|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S);
|
Facility
|
OP
|
$15,432.16
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$15,432.16 |
| Rate for Payer: Aetna Medicare |
$5,289.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,357.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,357.20
|
| Rate for Payer: BCBS Complete |
$2,921.26
|
| Rate for Payer: BCBS MAPPO |
$5,085.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,019.64
|
| Rate for Payer: BCN Medicare Advantage |
$5,085.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,085.76
|
| Rate for Payer: Mclaren Medicaid |
$2,781.91
|
| Rate for Payer: Mclaren Medicare |
$5,085.76
|
| Rate for Payer: Meridian Medicaid |
$2,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,340.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,848.62
|
| Rate for Payer: PACE Medicare |
$4,831.47
|
| Rate for Payer: PACE SWMI |
$5,085.76
|
| Rate for Payer: PHP Medicare Advantage |
$5,085.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,432.16
|
| Rate for Payer: Priority Health Medicare |
$5,085.76
|
| Rate for Payer: Priority Health Narrow Network |
$12,345.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,085.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.12
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,085.76
|
| Rate for Payer: UHC Exchange |
$351.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,238.33
|
| Rate for Payer: VA VA |
$5,085.76
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS CIRCUIT
|
Facility
|
OP
|
$51,507.72
|
|
|
Service Code
|
CPT 36906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.58 |
| 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: BCBS Trust/PPO |
$8,957.83
|
| 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) |
$535.24
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$486.58
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.42 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,721.77
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.56
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$421.42
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTIONS AND FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 37187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.92 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.59
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.41
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$374.92
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$10,308.37
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$701.71 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,984.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.88
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$701.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.47 |
| 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 |
$925.58
|
| 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) |
$297.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$39,879.74
|
|
|
Service Code
|
MS-DRG 041
|
| Min. Negotiated Rate |
$15,729.88 |
| Max. Negotiated Rate |
$39,879.74 |
| Rate for Payer: Aetna Medicare |
$17,220.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,697.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,697.21
|
| Rate for Payer: BCBS MAPPO |
$16,557.77
|
| Rate for Payer: BCBS Trust/PPO |
$39,879.74
|
| Rate for Payer: BCN Medicare Advantage |
$16,557.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,557.77
|
| Rate for Payer: Mclaren Medicare |
$16,557.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,385.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,041.44
|
| Rate for Payer: PACE Medicare |
$15,729.88
|
| Rate for Payer: PACE SWMI |
$16,557.77
|
| Rate for Payer: PHP Medicare Advantage |
$16,557.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,010.37
|
| Rate for Payer: Priority Health Medicare |
$16,557.77
|
| Rate for Payer: Priority Health Narrow Network |
$25,608.30
|
| Rate for Payer: Railroad Medicare Medicare |
$16,557.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,027.10
|
| Rate for Payer: UHC Core |
$20,879.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,557.77
|
| Rate for Payer: UHC Exchange |
$22,362.77
|
| Rate for Payer: UHC Medicare Advantage |
$17,054.50
|
| Rate for Payer: VA VA |
$16,557.77
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$58,735.53
|
|
|
Service Code
|
MS-DRG 040
|
| Min. Negotiated Rate |
$26,812.06 |
| Max. Negotiated Rate |
$58,735.53 |
| Rate for Payer: Aetna Medicare |
$29,352.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,279.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,279.02
|
| Rate for Payer: BCBS MAPPO |
$28,223.22
|
| Rate for Payer: BCBS Trust/PPO |
$57,067.05
|
| Rate for Payer: BCN Medicare Advantage |
$28,223.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,223.22
|
| Rate for Payer: Mclaren Medicare |
$28,223.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29,634.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,456.70
|
| Rate for Payer: PACE Medicare |
$26,812.06
|
| Rate for Payer: PACE SWMI |
$28,223.22
|
| Rate for Payer: PHP Medicare Advantage |
$28,223.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,254.37
|
| Rate for Payer: Priority Health Medicare |
$28,223.22
|
| Rate for Payer: Priority Health Narrow Network |
$44,203.50
|
| Rate for Payer: Railroad Medicare Medicare |
$28,223.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,735.53
|
| Rate for Payer: UHC Core |
$36,040.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,223.22
|
| Rate for Payer: UHC Exchange |
$38,601.26
|
| Rate for Payer: UHC Medicare Advantage |
$29,069.92
|
| Rate for Payer: VA VA |
$28,223.22
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,585.43
|
|
|
Service Code
|
MS-DRG 042
|
| Min. Negotiated Rate |
$12,371.30 |
| Max. Negotiated Rate |
$34,585.43 |
| Rate for Payer: Aetna Medicare |
$13,543.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,278.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,278.02
|
| Rate for Payer: BCBS MAPPO |
$13,022.42
|
| Rate for Payer: BCBS Trust/PPO |
$34,585.43
|
| Rate for Payer: BCN Medicare Advantage |
$13,022.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,022.42
|
| Rate for Payer: Mclaren Medicare |
$13,022.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,673.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,975.78
|
| Rate for Payer: PACE Medicare |
$12,371.30
|
| Rate for Payer: PACE SWMI |
$13,022.42
|
| Rate for Payer: PHP Medicare Advantage |
$13,022.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,965.99
|
| Rate for Payer: Priority Health Medicare |
$13,022.42
|
| Rate for Payer: Priority Health Narrow Network |
$19,972.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,022.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,538.91
|
| Rate for Payer: UHC Core |
$16,284.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,022.42
|
| Rate for Payer: UHC Exchange |
$17,441.50
|
| Rate for Payer: UHC Medicare Advantage |
$13,413.09
|
| Rate for Payer: VA VA |
$13,022.42
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$16,871.10
|
|
|
Service Code
|
MS-DRG 300
|
| Min. Negotiated Rate |
$7,768.18 |
| Max. Negotiated Rate |
$16,871.10 |
| Rate for Payer: Aetna Medicare |
$8,504.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,221.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,221.29
|
| Rate for Payer: BCBS MAPPO |
$8,177.03
|
| Rate for Payer: BCBS Trust/PPO |
$16,871.10
|
| Rate for Payer: BCN Medicare Advantage |
$8,177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,177.03
|
| Rate for Payer: Mclaren Medicare |
$8,177.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,585.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,403.58
|
| Rate for Payer: PACE Medicare |
$7,768.18
|
| Rate for Payer: PACE SWMI |
$8,177.03
|
| Rate for Payer: PHP Medicare Advantage |
$8,177.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,311.36
|
| Rate for Payer: Priority Health Medicare |
$8,177.03
|
| Rate for Payer: Priority Health Narrow Network |
$12,249.09
|
| Rate for Payer: Railroad Medicare Medicare |
$8,177.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,276.02
|
| Rate for Payer: UHC Core |
$9,987.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,177.03
|
| Rate for Payer: UHC Exchange |
$10,696.68
|
| Rate for Payer: UHC Medicare Advantage |
$8,422.34
|
| Rate for Payer: VA VA |
$8,177.03
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$24,135.14
|
|
|
Service Code
|
MS-DRG 299
|
| Min. Negotiated Rate |
$11,251.99 |
| Max. Negotiated Rate |
$24,135.14 |
| Rate for Payer: Aetna Medicare |
$12,317.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,805.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,805.25
|
| Rate for Payer: BCBS MAPPO |
$11,844.20
|
| Rate for Payer: BCBS Trust/PPO |
$24,135.14
|
| Rate for Payer: BCN Medicare Advantage |
$11,844.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,844.20
|
| Rate for Payer: Mclaren Medicare |
$11,844.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,436.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,620.83
|
| Rate for Payer: PACE Medicare |
$11,251.99
|
| Rate for Payer: PACE SWMI |
$11,844.20
|
| Rate for Payer: PHP Medicare Advantage |
$11,844.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,618.34
|
| Rate for Payer: Priority Health Medicare |
$11,844.20
|
| Rate for Payer: Priority Health Narrow Network |
$18,094.67
|
| Rate for Payer: Railroad Medicare Medicare |
$11,844.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,043.35
|
| Rate for Payer: UHC Core |
$14,753.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,844.20
|
| Rate for Payer: UHC Exchange |
$15,801.41
|
| Rate for Payer: UHC Medicare Advantage |
$12,199.53
|
| Rate for Payer: VA VA |
$11,844.20
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,034.00
|
|
|
Service Code
|
MS-DRG 301
|
| Min. Negotiated Rate |
$5,324.32 |
| Max. Negotiated Rate |
$14,034.00 |
| Rate for Payer: Aetna Medicare |
$5,828.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,005.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,005.69
|
| Rate for Payer: BCBS MAPPO |
$5,604.55
|
| Rate for Payer: BCBS Trust/PPO |
$14,034.00
|
| Rate for Payer: BCN Medicare Advantage |
$5,604.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,604.55
|
| Rate for Payer: Mclaren Medicare |
$5,604.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,884.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,445.23
|
| Rate for Payer: PACE Medicare |
$5,324.32
|
| Rate for Payer: PACE SWMI |
$5,604.55
|
| Rate for Payer: PHP Medicare Advantage |
$5,604.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,185.57
|
| Rate for Payer: Priority Health Medicare |
$5,604.55
|
| Rate for Payer: Priority Health Narrow Network |
$8,148.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,604.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,827.29
|
| Rate for Payer: UHC Core |
$6,643.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,604.55
|
| Rate for Payer: UHC Exchange |
$7,115.75
|
| Rate for Payer: UHC Medicare Advantage |
$5,772.69
|
| Rate for Payer: VA VA |
$5,604.55
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$135.60
|
|
|
Service Code
|
NDC 49230-206-92
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.26
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.92
|
| Rate for Payer: Priority Health SBD |
$85.43
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-206-94
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
|
|
PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-212-94
|
| Hospital Charge Code |
27803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
|
|
PERITONEAL ADHESIOLYSIS WITH CC
|
Facility
|
IP
|
$33,687.30
|
|
|
Service Code
|
MS-DRG 336
|
| Min. Negotiated Rate |
$14,871.93 |
| Max. Negotiated Rate |
$33,687.30 |
| Rate for Payer: Aetna Medicare |
$16,280.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,568.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,568.32
|
| Rate for Payer: BCBS MAPPO |
$15,654.66
|
| Rate for Payer: BCBS Trust/PPO |
$33,687.30
|
| Rate for Payer: BCN Medicare Advantage |
$15,654.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,654.66
|
| Rate for Payer: Mclaren Medicare |
$15,654.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,437.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,002.86
|
| Rate for Payer: PACE Medicare |
$14,871.93
|
| Rate for Payer: PACE SWMI |
$15,654.66
|
| Rate for Payer: PHP Medicare Advantage |
$15,654.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,210.89
|
| Rate for Payer: Priority Health Medicare |
$15,654.66
|
| Rate for Payer: Priority Health Narrow Network |
$24,168.71
|
| Rate for Payer: Railroad Medicare Medicare |
$15,654.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,114.25
|
| Rate for Payer: UHC Core |
$19,705.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,654.66
|
| Rate for Payer: UHC Exchange |
$21,105.63
|
| Rate for Payer: UHC Medicare Advantage |
$16,124.30
|
| Rate for Payer: VA VA |
$15,654.66
|
|
|
PERITONEAL ADHESIOLYSIS WITH MCC
|
Facility
|
IP
|
$54,533.05
|
|
|
Service Code
|
MS-DRG 335
|
| Min. Negotiated Rate |
$24,927.17 |
| Max. Negotiated Rate |
$54,533.05 |
| Rate for Payer: Aetna Medicare |
$27,288.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,798.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,798.91
|
| Rate for Payer: BCBS MAPPO |
$26,239.13
|
| Rate for Payer: BCBS Trust/PPO |
$51,599.26
|
| Rate for Payer: BCN Medicare Advantage |
$26,239.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,239.13
|
| Rate for Payer: Mclaren Medicare |
$26,239.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,551.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,175.00
|
| Rate for Payer: PACE Medicare |
$24,927.17
|
| Rate for Payer: PACE SWMI |
$26,239.13
|
| Rate for Payer: PHP Medicare Advantage |
$26,239.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,300.96
|
| Rate for Payer: Priority Health Medicare |
$26,239.13
|
| Rate for Payer: Priority Health Narrow Network |
$41,040.77
|
| Rate for Payer: Railroad Medicare Medicare |
$26,239.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54,533.05
|
| Rate for Payer: UHC Core |
$33,462.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$26,239.13
|
| Rate for Payer: UHC Exchange |
$35,839.38
|
| Rate for Payer: UHC Medicare Advantage |
$27,026.30
|
| Rate for Payer: VA VA |
$26,239.13
|
|
|
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$28,335.89
|
|
|
Service Code
|
MS-DRG 337
|
| Min. Negotiated Rate |
$10,706.02 |
| Max. Negotiated Rate |
$28,335.89 |
| Rate for Payer: Aetna Medicare |
$11,720.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,086.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,086.86
|
| Rate for Payer: BCBS MAPPO |
$11,269.49
|
| Rate for Payer: BCBS Trust/PPO |
$28,335.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,269.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,269.49
|
| Rate for Payer: Mclaren Medicare |
$11,269.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,832.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,959.91
|
| Rate for Payer: PACE Medicare |
$10,706.02
|
| Rate for Payer: PACE SWMI |
$11,269.49
|
| Rate for Payer: PHP Medicare Advantage |
$11,269.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,473.22
|
| Rate for Payer: Priority Health Medicare |
$11,269.49
|
| Rate for Payer: Priority Health Narrow Network |
$17,178.58
|
| Rate for Payer: Railroad Medicare Medicare |
$11,269.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,826.09
|
| Rate for Payer: UHC Core |
$14,006.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,269.49
|
| Rate for Payer: UHC Exchange |
$15,001.41
|
| Rate for Payer: UHC Medicare Advantage |
$11,607.57
|
| Rate for Payer: VA VA |
$11,269.49
|
|
|
PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-209-94
|
| Hospital Charge Code |
27800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.75 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
|
|
PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$135.60
|
|
|
Service Code
|
NDC 49230-209-92
|
| Hospital Charge Code |
27800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.43 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.26
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.92
|
| Rate for Payer: Priority Health SBD |
$85.43
|
|
|
PERITONEAL DIALYSIS SOLN 7-2.5 % DEXT.LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$162.72
|
|
|
Service Code
|
NDC 49230-209-95
|
| Hospital Charge Code |
27800
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.51 |
| Max. Negotiated Rate |
$146.45 |
| Rate for Payer: Aetna Commercial |
$138.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.77
|
| Rate for Payer: Cash Price |
$130.18
|
| Rate for Payer: Cofinity Commercial |
$113.90
|
| Rate for Payer: Cofinity Commercial |
$139.94
|
| Rate for Payer: Healthscope Commercial |
$146.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$138.31
|
| Rate for Payer: PHP Commercial |
$138.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.90
|
| Rate for Payer: Priority Health SBD |
$102.51
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC
|
Facility
|
IP
|
$41,285.12
|
|
|
Service Code
|
MS-DRG 243
|
| Min. Negotiated Rate |
$16,050.75 |
| Max. Negotiated Rate |
$41,285.12 |
| Rate for Payer: Aetna Medicare |
$17,571.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,119.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,119.41
|
| Rate for Payer: BCBS MAPPO |
$16,895.53
|
| Rate for Payer: BCBS Trust/PPO |
$41,285.12
|
| Rate for Payer: BCN Medicare Advantage |
$16,895.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,895.53
|
| Rate for Payer: Mclaren Medicare |
$16,895.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,740.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,429.86
|
| Rate for Payer: PACE Medicare |
$16,050.75
|
| Rate for Payer: PACE SWMI |
$16,895.53
|
| Rate for Payer: PHP Medicare Advantage |
$16,895.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,683.38
|
| Rate for Payer: Priority Health Medicare |
$16,895.53
|
| Rate for Payer: Priority Health Narrow Network |
$26,146.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16,895.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,742.51
|
| Rate for Payer: UHC Core |
$21,318.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,895.53
|
| Rate for Payer: UHC Exchange |
$22,832.94
|
| Rate for Payer: UHC Medicare Advantage |
$17,402.40
|
| Rate for Payer: VA VA |
$16,895.53
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC
|
Facility
|
IP
|
$64,743.92
|
|
|
Service Code
|
MS-DRG 242
|
| Min. Negotiated Rate |
$24,106.86 |
| Max. Negotiated Rate |
$64,743.92 |
| Rate for Payer: Aetna Medicare |
$26,390.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,719.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,719.55
|
| Rate for Payer: BCBS MAPPO |
$25,375.64
|
| Rate for Payer: BCBS Trust/PPO |
$64,743.92
|
| Rate for Payer: BCN Medicare Advantage |
$25,375.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,375.64
|
| Rate for Payer: Mclaren Medicare |
$25,375.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,644.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,181.99
|
| Rate for Payer: PACE Medicare |
$24,106.86
|
| Rate for Payer: PACE SWMI |
$25,375.64
|
| Rate for Payer: PHP Medicare Advantage |
$25,375.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,580.41
|
| Rate for Payer: Priority Health Medicare |
$25,375.64
|
| Rate for Payer: Priority Health Narrow Network |
$39,664.33
|
| Rate for Payer: Railroad Medicare Medicare |
$25,375.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,704.10
|
| Rate for Payer: UHC Core |
$32,339.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,375.64
|
| Rate for Payer: UHC Exchange |
$34,637.38
|
| Rate for Payer: UHC Medicare Advantage |
$26,136.91
|
| Rate for Payer: VA VA |
$25,375.64
|
|
|
PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$37,334.69
|
|
|
Service Code
|
MS-DRG 244
|
| Min. Negotiated Rate |
$12,984.99 |
| Max. Negotiated Rate |
$37,334.69 |
| Rate for Payer: Aetna Medicare |
$14,215.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,085.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,085.51
|
| Rate for Payer: BCBS MAPPO |
$13,668.41
|
| Rate for Payer: BCBS Trust/PPO |
$37,334.69
|
| Rate for Payer: BCN Medicare Advantage |
$13,668.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,668.41
|
| Rate for Payer: Mclaren Medicare |
$13,668.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,351.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,718.67
|
| Rate for Payer: PACE Medicare |
$12,984.99
|
| Rate for Payer: PACE SWMI |
$13,668.41
|
| Rate for Payer: PHP Medicare Advantage |
$13,668.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,253.18
|
| Rate for Payer: Priority Health Medicare |
$13,668.41
|
| Rate for Payer: Priority Health Narrow Network |
$21,002.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13,668.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,907.19
|
| Rate for Payer: UHC Core |
$17,124.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,668.41
|
| Rate for Payer: UHC Exchange |
$18,340.74
|
| Rate for Payer: UHC Medicare Advantage |
$14,078.46
|
| Rate for Payer: VA VA |
$13,668.41
|
|
|
PERMETHRIN 1 % TOPICAL LIQUID
|
Facility
|
IP
|
$39.65
|
|
|
Service Code
|
NDC 6373612002
|
| Hospital Charge Code |
10918
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.77
|
| Rate for Payer: Cash Price |
$31.72
|
| Rate for Payer: Cofinity Commercial |
$27.76
|
| Rate for Payer: Cofinity Commercial |
$34.10
|
| Rate for Payer: Healthscope Commercial |
$35.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.70
|
| Rate for Payer: PHP Commercial |
$33.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.76
|
| Rate for Payer: Priority Health SBD |
$24.98
|
|
