|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$34,908.81
|
|
|
Service Code
|
APR-DRG 1834
|
| Min. Negotiated Rate |
$33,246.49 |
| Max. Negotiated Rate |
$34,908.81 |
| Rate for Payer: BCBS Complete |
$34,908.81
|
| Rate for Payer: Mclaren Medicaid |
$33,246.49
|
| Rate for Payer: Meridian Medicaid |
$34,908.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$33,246.49
|
| Rate for Payer: UHC Medicaid |
$33,246.49
|
| Rate for Payer: UHCCP Medicaid |
$33,246.49
|
|
|
PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES
|
Facility
|
IP
|
$19,663.04
|
|
|
Service Code
|
APR-DRG 1832
|
| Min. Negotiated Rate |
$18,726.71 |
| Max. Negotiated Rate |
$19,663.04 |
| Rate for Payer: BCBS Complete |
$19,663.04
|
| Rate for Payer: Mclaren Medicaid |
$18,726.71
|
| Rate for Payer: Meridian Medicaid |
$19,663.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,726.71
|
| Rate for Payer: UHC Medicaid |
$18,726.71
|
| Rate for Payer: UHCCP Medicaid |
$18,726.71
|
|
|
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
|
$59,069.70
|
|
|
Service Code
|
CPT 36906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,552.97 |
| Max. Negotiated Rate |
$59,069.70 |
| Rate for Payer: Aetna Medicare |
$18,996.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,832.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,832.15
|
| Rate for Payer: BCBS Complete |
$10,031.53
|
| Rate for Payer: BCBS MAPPO |
$18,265.72
|
| Rate for Payer: BCBS Trust/PPO |
$11,815.28
|
| Rate for Payer: BCN Commercial |
$11,815.28
|
| Rate for Payer: BCN Medicare Advantage |
$18,265.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,265.72
|
| Rate for Payer: Mclaren Medicaid |
$9,552.97
|
| Rate for Payer: Mclaren Medicare |
$18,265.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,179.01
|
| Rate for Payer: Meridian Medicaid |
$19,179.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,005.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,092.29
|
| Rate for Payer: Nomi Health Commercial |
$54,797.16
|
| Rate for Payer: PACE Medicare |
$17,352.43
|
| Rate for Payer: PACE SWMI |
$18,265.72
|
| Rate for Payer: PHP Medicare Advantage |
$18,265.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,552.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59,069.70
|
| Rate for Payer: Priority Health Medicare |
$18,265.72
|
| Rate for Payer: Priority Health Tiered Network |
$47,255.76
|
| Rate for Payer: Railroad Medicare Medicare |
$18,265.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,265.72
|
| Rate for Payer: UHC Medicaid |
$9,552.97
|
| Rate for Payer: UHCCP Medicaid |
$9,552.97
|
| Rate for Payer: VA VA |
$18,265.72
|
|
|
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
|
$37,198.61
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCBS Trust/PPO |
$7,546.95
|
| Rate for Payer: BCN Commercial |
$7,546.95
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Mclaren Medicaid |
$6,015.90
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$4,992.87
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$4,755.11 |
| Max. Negotiated Rate |
$4,992.87 |
| Rate for Payer: BCBS Complete |
$4,992.87
|
| Rate for Payer: Mclaren Medicaid |
$4,755.11
|
| Rate for Payer: Meridian Medicaid |
$4,992.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,755.11
|
| Rate for Payer: UHC Medicaid |
$4,755.11
|
| Rate for Payer: UHCCP Medicaid |
$4,755.11
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$11,448.23
|
|
|
Service Code
|
APR-DRG 1974
|
| Min. Negotiated Rate |
$10,903.07 |
| Max. Negotiated Rate |
$11,448.23 |
| Rate for Payer: BCBS Complete |
$11,448.23
|
| Rate for Payer: Mclaren Medicaid |
$10,903.07
|
| Rate for Payer: Meridian Medicaid |
$11,448.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,903.07
|
| Rate for Payer: UHC Medicaid |
$10,903.07
|
| Rate for Payer: UHCCP Medicaid |
$10,903.07
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$7,849.62
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$7,475.83 |
| Max. Negotiated Rate |
$7,849.62 |
| Rate for Payer: BCBS Complete |
$7,849.62
|
| Rate for Payer: Mclaren Medicaid |
$7,475.83
|
| Rate for Payer: Meridian Medicaid |
$7,849.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,475.83
|
| Rate for Payer: UHC Medicaid |
$7,475.83
|
| Rate for Payer: UHCCP Medicaid |
$7,475.83
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$3,794.10
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$3,613.43 |
| Max. Negotiated Rate |
$3,794.10 |
| Rate for Payer: BCBS Complete |
$3,794.10
|
| Rate for Payer: Mclaren Medicaid |
$3,613.43
|
| Rate for Payer: Meridian Medicaid |
$3,794.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,613.43
|
| Rate for Payer: UHC Medicaid |
$3,613.43
|
| Rate for Payer: UHCCP Medicaid |
$3,613.43
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$5,382.71
|
|
|
Service Code
|
APR-DRG 0482
|
| Min. Negotiated Rate |
$5,126.39 |
| Max. Negotiated Rate |
$5,382.71 |
| Rate for Payer: BCBS Complete |
$5,382.71
|
| Rate for Payer: Mclaren Medicaid |
$5,126.39
|
| Rate for Payer: Meridian Medicaid |
$5,382.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,126.39
|
| Rate for Payer: UHC Medicaid |
$5,126.39
|
| Rate for Payer: UHCCP Medicaid |
$5,126.39
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$13,039.14
|
|
|
Service Code
|
APR-DRG 0484
|
| Min. Negotiated Rate |
$12,418.22 |
| Max. Negotiated Rate |
$13,039.14 |
| Rate for Payer: BCBS Complete |
$13,039.14
|
| Rate for Payer: Mclaren Medicaid |
$12,418.22
|
| Rate for Payer: Meridian Medicaid |
$13,039.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,418.22
|
| Rate for Payer: UHC Medicaid |
$12,418.22
|
| Rate for Payer: UHCCP Medicaid |
$12,418.22
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$8,198.19
|
|
|
Service Code
|
APR-DRG 0483
|
| Min. Negotiated Rate |
$7,807.80 |
| Max. Negotiated Rate |
$8,198.19 |
| Rate for Payer: BCBS Complete |
$8,198.19
|
| Rate for Payer: Mclaren Medicaid |
$7,807.80
|
| Rate for Payer: Meridian Medicaid |
$8,198.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,807.80
|
| Rate for Payer: UHC Medicaid |
$7,807.80
|
| Rate for Payer: UHCCP Medicaid |
$7,807.80
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$4,183.37
|
|
|
Service Code
|
APR-DRG 0481
|
| Min. Negotiated Rate |
$3,984.16 |
| Max. Negotiated Rate |
$4,183.37 |
| Rate for Payer: BCBS Complete |
$4,183.37
|
| Rate for Payer: Mclaren Medicaid |
$3,984.16
|
| Rate for Payer: Meridian Medicaid |
$4,183.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,984.16
|
| Rate for Payer: UHC Medicaid |
$3,984.16
|
| Rate for Payer: UHCCP Medicaid |
$3,984.16
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$42,511.27
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$16,692.50 |
| Max. Negotiated Rate |
$42,511.27 |
| Rate for Payer: Aetna Medicare |
$18,273.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,963.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,963.81
|
| Rate for Payer: BCBS MAPPO |
$17,571.05
|
| Rate for Payer: BCBS Trust/PPO |
$42,511.27
|
| Rate for Payer: BCN Commercial |
$42,511.27
|
| Rate for Payer: BCN Medicare Advantage |
$17,571.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,571.05
|
| Rate for Payer: Mclaren Medicare |
$17,571.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,449.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,206.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,328.15
|
| Rate for Payer: Nomi Health Commercial |
$28,363.23
|
| Rate for Payer: PACE Medicare |
$16,692.50
|
| Rate for Payer: PACE SWMI |
$17,571.05
|
| Rate for Payer: PHP Medicare Advantage |
$17,571.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,447.75
|
| Rate for Payer: Priority Health Medicare |
$17,571.05
|
| Rate for Payer: Priority Health Tiered Network |
$28,358.19
|
| Rate for Payer: Railroad Medicare Medicare |
$17,571.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,838.81
|
| Rate for Payer: UHC Core |
$29,983.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,571.05
|
| Rate for Payer: UHC Exchange |
$24,486.92
|
| Rate for Payer: VA VA |
$17,571.05
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$62,937.56
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$28,898.26 |
| Max. Negotiated Rate |
$62,937.56 |
| Rate for Payer: Aetna Medicare |
$31,635.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,024.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,024.03
|
| Rate for Payer: BCBS MAPPO |
$30,419.22
|
| Rate for Payer: BCBS Trust/PPO |
$60,832.71
|
| Rate for Payer: BCN Commercial |
$60,832.71
|
| Rate for Payer: BCN Medicare Advantage |
$30,419.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,419.22
|
| Rate for Payer: Mclaren Medicare |
$30,419.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,940.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,982.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,461.14
|
| Rate for Payer: Nomi Health Commercial |
$49,809.48
|
| Rate for Payer: PACE Medicare |
$28,898.26
|
| Rate for Payer: PACE SWMI |
$30,419.22
|
| Rate for Payer: PHP Medicare Advantage |
$30,419.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,250.81
|
| Rate for Payer: Priority Health Medicare |
$30,419.22
|
| Rate for Payer: Priority Health Tiered Network |
$49,800.64
|
| Rate for Payer: Railroad Medicare Medicare |
$30,419.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,937.56
|
| Rate for Payer: UHC Core |
$52,655.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,419.22
|
| Rate for Payer: UHC Exchange |
$43,002.18
|
| Rate for Payer: VA VA |
$30,419.22
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,867.60
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$13,234.51 |
| Max. Negotiated Rate |
$36,867.60 |
| Rate for Payer: Aetna Medicare |
$14,488.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,413.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,413.83
|
| Rate for Payer: BCBS MAPPO |
$13,931.06
|
| Rate for Payer: BCBS Trust/PPO |
$36,867.60
|
| Rate for Payer: BCN Commercial |
$36,867.60
|
| Rate for Payer: BCN Medicare Advantage |
$13,931.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,931.06
|
| Rate for Payer: Mclaren Medicare |
$13,931.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,627.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,020.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,324.17
|
| Rate for Payer: Nomi Health Commercial |
$22,287.33
|
| Rate for Payer: PACE Medicare |
$13,234.51
|
| Rate for Payer: PACE SWMI |
$13,931.06
|
| Rate for Payer: PHP Medicare Advantage |
$13,931.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,854.22
|
| Rate for Payer: Priority Health Medicare |
$13,931.06
|
| Rate for Payer: Priority Health Tiered Network |
$22,283.37
|
| Rate for Payer: Railroad Medicare Medicare |
$13,931.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,161.51
|
| Rate for Payer: UHC Core |
$23,560.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,931.06
|
| Rate for Payer: UHC Exchange |
$19,241.39
|
| Rate for Payer: VA VA |
$13,931.06
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$17,984.37
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$8,387.45 |
| Max. Negotiated Rate |
$17,984.37 |
| Rate for Payer: Aetna Medicare |
$9,182.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,036.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,036.11
|
| Rate for Payer: BCBS MAPPO |
$8,828.89
|
| Rate for Payer: BCBS Trust/PPO |
$17,984.37
|
| Rate for Payer: BCN Commercial |
$17,984.37
|
| Rate for Payer: BCN Medicare Advantage |
$8,828.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,828.89
|
| Rate for Payer: Mclaren Medicare |
$8,828.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,270.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,153.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,711.78
|
| Rate for Payer: Nomi Health Commercial |
$13,770.75
|
| Rate for Payer: PACE Medicare |
$8,387.45
|
| Rate for Payer: PACE SWMI |
$8,828.89
|
| Rate for Payer: PHP Medicare Advantage |
$8,828.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,210.38
|
| Rate for Payer: Priority Health Medicare |
$8,828.89
|
| Rate for Payer: Priority Health Tiered Network |
$13,768.31
|
| Rate for Payer: Railroad Medicare Medicare |
$8,828.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,400.25
|
| Rate for Payer: UHC Core |
$14,557.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,828.89
|
| Rate for Payer: UHC Exchange |
$11,888.75
|
| Rate for Payer: VA VA |
$8,828.89
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$26,613.01
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$12,537.03 |
| Max. Negotiated Rate |
$26,613.01 |
| Rate for Payer: Aetna Medicare |
$13,724.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,496.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,496.09
|
| Rate for Payer: BCBS MAPPO |
$13,196.87
|
| Rate for Payer: BCBS Trust/PPO |
$25,727.73
|
| Rate for Payer: BCN Commercial |
$25,727.73
|
| Rate for Payer: BCN Medicare Advantage |
$13,196.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,196.87
|
| Rate for Payer: Mclaren Medicare |
$13,196.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,856.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,176.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,516.56
|
| Rate for Payer: Nomi Health Commercial |
$21,061.83
|
| Rate for Payer: PACE Medicare |
$12,537.03
|
| Rate for Payer: PACE SWMI |
$13,196.87
|
| Rate for Payer: PHP Medicare Advantage |
$13,196.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,322.62
|
| Rate for Payer: Priority Health Medicare |
$13,196.87
|
| Rate for Payer: Priority Health Tiered Network |
$21,058.09
|
| Rate for Payer: Railroad Medicare Medicare |
$13,196.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,613.01
|
| Rate for Payer: UHC Core |
$22,265.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,196.87
|
| Rate for Payer: UHC Exchange |
$18,183.38
|
| Rate for Payer: VA VA |
$13,196.87
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,960.05
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$5,833.94 |
| Max. Negotiated Rate |
$14,960.05 |
| Rate for Payer: Aetna Medicare |
$6,386.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,676.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,676.24
|
| Rate for Payer: BCBS MAPPO |
$6,140.99
|
| Rate for Payer: BCBS Trust/PPO |
$14,960.05
|
| Rate for Payer: BCN Commercial |
$14,960.05
|
| Rate for Payer: BCN Medicare Advantage |
$6,140.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,140.99
|
| Rate for Payer: Mclaren Medicare |
$6,140.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,448.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,062.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,755.09
|
| Rate for Payer: Nomi Health Commercial |
$9,284.13
|
| Rate for Payer: PACE Medicare |
$5,833.94
|
| Rate for Payer: PACE SWMI |
$6,140.99
|
| Rate for Payer: PHP Medicare Advantage |
$6,140.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,603.10
|
| Rate for Payer: Priority Health Medicare |
$6,140.99
|
| Rate for Payer: Priority Health Tiered Network |
$9,282.48
|
| Rate for Payer: Railroad Medicare Medicare |
$6,140.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,731.11
|
| Rate for Payer: UHC Core |
$9,814.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,140.99
|
| Rate for Payer: UHC Exchange |
$8,015.30
|
| Rate for Payer: VA VA |
$6,140.99
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
NDC 46163020692
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna Medicare |
$55.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.60
|
| Rate for Payer: UHC Core |
$57.39
|
| Rate for Payer: UHC Exchange |
$43.29
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
OP
|
$135.60
|
|
|
Service Code
|
NDC 49230020692
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.29 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna Medicare |
$67.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: BCBS Complete |
$54.24
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Advantage |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.70
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health SBD |
$85.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.14
|
| Rate for Payer: UHC Core |
$70.65
|
| Rate for Payer: UHC Exchange |
$53.29
|
|
|
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 49230020692
|
| 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 Advantage |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.70
|
| Rate for Payer: PHP Commercial |
$115.26
|
| 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
|
OP
|
$118.65
|
|
|
Service Code
|
NDC 49230020694
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna Medicare |
$59.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: BCBS Complete |
$47.46
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Advantage |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.99
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.12
|
| Rate for Payer: UHC Core |
$61.82
|
| Rate for Payer: UHC Exchange |
$46.63
|
|
|
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 49230020694
|
| 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 Advantage |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.99
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health SBD |
$74.75
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
NDC 46163020692
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$99.14 |
| Rate for Payer: Aetna Commercial |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.60
|
| Rate for Payer: Cash Price |
$88.13
|
| Rate for Payer: Cofinity Advantage |
$77.11
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.13
|
| Rate for Payer: Healthscope Commercial |
$99.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.62
|
| Rate for Payer: PHP Commercial |
$93.64
|
| Rate for Payer: Priority Health SBD |
$69.40
|
|
|
PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
OP
|
$118.65
|
|
|
Service Code
|
NDC 49230021294
|
| Hospital Charge Code |
27803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna Medicare |
$59.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: BCBS Complete |
$47.46
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Advantage |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.99
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.12
|
| Rate for Payer: UHC Core |
$61.82
|
| Rate for Payer: UHC Exchange |
$46.63
|
|
