|
COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,228.76
|
|
|
Service Code
|
CPT 45385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$245.25 |
| Max. Negotiated Rate |
$3,228.76 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$448.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,228.76
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,583.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.78
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$245.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 44388
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.28 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$633.66
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,491.90
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,993.52
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.41
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$151.28
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,247.14
|
|
|
Service Code
|
CPT 44389
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$166.01 |
| Max. Negotiated Rate |
$3,247.14 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$480.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,247.14
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Priority Health Narrow Network |
$2,597.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.61
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$166.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$2,491.90
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$2,491.90 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$417.60
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,491.90
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,993.52
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.31
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$2,491.90
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.78 |
| Max. Negotiated Rate |
$2,491.90 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$418.67
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,491.90
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,993.52
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.66
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$178.78
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$2,491.90
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$2,491.90 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$519.48
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,491.90
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,993.52
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.87
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Exchange |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
COLPOCLEISIS (LE FORT TYPE)
|
Facility
|
OP
|
$5,532.19
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.54 |
| Max. Negotiated Rate |
$5,532.19 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.06
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.09
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$525.54
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
|
Facility
|
OP
|
$8,404.69
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$8,404.69 |
| Rate for Payer: Aetna Medicare |
$6,992.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,404.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,404.69
|
| Rate for Payer: BCBS Complete |
$3,862.12
|
| Rate for Payer: BCBS MAPPO |
$6,723.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,031.39
|
| Rate for Payer: BCN Medicare Advantage |
$6,723.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,723.75
|
| Rate for Payer: Mclaren Medicaid |
$3,677.89
|
| Rate for Payer: Mclaren Medicare |
$6,723.75
|
| Rate for Payer: Meridian Medicaid |
$3,862.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,059.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,732.31
|
| Rate for Payer: PACE Medicare |
$6,387.56
|
| Rate for Payer: PACE SWMI |
$6,723.75
|
| Rate for Payer: PHP Medicare Advantage |
$6,723.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,677.89
|
| Rate for Payer: Priority Health Medicare |
$6,723.75
|
| Rate for Payer: Railroad Medicare Medicare |
$6,723.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.91
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,723.75
|
| Rate for Payer: UHC Exchange |
$689.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,925.46
|
| Rate for Payer: VA VA |
$6,723.75
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.39 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$827.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.43
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$330.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 57455
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.42 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$124.07
|
| Rate for Payer: BCCCP Commercial |
$170.70
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.06
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$106.42
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: BCCCP Commercial |
$179.90
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$131.30
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 57456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$117.15
|
| Rate for Payer: BCCCP Commercial |
$161.36
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$99.21
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.52 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.43
|
| Rate for Payer: BCCCP Commercial |
$331.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.17
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$156.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.11 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,767.43
|
| Rate for Payer: BCCCP Commercial |
$370.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.02
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$179.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$93,298.04
|
|
|
Service Code
|
MS-DRG 454
|
| Min. Negotiated Rate |
$42,314.01 |
| Max. Negotiated Rate |
$93,298.04 |
| Rate for Payer: Aetna Medicare |
$46,322.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,676.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,676.32
|
| Rate for Payer: BCBS MAPPO |
$44,541.06
|
| Rate for Payer: BCBS Trust/PPO |
$75,552.14
|
| Rate for Payer: BCN Medicare Advantage |
$44,541.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,541.06
|
| Rate for Payer: Mclaren Medicare |
$44,541.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,768.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51,222.22
|
| Rate for Payer: PACE Medicare |
$42,314.01
|
| Rate for Payer: PACE SWMI |
$44,541.06
|
| Rate for Payer: PHP Medicare Advantage |
$44,541.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,768.42
|
| Rate for Payer: Priority Health Medicare |
$44,541.06
|
| Rate for Payer: Priority Health Narrow Network |
$70,214.74
|
| Rate for Payer: Railroad Medicare Medicare |
$44,541.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93,298.04
|
| Rate for Payer: UHC Core |
$57,248.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,541.06
|
| Rate for Payer: UHC Exchange |
$61,315.91
|
| Rate for Payer: UHC Medicare Advantage |
$45,877.29
|
| Rate for Payer: VA VA |
$44,541.06
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$135,171.80
|
|
|
Service Code
|
MS-DRG 453
|
| Min. Negotiated Rate |
$61,095.15 |
| Max. Negotiated Rate |
$135,171.80 |
| Rate for Payer: Aetna Medicare |
$66,883.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80,388.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80,388.35
|
| Rate for Payer: BCBS MAPPO |
$64,310.68
|
| Rate for Payer: BCBS Trust/PPO |
$110,469.14
|
| Rate for Payer: BCN Medicare Advantage |
$64,310.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64,310.68
|
| Rate for Payer: Mclaren Medicare |
$64,310.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67,526.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73,957.28
|
| Rate for Payer: PACE Medicare |
$61,095.15
|
| Rate for Payer: PACE SWMI |
$64,310.68
|
| Rate for Payer: PHP Medicare Advantage |
$64,310.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127,160.38
|
| Rate for Payer: Priority Health Medicare |
$64,310.68
|
| Rate for Payer: Priority Health Narrow Network |
$101,728.30
|
| Rate for Payer: Railroad Medicare Medicare |
$64,310.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135,171.80
|
| Rate for Payer: UHC Core |
$82,942.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$64,310.68
|
| Rate for Payer: UHC Exchange |
$88,835.54
|
| Rate for Payer: UHC Medicare Advantage |
$66,240.00
|
| Rate for Payer: VA VA |
$64,310.68
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$70,253.82
|
|
|
Service Code
|
MS-DRG 455
|
| Min. Negotiated Rate |
$31,978.24 |
| Max. Negotiated Rate |
$70,253.82 |
| Rate for Payer: Aetna Medicare |
$35,007.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,076.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,076.62
|
| Rate for Payer: BCBS MAPPO |
$33,661.30
|
| Rate for Payer: BCBS Trust/PPO |
$62,161.54
|
| Rate for Payer: BCN Medicare Advantage |
$33,661.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,661.30
|
| Rate for Payer: Mclaren Medicare |
$33,661.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35,344.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,710.50
|
| Rate for Payer: PACE Medicare |
$31,978.24
|
| Rate for Payer: PACE SWMI |
$33,661.30
|
| Rate for Payer: PHP Medicare Advantage |
$33,661.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,089.99
|
| Rate for Payer: Priority Health Medicare |
$33,661.30
|
| Rate for Payer: Priority Health Narrow Network |
$52,871.99
|
| Rate for Payer: Railroad Medicare Medicare |
$33,661.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70,253.82
|
| Rate for Payer: UHC Core |
$43,108.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$33,661.30
|
| Rate for Payer: UHC Exchange |
$46,171.14
|
| Rate for Payer: UHC Medicare Advantage |
$34,671.14
|
| Rate for Payer: VA VA |
$33,661.30
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$5,532.19
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$768.51 |
| Max. Negotiated Rate |
$5,532.19 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,394.54
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.36
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$768.51
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$6,837.00
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$859.21 |
| Max. Negotiated Rate |
$6,837.00 |
| Rate for Payer: Aetna Medicare |
$4,602.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,532.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,532.19
|
| Rate for Payer: BCBS Complete |
$2,542.15
|
| Rate for Payer: BCBS MAPPO |
$4,425.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.67
|
| Rate for Payer: BCN Medicare Advantage |
$4,425.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,425.75
|
| Rate for Payer: Mclaren Medicaid |
$2,420.89
|
| Rate for Payer: Mclaren Medicare |
$4,425.75
|
| Rate for Payer: Meridian Medicaid |
$2,542.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,647.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,089.61
|
| Rate for Payer: PACE Medicare |
$4,204.46
|
| Rate for Payer: PACE SWMI |
$4,425.75
|
| Rate for Payer: PHP Medicare Advantage |
$4,425.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,420.89
|
| Rate for Payer: Priority Health Medicare |
$4,425.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4,425.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.13
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,425.75
|
| Rate for Payer: UHC Exchange |
$859.21
|
| Rate for Payer: UHC Medicare Advantage |
$4,558.52
|
| Rate for Payer: VA VA |
$4,425.75
|
|
|
COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 51729
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$158.79 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.79
|
| Rate for Payer: BCBS Complete |
$349.14
|
| Rate for Payer: BCBS MAPPO |
$607.83
|
| Rate for Payer: BCBS Trust/PPO |
$158.79
|
| Rate for Payer: BCN Medicare Advantage |
$607.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.83
|
| Rate for Payer: Mclaren Medicaid |
$332.48
|
| Rate for Payer: Mclaren Medicare |
$607.83
|
| Rate for Payer: Meridian Medicaid |
$349.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$638.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.00
|
| Rate for Payer: PACE Medicare |
$577.44
|
| Rate for Payer: PACE SWMI |
$607.83
|
| Rate for Payer: PHP Medicare Advantage |
$607.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.48
|
| Rate for Payer: Priority Health Medicare |
$607.83
|
| Rate for Payer: Railroad Medicare Medicare |
$607.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.83
|
| Rate for Payer: UHC Exchange |
$376.89
|
| Rate for Payer: UHC Medicare Advantage |
$626.06
|
| Rate for Payer: VA VA |
$607.83
|
|
|
COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 51741
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$349.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$349.11
|
| Rate for Payer: BCBS Complete |
$160.42
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCBS Trust/PPO |
$71.58
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Mclaren Medicaid |
$152.77
|
| Rate for Payer: Mclaren Medicare |
$279.29
|
| Rate for Payer: Meridian Medicaid |
$160.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.18
|
| Rate for Payer: PACE Medicare |
$265.33
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.07
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: Priority Health Narrow Network |
$348.85
|
| Rate for Payer: Railroad Medicare Medicare |
$279.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.49
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$287.67
|
| Rate for Payer: VA VA |
$279.29
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$16,367.54
|
|
|
Service Code
|
MS-DRG 381
|
| Min. Negotiated Rate |
$7,809.25 |
| Max. Negotiated Rate |
$16,367.54 |
| Rate for Payer: Aetna Medicare |
$8,549.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,275.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,275.32
|
| Rate for Payer: BCBS MAPPO |
$8,220.26
|
| Rate for Payer: BCBS Trust/PPO |
$16,104.73
|
| Rate for Payer: BCN Medicare Advantage |
$8,220.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,220.26
|
| Rate for Payer: Mclaren Medicare |
$8,220.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,631.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,453.30
|
| Rate for Payer: PACE Medicare |
$7,809.25
|
| Rate for Payer: PACE SWMI |
$8,220.26
|
| Rate for Payer: PHP Medicare Advantage |
$8,220.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,397.46
|
| Rate for Payer: Priority Health Medicare |
$8,220.26
|
| Rate for Payer: Priority Health Narrow Network |
$12,317.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8,220.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,367.54
|
| Rate for Payer: UHC Core |
$10,043.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,220.26
|
| Rate for Payer: UHC Exchange |
$10,756.83
|
| Rate for Payer: UHC Medicare Advantage |
$8,466.87
|
| Rate for Payer: VA VA |
$8,220.26
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$35,050.96
|
|
|
Service Code
|
MS-DRG 380
|
| Min. Negotiated Rate |
$13,799.14 |
| Max. Negotiated Rate |
$35,050.96 |
| Rate for Payer: Aetna Medicare |
$15,106.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,156.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,156.76
|
| Rate for Payer: BCBS MAPPO |
$14,525.41
|
| Rate for Payer: BCBS Trust/PPO |
$35,050.96
|
| Rate for Payer: BCN Medicare Advantage |
$14,525.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,525.41
|
| Rate for Payer: Mclaren Medicare |
$14,525.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,251.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,704.22
|
| Rate for Payer: PACE Medicare |
$13,799.14
|
| Rate for Payer: PACE SWMI |
$14,525.41
|
| Rate for Payer: PHP Medicare Advantage |
$14,525.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,960.82
|
| Rate for Payer: Priority Health Medicare |
$14,525.41
|
| Rate for Payer: Priority Health Narrow Network |
$22,368.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14,525.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,722.42
|
| Rate for Payer: UHC Core |
$18,237.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,525.41
|
| Rate for Payer: UHC Exchange |
$19,533.71
|
| Rate for Payer: UHC Medicare Advantage |
$14,961.17
|
| Rate for Payer: VA VA |
$14,525.41
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$13,151.25
|
|
|
Service Code
|
MS-DRG 382
|
| Min. Negotiated Rate |
$5,647.94 |
| Max. Negotiated Rate |
$13,151.25 |
| Rate for Payer: Aetna Medicare |
$6,183.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,431.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,431.50
|
| Rate for Payer: BCBS MAPPO |
$5,945.20
|
| Rate for Payer: BCBS Trust/PPO |
$13,151.25
|
| Rate for Payer: BCN Medicare Advantage |
$5,945.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,945.20
|
| Rate for Payer: Mclaren Medicare |
$5,945.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,242.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,836.98
|
| Rate for Payer: PACE Medicare |
$5,647.94
|
| Rate for Payer: PACE SWMI |
$5,945.20
|
| Rate for Payer: PHP Medicare Advantage |
$5,945.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,864.32
|
| Rate for Payer: Priority Health Medicare |
$5,945.20
|
| Rate for Payer: Priority Health Narrow Network |
$8,691.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,945.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,548.80
|
| Rate for Payer: UHC Core |
$7,086.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,945.20
|
| Rate for Payer: UHC Exchange |
$7,589.93
|
| Rate for Payer: UHC Medicare Advantage |
$6,123.56
|
| Rate for Payer: VA VA |
$5,945.20
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$17,813.14
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$7,541.05 |
| Max. Negotiated Rate |
$17,813.14 |
| Rate for Payer: Aetna Medicare |
$8,255.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,922.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,922.44
|
| Rate for Payer: BCBS MAPPO |
$7,937.95
|
| Rate for Payer: BCBS Trust/PPO |
$17,813.14
|
| Rate for Payer: BCN Medicare Advantage |
$7,937.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,937.95
|
| Rate for Payer: Mclaren Medicare |
$7,937.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,334.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,128.64
|
| Rate for Payer: PACE Medicare |
$7,541.05
|
| Rate for Payer: PACE SWMI |
$7,937.95
|
| Rate for Payer: PHP Medicare Advantage |
$7,937.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,834.95
|
| Rate for Payer: Priority Health Medicare |
$7,937.95
|
| Rate for Payer: Priority Health Narrow Network |
$11,867.96
|
| Rate for Payer: Railroad Medicare Medicare |
$7,937.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,769.59
|
| Rate for Payer: UHC Core |
$9,676.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,937.95
|
| Rate for Payer: UHC Exchange |
$10,363.85
|
| Rate for Payer: UHC Medicare Advantage |
$8,176.09
|
| Rate for Payer: VA VA |
$7,937.95
|
|
