|
PENTAMIDINE 300 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$168.58
|
|
|
Service Code
|
NDC 63323-113-10
|
| Hospital Charge Code |
27430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$106.21 |
| Max. Negotiated Rate |
$151.72 |
| Rate for Payer: Aetna Commercial |
$143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.58
|
| Rate for Payer: Cash Price |
$134.86
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Healthscope Commercial |
$151.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$143.29
|
| Rate for Payer: PHP Commercial |
$143.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.01
|
| Rate for Payer: Priority Health SBD |
$106.21
|
|
|
PENTOSAN POLYSULFATE SODIUM 100 MG CAPSULE
|
Facility
|
IP
|
$3,755.87
|
|
|
Service Code
|
NDC 50458-098-01
|
| Hospital Charge Code |
12912
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,366.20 |
| Max. Negotiated Rate |
$3,380.28 |
| Rate for Payer: Aetna Commercial |
$3,192.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.32
|
| Rate for Payer: Cash Price |
$3,004.70
|
| Rate for Payer: Cofinity Commercial |
$2,629.11
|
| Rate for Payer: Cofinity Commercial |
$3,230.05
|
| Rate for Payer: Healthscope Commercial |
$3,380.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,192.49
|
| Rate for Payer: PHP Commercial |
$3,192.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,629.11
|
| Rate for Payer: Priority Health SBD |
$2,366.20
|
|
|
PENTOXIFYLLINE ER 400 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 0904-5448-61
|
| Hospital Charge Code |
10911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$348.98 |
| Rate for Payer: Aetna Commercial |
$329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.04
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$271.42
|
| Rate for Payer: Cofinity Commercial |
$333.46
|
| Rate for Payer: Healthscope Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: PHP Commercial |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: Priority Health SBD |
$244.28
|
|
|
PEPTAMEN INTENSE VHP BOLUS FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 4390043271
|
| Hospital Charge Code |
300293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9.91
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390049322
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CONTINUOUS FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390072395
|
| Hospital Charge Code |
181406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
|
|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$15.73
|
|
|
Service Code
|
NDC 4390073049
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$14.16 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.22
|
| Rate for Payer: Cash Price |
$12.58
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Cofinity Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$14.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.37
|
| Rate for Payer: PHP Commercial |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health SBD |
$9.91
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$60,999.91
|
|
|
Service Code
|
MS-DRG 273
|
| Min. Negotiated Rate |
$27,130.20 |
| Max. Negotiated Rate |
$60,999.91 |
| Rate for Payer: Aetna Medicare |
$29,700.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,697.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,697.64
|
| Rate for Payer: BCBS MAPPO |
$28,558.11
|
| Rate for Payer: BCBS Trust/PPO |
$60,999.91
|
| Rate for Payer: BCN Medicare Advantage |
$28,558.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,558.11
|
| Rate for Payer: Mclaren Medicare |
$28,558.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,986.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,841.83
|
| Rate for Payer: PACE Medicare |
$27,130.20
|
| Rate for Payer: PACE SWMI |
$28,558.11
|
| Rate for Payer: PHP Medicare Advantage |
$28,558.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,921.64
|
| Rate for Payer: Priority Health Medicare |
$28,558.11
|
| Rate for Payer: Priority Health Narrow Network |
$44,737.31
|
| Rate for Payer: Railroad Medicare Medicare |
$28,558.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,444.84
|
| Rate for Payer: UHC Core |
$36,475.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,558.11
|
| Rate for Payer: UHC Exchange |
$39,067.43
|
| Rate for Payer: UHC Medicare Advantage |
$29,414.85
|
| Rate for Payer: VA VA |
$28,558.11
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$53,448.21
|
|
|
Service Code
|
MS-DRG 274
|
| Min. Negotiated Rate |
$22,640.68 |
| Max. Negotiated Rate |
$53,448.21 |
| Rate for Payer: Aetna Medicare |
$24,785.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,790.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,790.38
|
| Rate for Payer: BCBS MAPPO |
$23,832.30
|
| Rate for Payer: BCBS Trust/PPO |
$53,448.21
|
| Rate for Payer: BCN Medicare Advantage |
$23,832.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,832.30
|
| Rate for Payer: Mclaren Medicare |
$23,832.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,023.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,407.14
|
| Rate for Payer: PACE Medicare |
$22,640.68
|
| Rate for Payer: PACE SWMI |
$23,832.30
|
| Rate for Payer: PHP Medicare Advantage |
$23,832.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,505.22
|
| Rate for Payer: Priority Health Medicare |
$23,832.30
|
| Rate for Payer: Priority Health Narrow Network |
$37,204.18
|
| Rate for Payer: Railroad Medicare Medicare |
$23,832.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,435.16
|
| Rate for Payer: UHC Core |
$30,333.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,832.30
|
| Rate for Payer: UHC Exchange |
$32,489.02
|
| Rate for Payer: UHC Medicare Advantage |
$24,547.27
|
| Rate for Payer: VA VA |
$23,832.30
|
|
|
PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION, UPPER EXTREMITY, SINGLE ACCESS OF BOTH THE PERIPHERAL ARTERY AND PERIPHERAL VEIN, INCLUDING FISTULA MATURATION PROCEDURES (EG, TRANSLUMINAL BALLOON ANGIOPLASTY, COIL EMBOLIZATION) WHEN PERFORMED, INCLUDING ALL VASCULAR ACCESS, IMAGING GUIDANCE AND RADIOLOGIC SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$51,507.72
|
|
|
Service Code
|
CPT 36836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.54 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.59
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$340.54
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$54,480.28
|
|
|
Service Code
|
MS-DRG 321
|
| Min. Negotiated Rate |
$20,135.93 |
| Max. Negotiated Rate |
$54,480.28 |
| Rate for Payer: Aetna Medicare |
$22,043.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,494.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,494.65
|
| Rate for Payer: BCBS MAPPO |
$21,195.72
|
| Rate for Payer: BCBS Trust/PPO |
$54,480.28
|
| Rate for Payer: BCN Medicare Advantage |
$21,195.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,195.72
|
| Rate for Payer: Mclaren Medicare |
$21,195.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,255.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,375.08
|
| Rate for Payer: PACE Medicare |
$20,135.93
|
| Rate for Payer: PACE SWMI |
$21,195.72
|
| Rate for Payer: PHP Medicare Advantage |
$21,195.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,251.72
|
| Rate for Payer: Priority Health Medicare |
$21,195.72
|
| Rate for Payer: Priority Health Narrow Network |
$33,001.38
|
| Rate for Payer: Railroad Medicare Medicare |
$21,195.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,850.67
|
| Rate for Payer: UHC Core |
$26,907.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,195.72
|
| Rate for Payer: UHC Exchange |
$28,818.87
|
| Rate for Payer: UHC Medicare Advantage |
$21,831.59
|
| Rate for Payer: VA VA |
$21,195.72
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$37,819.99
|
|
|
Service Code
|
MS-DRG 322
|
| Min. Negotiated Rate |
$12,943.26 |
| Max. Negotiated Rate |
$37,819.99 |
| Rate for Payer: Aetna Medicare |
$14,169.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,030.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,030.60
|
| Rate for Payer: BCBS MAPPO |
$13,624.48
|
| Rate for Payer: BCBS Trust/PPO |
$37,819.99
|
| Rate for Payer: BCN Medicare Advantage |
$13,624.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,624.48
|
| Rate for Payer: Mclaren Medicare |
$13,624.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,305.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,668.15
|
| Rate for Payer: PACE Medicare |
$12,943.26
|
| Rate for Payer: PACE SWMI |
$13,624.48
|
| Rate for Payer: PHP Medicare Advantage |
$13,624.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,165.64
|
| Rate for Payer: Priority Health Medicare |
$13,624.48
|
| Rate for Payer: Priority Health Narrow Network |
$20,932.51
|
| Rate for Payer: Railroad Medicare Medicare |
$13,624.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,814.14
|
| Rate for Payer: UHC Core |
$17,067.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,624.48
|
| Rate for Payer: UHC Exchange |
$18,279.59
|
| Rate for Payer: UHC Medicare Advantage |
$14,033.21
|
| Rate for Payer: VA VA |
$13,624.48
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$45,477.09
|
|
|
Service Code
|
MS-DRG 250
|
| Min. Negotiated Rate |
$16,551.56 |
| Max. Negotiated Rate |
$45,477.09 |
| Rate for Payer: Aetna Medicare |
$18,119.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,778.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,778.38
|
| Rate for Payer: BCBS MAPPO |
$17,422.70
|
| Rate for Payer: BCBS Trust/PPO |
$45,477.09
|
| Rate for Payer: BCN Medicare Advantage |
$17,422.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,422.70
|
| Rate for Payer: Mclaren Medicare |
$17,422.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,293.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,036.10
|
| Rate for Payer: PACE Medicare |
$16,551.56
|
| Rate for Payer: PACE SWMI |
$17,422.70
|
| Rate for Payer: PHP Medicare Advantage |
$17,422.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,733.79
|
| Rate for Payer: Priority Health Medicare |
$17,422.70
|
| Rate for Payer: Priority Health Narrow Network |
$26,987.03
|
| Rate for Payer: Railroad Medicare Medicare |
$17,422.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,859.10
|
| Rate for Payer: UHC Core |
$22,003.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,422.70
|
| Rate for Payer: UHC Exchange |
$23,566.77
|
| Rate for Payer: UHC Medicare Advantage |
$17,945.38
|
| Rate for Payer: VA VA |
$17,422.70
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$29,223.04
|
|
|
Service Code
|
MS-DRG 251
|
| Min. Negotiated Rate |
$11,325.20 |
| Max. Negotiated Rate |
$29,223.04 |
| Rate for Payer: Aetna Medicare |
$12,398.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,901.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,901.58
|
| Rate for Payer: BCBS MAPPO |
$11,921.26
|
| Rate for Payer: BCBS Trust/PPO |
$29,223.04
|
| Rate for Payer: BCN Medicare Advantage |
$11,921.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,921.26
|
| Rate for Payer: Mclaren Medicare |
$11,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,517.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,709.45
|
| Rate for Payer: PACE Medicare |
$11,325.20
|
| Rate for Payer: PACE SWMI |
$11,921.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,921.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,771.89
|
| Rate for Payer: Priority Health Medicare |
$11,921.26
|
| Rate for Payer: Priority Health Narrow Network |
$18,217.51
|
| Rate for Payer: Railroad Medicare Medicare |
$11,921.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,206.57
|
| Rate for Payer: UHC Core |
$14,853.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,921.26
|
| Rate for Payer: UHC Exchange |
$15,908.67
|
| Rate for Payer: UHC Medicare Advantage |
$12,278.90
|
| Rate for Payer: VA VA |
$11,921.26
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: Aetna Medicare |
$6,328.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.78
|
| Rate for Payer: BCBS Complete |
$3,495.47
|
| Rate for Payer: BCBS MAPPO |
$6,085.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,505.13
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.42
|
| Rate for Payer: Mclaren Medicaid |
$3,328.72
|
| Rate for Payer: Mclaren Medicare |
$6,085.42
|
| Rate for Payer: Meridian Medicaid |
$3,495.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,389.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.23
|
| Rate for Payer: PACE Medicare |
$5,781.15
|
| Rate for Payer: PACE SWMI |
$6,085.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,328.72
|
| Rate for Payer: Priority Health Medicare |
$6,085.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.42
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,267.98
|
| Rate for Payer: VA VA |
$6,085.42
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$25,696.90
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,094.97 |
| Max. Negotiated Rate |
$25,696.90 |
| Rate for Payer: Aetna Medicare |
$8,524.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,246.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,246.31
|
| Rate for Payer: BCBS Complete |
$4,708.39
|
| Rate for Payer: BCBS MAPPO |
$8,197.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,502.55
|
| Rate for Payer: BCN Medicare Advantage |
$8,197.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,197.05
|
| Rate for Payer: Mclaren Medicaid |
$4,483.79
|
| Rate for Payer: Mclaren Medicare |
$8,197.05
|
| Rate for Payer: Meridian Medicaid |
$4,708.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,606.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,426.61
|
| Rate for Payer: PACE Medicare |
$7,787.20
|
| Rate for Payer: PACE SWMI |
$8,197.05
|
| Rate for Payer: PHP Medicare Advantage |
$8,197.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,483.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,696.90
|
| Rate for Payer: Priority Health Medicare |
$8,197.05
|
| Rate for Payer: Priority Health Narrow Network |
$20,557.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,197.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.47
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,197.05
|
| Rate for Payer: UHC Exchange |
$1,094.97
|
| Rate for Payer: UHC Medicare Advantage |
$8,442.96
|
| Rate for Payer: VA VA |
$8,197.05
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; SIMPLE (EG, STONE[S] UP TO 2 CM IN SINGLE LOCATION OF KIDNEY OR RENAL PELVIS, NONBRANCHING STONES)
|
Facility
|
OP
|
$25,696.90
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.75 |
| Max. Negotiated Rate |
$25,696.90 |
| Rate for Payer: Aetna Medicare |
$8,524.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,246.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,246.31
|
| Rate for Payer: BCBS Complete |
$4,708.39
|
| Rate for Payer: BCBS MAPPO |
$8,197.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,776.96
|
| Rate for Payer: BCN Medicare Advantage |
$8,197.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,197.05
|
| Rate for Payer: Mclaren Medicaid |
$4,483.79
|
| Rate for Payer: Mclaren Medicare |
$8,197.05
|
| Rate for Payer: Meridian Medicaid |
$4,708.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,606.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,426.61
|
| Rate for Payer: PACE Medicare |
$7,787.20
|
| Rate for Payer: PACE SWMI |
$8,197.05
|
| Rate for Payer: PHP Medicare Advantage |
$8,197.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,483.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,696.90
|
| Rate for Payer: Priority Health Medicare |
$8,197.05
|
| Rate for Payer: Priority Health Narrow Network |
$20,557.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,197.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.82
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,197.05
|
| Rate for Payer: UHC Exchange |
$680.75
|
| Rate for Payer: UHC Medicare Advantage |
$8,442.96
|
| Rate for Payer: VA VA |
$8,197.05
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.60 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.15
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.66
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$670.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 26776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$454.16 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.58
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$454.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$485.92 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.51
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$485.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.02 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.82
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$388.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 28606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$392.93 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.22
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$392.93
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 25651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.76 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$544.24
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$494.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.96
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$479.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
