|
MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 27570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,313.95
|
| Rate for Payer: BCN Commercial |
$1,313.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 23700
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$929.01
|
| Rate for Payer: BCN Commercial |
$929.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$105.09
|
|
|
Service Code
|
NDC 00990771503
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Advantage |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health SBD |
$66.21
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 00990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Advantage |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health SBD |
$66.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.31
|
| Rate for Payer: UHC Core |
$54.75
|
| Rate for Payer: UHC Exchange |
$41.30
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 00990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.70
|
| Rate for Payer: UHC Core |
$49.45
|
| Rate for Payer: UHC Exchange |
$37.30
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$94.92
|
|
|
Service Code
|
NDC 00990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.30 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna Medicare |
$47.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: BCBS Complete |
$37.97
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.70
|
| Rate for Payer: UHC Core |
$49.45
|
| Rate for Payer: UHC Exchange |
$37.30
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$98.31
|
|
|
Service Code
|
NDC 338035703
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$88.48 |
| Rate for Payer: Aetna Commercial |
$83.56
|
| Rate for Payer: Aetna Medicare |
$49.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.90
|
| Rate for Payer: BCBS Complete |
$39.32
|
| Rate for Payer: Cash Price |
$78.65
|
| Rate for Payer: Cofinity Advantage |
$68.82
|
| Rate for Payer: Cofinity Commercial |
$84.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$88.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.73
|
| Rate for Payer: PHP Commercial |
$83.56
|
| Rate for Payer: Priority Health SBD |
$61.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.90
|
| Rate for Payer: UHC Core |
$51.22
|
| Rate for Payer: UHC Exchange |
$38.64
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00990771502
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.09
|
|
|
Service Code
|
NDC 00990771503
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna Medicare |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Advantage |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health SBD |
$66.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.31
|
| Rate for Payer: UHC Core |
$54.75
|
| Rate for Payer: UHC Exchange |
$41.30
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$94.92
|
|
|
Service Code
|
NDC 00990771512
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.80 |
| Max. Negotiated Rate |
$85.43 |
| Rate for Payer: Aetna Commercial |
$80.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.70
|
| Rate for Payer: Cash Price |
$75.94
|
| Rate for Payer: Cofinity Advantage |
$66.44
|
| Rate for Payer: Cofinity Commercial |
$81.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.94
|
| Rate for Payer: Healthscope Commercial |
$85.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.19
|
| Rate for Payer: PHP Commercial |
$80.68
|
| Rate for Payer: Priority Health SBD |
$59.80
|
|
|
MANNITOL 20 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$105.09
|
|
|
Service Code
|
NDC 00990771513
|
| Hospital Charge Code |
4749
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.21 |
| Max. Negotiated Rate |
$94.58 |
| Rate for Payer: Aetna Commercial |
$89.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: Cash Price |
$84.07
|
| Rate for Payer: Cofinity Advantage |
$73.56
|
| Rate for Payer: Cofinity Commercial |
$90.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.07
|
| Rate for Payer: Healthscope Commercial |
$94.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.82
|
| Rate for Payer: PHP Commercial |
$89.33
|
| Rate for Payer: Priority Health SBD |
$66.21
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$87.73
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
4750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Commercial |
$64.38
|
| Rate for Payer: Aetna Medicare |
$37.87
|
| Rate for Payer: Aetna Medicare |
$43.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.23
|
| Rate for Payer: BCBS Complete |
$30.30
|
| Rate for Payer: BCBS Complete |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Advantage |
$53.02
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.80
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: PHP Commercial |
$64.38
|
| Rate for Payer: Priority Health SBD |
$55.27
|
| Rate for Payer: Priority Health SBD |
$47.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Core |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
| Rate for Payer: UHC Exchange |
$0.10
|
|
|
MANNITOL 25 % INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$87.73
|
|
|
Service Code
|
HCPCS J2151
|
| Hospital Charge Code |
4750
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.27 |
| Max. Negotiated Rate |
$78.96 |
| Rate for Payer: Aetna Commercial |
$74.57
|
| Rate for Payer: Aetna Commercial |
$64.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.02
|
| Rate for Payer: Cash Price |
$60.59
|
| Rate for Payer: Cash Price |
$70.18
|
| Rate for Payer: Cofinity Advantage |
$61.41
|
| Rate for Payer: Cofinity Advantage |
$53.02
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$75.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.18
|
| Rate for Payer: Healthscope Commercial |
$68.17
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.80
|
| Rate for Payer: PHP Commercial |
$64.38
|
| Rate for Payer: PHP Commercial |
$74.57
|
| Rate for Payer: Priority Health SBD |
$47.72
|
| Rate for Payer: Priority Health SBD |
$55.27
|
|
|
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.86
|
| Rate for Payer: BCN Commercial |
$1,830.86
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$1,686.93
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
MASTECTOMY FOR MALIGNANCY WITH CC/MCC
|
Facility
|
IP
|
$74,156.54
|
|
|
Service Code
|
MSDRG 582
|
| Min. Negotiated Rate |
$14,694.80 |
| Max. Negotiated Rate |
$74,156.54 |
| Rate for Payer: Aetna Medicare |
$16,086.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,335.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,335.26
|
| Rate for Payer: BCBS MAPPO |
$15,468.21
|
| Rate for Payer: BCBS Trust/PPO |
$74,156.54
|
| Rate for Payer: BCN Commercial |
$74,156.54
|
| Rate for Payer: BCN Medicare Advantage |
$15,468.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,468.21
|
| Rate for Payer: Mclaren Medicare |
$15,468.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,241.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,788.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,015.03
|
| Rate for Payer: Nomi Health Commercial |
$24,853.14
|
| Rate for Payer: PACE Medicare |
$14,694.80
|
| Rate for Payer: PACE SWMI |
$15,468.21
|
| Rate for Payer: PHP Medicare Advantage |
$15,468.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,060.91
|
| Rate for Payer: Priority Health Medicare |
$15,468.21
|
| Rate for Payer: Priority Health Tiered Network |
$24,848.73
|
| Rate for Payer: Railroad Medicare Medicare |
$15,468.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,403.58
|
| Rate for Payer: UHC Core |
$26,273.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,468.21
|
| Rate for Payer: UHC Exchange |
$21,456.54
|
| Rate for Payer: VA VA |
$15,468.21
|
|
|
MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$67,054.56
|
|
|
Service Code
|
MSDRG 583
|
| Min. Negotiated Rate |
$13,210.29 |
| Max. Negotiated Rate |
$67,054.56 |
| Rate for Payer: Railroad Medicare Medicare |
$13,905.57
|
| Rate for Payer: Aetna Medicare |
$14,461.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,381.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,381.96
|
| Rate for Payer: BCBS MAPPO |
$13,905.57
|
| Rate for Payer: BCBS Trust/PPO |
$67,054.56
|
| Rate for Payer: BCN Commercial |
$67,054.56
|
| Rate for Payer: BCN Medicare Advantage |
$13,905.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,905.57
|
| Rate for Payer: Mclaren Medicare |
$13,905.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,600.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,991.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,296.13
|
| Rate for Payer: Nomi Health Commercial |
$22,244.76
|
| Rate for Payer: PACE Medicare |
$13,210.29
|
| Rate for Payer: PACE SWMI |
$13,905.57
|
| Rate for Payer: PHP Medicare Advantage |
$13,905.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,801.02
|
| Rate for Payer: Priority Health Medicare |
$13,905.57
|
| Rate for Payer: Priority Health Tiered Network |
$22,240.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,107.72
|
| Rate for Payer: UHC Core |
$23,515.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,905.57
|
| Rate for Payer: UHC Exchange |
$19,204.64
|
| Rate for Payer: VA VA |
$13,905.57
|
|
|
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY);
|
Facility
|
OP
|
$12,616.62
|
|
|
Service Code
|
CPT 19301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,040.41 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.02
|
| Rate for Payer: BCN Commercial |
$2,915.02
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$11,219.48
|
|
|
Service Code
|
APR-DRG 3621
|
| Min. Negotiated Rate |
$10,685.22 |
| Max. Negotiated Rate |
$11,219.48 |
| Rate for Payer: BCBS Complete |
$11,219.48
|
| Rate for Payer: Mclaren Medicaid |
$10,685.22
|
| Rate for Payer: Meridian Medicaid |
$11,219.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,685.22
|
| Rate for Payer: UHC Medicaid |
$10,685.22
|
| Rate for Payer: UHCCP Medicaid |
$10,685.22
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$17,078.61
|
|
|
Service Code
|
APR-DRG 3624
|
| Min. Negotiated Rate |
$16,265.34 |
| Max. Negotiated Rate |
$17,078.61 |
| Rate for Payer: BCBS Complete |
$17,078.61
|
| Rate for Payer: Mclaren Medicaid |
$16,265.34
|
| Rate for Payer: Meridian Medicaid |
$17,078.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,265.34
|
| Rate for Payer: UHC Medicaid |
$16,265.34
|
| Rate for Payer: UHCCP Medicaid |
$16,265.34
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$14,968.86
|
|
|
Service Code
|
APR-DRG 3622
|
| Min. Negotiated Rate |
$14,256.06 |
| Max. Negotiated Rate |
$14,968.86 |
| Rate for Payer: BCBS Complete |
$14,968.86
|
| Rate for Payer: Mclaren Medicaid |
$14,256.06
|
| Rate for Payer: Meridian Medicaid |
$14,968.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,256.06
|
| Rate for Payer: UHC Medicaid |
$14,256.06
|
| Rate for Payer: UHCCP Medicaid |
$14,256.06
|
|
|
MASTECTOMY PROCEDURES
|
Facility
|
IP
|
$16,132.09
|
|
|
Service Code
|
APR-DRG 3623
|
| Min. Negotiated Rate |
$15,363.89 |
| Max. Negotiated Rate |
$16,132.09 |
| Rate for Payer: BCBS Complete |
$16,132.09
|
| Rate for Payer: Mclaren Medicaid |
$15,363.89
|
| Rate for Payer: Meridian Medicaid |
$16,132.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,363.89
|
| Rate for Payer: UHC Medicaid |
$15,363.89
|
| Rate for Payer: UHCCP Medicaid |
$15,363.89
|
|
|
MASTECTOMY, SIMPLE, COMPLETE
|
Facility
|
OP
|
$21,396.49
|
|
|
Service Code
|
CPT 19303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,460.32 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$5,653.23
|
| Rate for Payer: BCN Commercial |
$5,653.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Mclaren Medicaid |
$3,460.32
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
MASTOPEXY
|
Facility
|
OP
|
$21,396.49
|
|
|
Service Code
|
CPT 19316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,460.32 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$4,895.63
|
| Rate for Payer: BCN Commercial |
$4,895.63
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Mclaren Medicaid |
$3,460.32
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT
|
Facility
|
IP
|
$308.27
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
10512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$194.21 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$262.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.38
|
| Rate for Payer: Cash Price |
$246.62
|
| Rate for Payer: Cofinity Advantage |
$215.79
|
| Rate for Payer: Cofinity Commercial |
$265.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.62
|
| Rate for Payer: Healthscope Commercial |
$277.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.20
|
| Rate for Payer: PHP Commercial |
$262.03
|
| Rate for Payer: Priority Health SBD |
$194.21
|
|
|
MEASLES,MUMPS,RUBELLA VACCINE LIVE(PF)1,000-12,500TCID50/0.5 ML SUBCUT
|
Facility
|
OP
|
$308.27
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
10512
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.31 |
| Max. Negotiated Rate |
$277.44 |
| Rate for Payer: Aetna Commercial |
$262.03
|
| Rate for Payer: Aetna Medicare |
$154.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.38
|
| Rate for Payer: BCBS Complete |
$123.31
|
| Rate for Payer: BCBS Trust/PPO |
$234.42
|
| Rate for Payer: BCN Commercial |
$234.42
|
| Rate for Payer: Cash Price |
$246.62
|
| Rate for Payer: Cash Price |
$246.62
|
| Rate for Payer: Cofinity Advantage |
$215.79
|
| Rate for Payer: Cofinity Commercial |
$265.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.62
|
| Rate for Payer: Healthscope Commercial |
$277.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.20
|
| Rate for Payer: PHP Commercial |
$262.03
|
| Rate for Payer: Priority Health SBD |
$194.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.28
|
| Rate for Payer: UHC Core |
$193.28
|
| Rate for Payer: UHC Exchange |
$193.28
|
|
