rate for Payer: Mclaren Medicaid |
$10,613.15
|
| Rate for Payer: Meridian Medicaid |
$11,143.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,613.15
|
| Rate for Payer: UHC Medicaid |
$10,613.15
|
| Rate for Payer: UHCCP Medicaid |
$10,613.15
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$7,581.89
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$7,220.85 |
| Max. Negotiated Rate |
$7,581.89 |
| Rate for Payer: BCBS Complete |
$7,581.89
|
| Rate for Payer: Mclaren Medicaid |
$7,220.85
|
| Rate for Payer: Meridian Medicaid |
$7,581.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,220.85
|
| Rate for Payer: UHC Medicaid |
$7,220.85
|
| Rate for Payer: UHCCP Medicaid |
$7,220.85
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$6,748.31
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$6,426.97 |
| Max. Negotiated Rate |
$6,748.31 |
| Rate for Payer: BCBS Complete |
$6,748.31
|
| Rate for Payer: Mclaren Medicaid |
$6,426.97
|
| Rate for Payer: Meridian Medicaid |
$6,748.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,426.97
|
| Rate for Payer: UHC Medicaid |
$6,426.97
|
| Rate for Payer: UHCCP Medicaid |
$6,426.97
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$17,182.37
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$16,364.17 |
| Max. Negotiated Rate |
$17,182.37 |
| Rate for Payer: BCBS Complete |
$17,182.37
|
| Rate for Payer: Mclaren Medicaid |
$16,364.17
|
| Rate for Payer: Meridian Medicaid |
$17,182.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,364.17
|
| Rate for Payer: UHC Medicaid |
$16,364.17
|
| Rate for Payer: UHCCP Medicaid |
$16,364.17
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$41,982.25
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$13,728.61 |
| Max. Negotiated Rate |
$41,982.25 |
| Rate for Payer: Aetna Medicare |
$15,029.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,063.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,063.96
|
| Rate for Payer: BCBS MAPPO |
$14,451.17
|
| Rate for Payer: BCBS Trust/PPO |
$41,982.25
|
| Rate for Payer: BCN Commercial |
$41,982.25
|
| Rate for Payer: BCN Medicare Advantage |
$14,451.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,451.17
|
| Rate for Payer: Mclaren Medicare |
$14,451.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,173.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,618.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,896.29
|
| Rate for Payer: Nomi Health Commercial |
$23,155.50
|
| Rate for Payer: PACE Medicare |
$13,728.61
|
| Rate for Payer: PACE SWMI |
$14,451.17
|
| Rate for Payer: PHP Medicare Advantage |
$14,451.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,939.24
|
| Rate for Payer: Priority Health Medicare |
$14,451.17
|
| Rate for Payer: Priority Health Tiered Network |
$23,151.39
|
| Rate for Payer: Railroad Medicare Medicare |
$14,451.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,258.50
|
| Rate for Payer: UHC Core |
$24,478.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,451.17
|
| Rate for Payer: UHC Exchange |
$19,990.92
|
| Rate for Payer: VA VA |
$14,451.17
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,595.85
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$8,475.55 |
| Max. Negotiated Rate |
$17,595.85 |
| Rate for Payer: Aetna Medicare |
$9,278.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,152.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,152.04
|
| Rate for Payer: BCBS MAPPO |
$8,921.63
|
| Rate for Payer: BCBS Trust/PPO |
$16,205.36
|
| Rate for Payer: BCN Commercial |
$16,205.36
|
| Rate for Payer: BCN Medicare Advantage |
$8,921.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,921.63
|
| Rate for Payer: Mclaren Medicare |
$8,921.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,367.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,259.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,813.79
|
| Rate for Payer: Nomi Health Commercial |
$13,925.55
|
| Rate for Payer: PACE Medicare |
$8,475.55
|
| Rate for Payer: PACE SWMI |
$8,921.63
|
| Rate for Payer: PHP Medicare Advantage |
$8,921.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,403.85
|
| Rate for Payer: Priority Health Medicare |
$8,921.63
|
| Rate for Payer: Priority Health Tiered Network |
$13,923.08
|
| Rate for Payer: Railroad Medicare Medicare |
$8,921.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,595.85
|
| Rate for Payer: UHC Core |
$14,721.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,921.63
|
| Rate for Payer: UHC Exchange |
$12,022.39
|
| Rate for Payer: VA VA |
$8,921.63
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$17,568.14
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$8,463.06 |
| Max. Negotiated Rate |
$17,568.14 |
| Rate for Payer: Aetna Medicare |
$9,264.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,135.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,135.60
|
| Rate for Payer: BCBS MAPPO |
$8,908.48
|
| Rate for Payer: BCBS Trust/PPO |
$13,335.54
|
| Rate for Payer: BCN Commercial |
$13,335.54
|
| Rate for Payer: BCN Medicare Advantage |
$8,908.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,908.48
|
| Rate for Payer: Mclaren Medicare |
$8,908.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,353.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,244.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,799.33
|
| Rate for Payer: Nomi Health Commercial |
$13,903.62
|
| Rate for Payer: PACE Medicare |
$8,463.06
|
| Rate for Payer: PACE SWMI |
$8,908.48
|
| Rate for Payer: PHP Medicare Advantage |
$8,908.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,376.44
|
| Rate for Payer: Priority Health Medicare |
$8,908.48
|
| Rate for Payer: Priority Health Tiered Network |
$13,901.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8,908.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,568.14
|
| Rate for Payer: UHC Core |
$14,697.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,908.48
|
| Rate for Payer: UHC Exchange |
$12,003.46
|
| Rate for Payer: VA VA |
$8,908.48
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$6,712.77
|
|
|
Service Code
|
APR-DRG 4653
|
| Min. Negotiated Rate |
$6,393.11 |
| Max. Negotiated Rate |
$6,712.77 |
| Rate for Payer: BCBS Complete |
$6,712.77
|
| Rate for Payer: Mclaren Medicaid |
$6,393.11
|
| Rate for Payer: Meridian Medicaid |
$6,712.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,393.11
|
| Rate for Payer: UHC Medicaid |
$6,393.11
|
| Rate for Payer: UHCCP Medicaid |
$6,393.11
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$3,389.92
|
|
|
Service Code
|
APR-DRG 4651
|
| Min. Negotiated Rate |
$3,228.50 |
| Max. Negotiated Rate |
$3,389.92 |
| Rate for Payer: BCBS Complete |
$3,389.92
|
| Rate for Payer: Mclaren Medicaid |
$3,228.50
|
| Rate for Payer: Meridian Medicaid |
$3,389.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,228.50
|
| Rate for Payer: UHC Medicaid |
$3,228.50
|
| Rate for Payer: UHCCP Medicaid |
$3,228.50
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$12,504.25
|
|
|
Service Code
|
APR-DRG 4654
|
| Min. Negotiated Rate |
$11,908.81 |
| Max. Negotiated Rate |
$12,504.25 |
| Rate for Payer: BCBS Complete |
$12,504.25
|
| Rate for Payer: Mclaren Medicaid |
$11,908.81
|
| Rate for Payer: Meridian Medicaid |
$12,504.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,908.81
|
| Rate for Payer: UHC Medicaid |
$11,908.81
|
| Rate for Payer: UHCCP Medicaid |
$11,908.81
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$5,186.65
|
|
|
Service Code
|
APR-DRG 4652
|
| Min. Negotiated Rate |
$4,939.66 |
| Max. Negotiated Rate |
$5,186.65 |
| Rate for Payer: BCBS Complete |
$5,186.65
|
| Rate for Payer: Mclaren Medicaid |
$4,939.66
|
| Rate for Payer: Meridian Medicaid |
$5,186.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,939.66
|
| Rate for Payer: UHC Medicaid |
$4,939.66
|
| Rate for Payer: UHCCP Medicaid |
$4,939.66
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$21,915.35
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$10,421.13 |
| Max. Negotiated Rate |
$21,915.35 |
| Rate for Payer: Aetna Medicare |
$11,408.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,712.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,712.01
|
| Rate for Payer: BCBS MAPPO |
$10,969.61
|
| Rate for Payer: BCBS Trust/PPO |
$15,215.20
|
| Rate for Payer: BCN Commercial |
$15,215.20
|
| Rate for Payer: BCN Medicare Advantage |
$10,969.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,969.61
|
| Rate for Payer: Mclaren Medicare |
$10,969.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,518.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,615.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,066.57
|
| Rate for Payer: Nomi Health Commercial |
$17,344.05
|
| Rate for Payer: PACE Medicare |
$10,421.13
|
| Rate for Payer: PACE SWMI |
$10,969.61
|
| Rate for Payer: PHP Medicare Advantage |
$10,969.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,676.22
|
| Rate for Payer: Priority Health Medicare |
$10,969.61
|
| Rate for Payer: Priority Health Tiered Network |
$17,340.97
|
| Rate for Payer: Railroad Medicare Medicare |
$10,969.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,915.35
|
| Rate for Payer: UHC Core |
$18,334.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,969.61
|
| Rate for Payer: UHC Exchange |
$14,973.70
|
| Rate for Payer: VA VA |
$10,969.61
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$12,741.71
|
|
|
Service Code
|
MSDRG 694
|
| Min. Negotiated Rate |
$6,289.15 |
| Max. Negotiated Rate |
$12,741.71 |
| Rate for Payer: Aetna Medicare |
$6,884.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,275.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,275.20
|
| Rate for Payer: BCBS MAPPO |
$6,620.16
|
| Rate for Payer: BCBS Trust/PPO |
$11,837.43
|
| Rate for Payer: BCN Commercial |
$11,837.43
|
| Rate for Payer: BCN Medicare Advantage |
$6,620.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,620.16
|
| Rate for Payer: Mclaren Medicare |
$6,620.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,951.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,613.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,282.18
|
| Rate for Payer: Nomi Health Commercial |
$10,083.93
|
| Rate for Payer: PACE Medicare |
$6,289.15
|
| Rate for Payer: PACE SWMI |
$6,620.16
|
| Rate for Payer: PHP Medicare Advantage |
$6,620.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,602.68
|
| Rate for Payer: Priority Health Medicare |
$6,620.16
|
| Rate for Payer: Priority Health Tiered Network |
$10,082.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,620.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,741.71
|
| Rate for Payer: UHC Core |
$10,660.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,620.16
|
| Rate for Payer: UHC Exchange |
$8,705.79
|
| Rate for Payer: VA VA |
$6,620.16
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$231.66
|
|
|
Service Code
|
NDC 00904689004
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.95 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.58
|
| Rate for Payer: Cash Price |
$185.33
|
| Rate for Payer: Cofinity Advantage |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.33
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.75
|
| Rate for Payer: PHP Commercial |
$196.91
|
| Rate for Payer: Priority Health SBD |
$145.95
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
OP
|
$231.66
|
|
|
Service Code
|
NDC 00904689004
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.04 |
| Max. Negotiated Rate |
$208.49 |
| Rate for Payer: Aetna Commercial |
$196.91
|
| Rate for Payer: Aetna Medicare |
$115.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.58
|
| Rate for Payer: BCBS Complete |
$92.66
|
| Rate for Payer: Cash Price |
$185.33
|
| Rate for Payer: Cofinity Advantage |
$162.16
|
| Rate for Payer: Cofinity Commercial |
$199.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.33
|
| Rate for Payer: Healthscope Commercial |
$208.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$185.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.75
|
| Rate for Payer: PHP Commercial |
$196.91
|
| Rate for Payer: Priority Health SBD |
$145.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.58
|
| Rate for Payer: UHC Core |
$120.69
|
| Rate for Payer: UHC Exchange |
$91.04
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$427.92
|
|
|
Service Code
|
NDC 00904622106
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.59 |
| Max. Negotiated Rate |
$385.13 |
| Rate for Payer: Aetna Commercial |
$363.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.15
|
| Rate for Payer: Cash Price |
$342.34
|
| Rate for Payer: Cofinity Advantage |
$299.54
|
| Rate for Payer: Cofinity Commercial |
$368.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.34
|
| Rate for Payer: Healthscope Commercial |
$385.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$320.94
|
| Rate for Payer: PHP Commercial |
$363.73
|
| Rate for Payer: Priority Health SBD |
$269.59
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$470.64
|
|
|
Service Code
|
NDC 50268079715
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.96 |
| Max. Negotiated Rate |
$423.58 |
| Rate for Payer: Aetna Commercial |
$400.04
|
| Rate for Payer: Aetna Medicare |
$235.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.92
|
| Rate for Payer: BCBS Complete |
$188.26
|
| Rate for Payer: Cash Price |
$376.51
|
| Rate for Payer: Cofinity Advantage |
$329.45
|
| Rate for Payer: Cofinity Commercial |
$404.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.51
|
| Rate for Payer: Healthscope Commercial |
$423.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.98
|
| Rate for Payer: PHP Commercial |
$400.04
|
| Rate for Payer: Priority Health SBD |
$296.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.92
|
| Rate for Payer: UHC Core |
$245.20
|
| Rate for Payer: UHC Exchange |
$184.96
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$402.80
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.76 |
| Max. Negotiated Rate |
$362.52 |
| Rate for Payer: Aetna Commercial |
$342.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.82
|
| Rate for Payer: Cash Price |
$322.24
|
| Rate for Payer: Cofinity Advantage |
$281.96
|
| Rate for Payer: Cofinity Commercial |
$346.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.24
|
| Rate for Payer: Healthscope Commercial |
$362.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.10
|
| Rate for Payer: PHP Commercial |
$342.38
|
| Rate for Payer: Priority Health SBD |
$253.76
|
|
