|
PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION, UPPER EXTREMITY, SINGLE ACCESS OF BOTH THE PERIPHERAL ARTERY AND PERIPHERAL VEIN, INCLUDING FISTULA MATURATION PROCEDURES (EG, TRANSLUMINAL BALLOON ANGIOPLASTY, COIL EMBOLIZATION) WHEN PERFORMED, INCLUDING ALL VASCULAR ACCESS, IMAGING GUIDANCE AND RADIOLOGIC SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$55,296.52
|
|
|
Service Code
|
CPT 36836
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.87 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$9,409.04
|
| Rate for Payer: BCN Commercial |
$9,409.04
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.87
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,905.22
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$20,210.02
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.71 |
| Max. Negotiated Rate |
$20,210.02 |
| Rate for Payer: Aetna Medicare |
$6,687.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,037.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,037.75
|
| Rate for Payer: BCBS Complete |
$3,618.92
|
| Rate for Payer: BCBS MAPPO |
$6,430.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,639.18
|
| Rate for Payer: BCN Commercial |
$4,639.18
|
| Rate for Payer: BCN Medicare Advantage |
$6,430.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,430.20
|
| Rate for Payer: Mclaren Medicaid |
$3,446.59
|
| Rate for Payer: Mclaren Medicare |
$6,430.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,751.71
|
| Rate for Payer: Meridian Medicaid |
$3,618.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,394.73
|
| Rate for Payer: Nomi Health Commercial |
$13,503.42
|
| Rate for Payer: PACE Medicare |
$6,108.69
|
| Rate for Payer: PACE SWMI |
$6,430.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,430.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,446.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,210.02
|
| Rate for Payer: Priority Health Medicare |
$6,430.20
|
| Rate for Payer: Priority Health Narrow Network |
$16,168.02
|
| Rate for Payer: Railroad Medicare Medicare |
$6,430.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$321.71
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,430.20
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,430.20
|
| Rate for Payer: UHCCP Medicaid |
$3,620.20
|
| Rate for Payer: VA VA |
$6,430.20
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$28,475.97
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,188.36 |
| Max. Negotiated Rate |
$28,475.97 |
| Rate for Payer: Aetna Medicare |
$9,422.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,325.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,325.21
|
| Rate for Payer: BCBS Complete |
$5,099.06
|
| Rate for Payer: BCBS MAPPO |
$9,060.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,636.53
|
| Rate for Payer: BCN Commercial |
$4,636.53
|
| Rate for Payer: BCN Medicare Advantage |
$9,060.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,060.17
|
| Rate for Payer: Mclaren Medicaid |
$4,856.25
|
| Rate for Payer: Mclaren Medicare |
$9,060.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,513.18
|
| Rate for Payer: Meridian Medicaid |
$5,099.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,419.20
|
| Rate for Payer: Nomi Health Commercial |
$19,026.36
|
| Rate for Payer: PACE Medicare |
$8,607.16
|
| Rate for Payer: PACE SWMI |
$9,060.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,060.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,856.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,475.97
|
| Rate for Payer: Priority Health Medicare |
$9,060.17
|
| Rate for Payer: Priority Health Narrow Network |
$22,780.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,060.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,188.36
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,060.17
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$9,060.17
|
| Rate for Payer: UHCCP Medicaid |
$5,100.88
|
| Rate for Payer: VA VA |
$9,060.17
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; SIMPLE (EG, STONE[S] UP TO 2 CM IN SINGLE LOCATION OF KIDNEY OR RENAL PELVIS, NONBRANCHING STONES)
|
Facility
|
OP
|
$28,475.97
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$736.31 |
| Max. Negotiated Rate |
$28,475.97 |
| Rate for Payer: Aetna Medicare |
$9,422.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,325.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,325.21
|
| Rate for Payer: BCBS Complete |
$5,099.06
|
| Rate for Payer: BCBS MAPPO |
$9,060.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,889.34
|
| Rate for Payer: BCN Commercial |
$3,889.34
|
| Rate for Payer: BCN Medicare Advantage |
$9,060.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,060.17
|
| Rate for Payer: Mclaren Medicaid |
$4,856.25
|
| Rate for Payer: Mclaren Medicare |
$9,060.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,513.18
|
| Rate for Payer: Meridian Medicaid |
$5,099.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,419.20
|
| Rate for Payer: Nomi Health Commercial |
$19,026.36
|
| Rate for Payer: PACE Medicare |
$8,607.16
|
| Rate for Payer: PACE SWMI |
$9,060.17
|
| Rate for Payer: PHP Medicare Advantage |
$9,060.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,856.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,475.97
|
| Rate for Payer: Priority Health Medicare |
$9,060.17
|
| Rate for Payer: Priority Health Narrow Network |
$22,780.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,060.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$736.31
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,060.17
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$9,060.17
|
| Rate for Payer: UHCCP Medicaid |
$5,100.88
|
| Rate for Payer: VA VA |
$9,060.17
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.50 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.01
|
| Rate for Payer: BCN Commercial |
$1,760.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$714.50
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$480.17 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.51
|
| Rate for Payer: BCN Commercial |
$1,089.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.17
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.02 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.36
|
| Rate for Payer: BCN Commercial |
$1,464.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.02
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$405.56 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$405.56
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$418.47 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.47
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$525.22 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.22
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$507.34 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.69
|
| Rate for Payer: BCN Commercial |
$1,676.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$507.34
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
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
|
$17,557.45
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.36 |
| Max. Negotiated Rate |
$17,557.45 |
| Rate for Payer: Aetna Medicare |
$5,809.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,982.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,982.80
|
| Rate for Payer: BCBS Complete |
$3,143.94
|
| Rate for Payer: BCBS MAPPO |
$5,586.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,109.49
|
| Rate for Payer: BCN Commercial |
$3,109.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.24
|
| Rate for Payer: Mclaren Medicaid |
$2,994.22
|
| Rate for Payer: Mclaren Medicare |
$5,586.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.55
|
| Rate for Payer: Meridian Medicaid |
$3,143.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,424.18
|
| Rate for Payer: Nomi Health Commercial |
$11,731.10
|
| Rate for Payer: PACE Medicare |
$5,306.93
|
| Rate for Payer: PACE SWMI |
$5,586.24
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,994.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,557.45
|
| Rate for Payer: Priority Health Medicare |
$5,586.24
|
| Rate for Payer: Priority Health Narrow Network |
$14,045.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5,586.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.36
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.24
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.24
|
| Rate for Payer: UHCCP Medicaid |
$3,145.05
|
| Rate for Payer: VA VA |
$5,586.24
|
|
|
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
|
$55,296.52
|
|
|
Service Code
|
CPT 36906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$535.25 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$9,224.38
|
| Rate for Payer: BCN Commercial |
$9,224.38
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.25
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$11,989.00
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,905.22
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
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
|
$34,922.52
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$462.86 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$5,892.02
|
| Rate for Payer: BCN Commercial |
$5,892.02
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.86
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTIONS AND FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$34,922.52
|
|
|
Service Code
|
CPT 37187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$412.63 |
| Max. Negotiated Rate |
$34,922.52 |
| Rate for Payer: Aetna Medicare |
$11,555.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,889.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,889.08
|
| Rate for Payer: BCBS Complete |
$6,253.42
|
| Rate for Payer: BCBS MAPPO |
$11,111.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,211.50
|
| Rate for Payer: BCN Commercial |
$2,211.50
|
| Rate for Payer: BCN Medicare Advantage |
$11,111.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,111.26
|
| Rate for Payer: Mclaren Medicaid |
$5,955.64
|
| Rate for Payer: Mclaren Medicare |
$11,111.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,666.82
|
| Rate for Payer: Meridian Medicaid |
$6,253.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,777.95
|
| Rate for Payer: Nomi Health Commercial |
$23,333.65
|
| Rate for Payer: PACE Medicare |
$10,555.70
|
| Rate for Payer: PACE SWMI |
$11,111.26
|
| Rate for Payer: PHP Medicare Advantage |
$11,111.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,955.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34,922.52
|
| Rate for Payer: Priority Health Medicare |
$11,111.26
|
| Rate for Payer: Priority Health Narrow Network |
$27,938.02
|
| Rate for Payer: Railroad Medicare Medicare |
$11,111.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.63
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,111.26
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$11,111.26
|
| Rate for Payer: UHCCP Medicaid |
$6,255.64
|
| Rate for Payer: VA VA |
$11,111.26
|
|
|
PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML INTRAVENOUS SUSPENSION
|
Facility
|
OP
|
$50.26
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
31270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$50.26 |
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$50.26
|
|
|
PERFLUTREN LIPID MICROSPHERES (DILUTED) INTRAVENOUS SUSP
|
Facility
|
OP
|
$50.26
|
|
|
Service Code
|
HCPCS Q9957
|
| Hospital Charge Code |
180013
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.26 |
| Max. Negotiated Rate |
$50.26 |
| Rate for Payer: BCBS Trust/PPO |
$50.26
|
| Rate for Payer: BCN Commercial |
$50.26
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$11,792.02
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$752.73 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$3,073.42
|
| Rate for Payer: BCN Commercial |
$3,073.42
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.73
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,112.29
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$291.49 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$953.12
|
| Rate for Payer: BCN Commercial |
$953.12
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.49
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
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 Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.06
|
| 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: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.12
|
| 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
|
$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 Commercial |
$116.62
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.92
|
| 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: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.14
|
| 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 |
$47.46 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| 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 Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.06
|
| 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: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.12
|
| 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
|
OP
|
$135.60
|
|
|
Service Code
|
NDC 49230020692
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.24 |
| 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 Commercial |
$116.62
|
| Rate for Payer: Cofinity Commercial |
$94.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.92
|
| 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: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.14
|
| Rate for Payer: Priority Health SBD |
$85.43
|
|
|
PERITON. DIALYSIS SOLN 8-4.25 % DEXTROSE CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230021294
|
| 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: Cofinity Medicare Advantage |
$83.06
|
| 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: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.12
|
| 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
|
OP
|
$118.65
|
|
|
Service Code
|
NDC 49230021294
|
| Hospital Charge Code |
27803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna Medicare |
$59.32
|
| 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 Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.06
|
| 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: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.12
|
| Rate for Payer: Priority Health SBD |
$74.75
|
|
