|
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 27299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$218.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.29
|
| Rate for Payer: BCBS Complete |
$120.53
|
| Rate for Payer: BCBS MAPPO |
$209.83
|
| Rate for Payer: BCBS Trust/PPO |
$104.02
|
| Rate for Payer: BCN Medicare Advantage |
$209.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.83
|
| Rate for Payer: Mclaren Medicaid |
$114.78
|
| Rate for Payer: Mclaren Medicare |
$209.83
|
| Rate for Payer: Meridian Medicaid |
$120.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.30
|
| Rate for Payer: PACE Medicare |
$199.34
|
| Rate for Payer: PACE SWMI |
$209.83
|
| Rate for Payer: PHP Medicare Advantage |
$209.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.75
|
| Rate for Payer: Priority Health Medicare |
$209.83
|
| Rate for Payer: Priority Health Narrow Network |
$513.40
|
| Rate for Payer: Railroad Medicare Medicare |
$209.83
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.83
|
| Rate for Payer: UHC Medicare Advantage |
$216.12
|
| Rate for Payer: VA VA |
$209.83
|
|
|
UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 42999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$92.18 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.68
|
| Rate for Payer: BCBS Complete |
$124.84
|
| Rate for Payer: BCBS MAPPO |
$217.34
|
| Rate for Payer: BCBS Trust/PPO |
$92.18
|
| Rate for Payer: BCN Medicare Advantage |
$217.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.34
|
| Rate for Payer: Mclaren Medicaid |
$118.88
|
| Rate for Payer: Mclaren Medicare |
$217.34
|
| Rate for Payer: Meridian Medicaid |
$124.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.94
|
| Rate for Payer: PACE Medicare |
$206.47
|
| Rate for Payer: PACE SWMI |
$217.34
|
| Rate for Payer: PHP Medicare Advantage |
$217.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$658.72
|
| Rate for Payer: Priority Health Medicare |
$217.34
|
| Rate for Payer: Priority Health Narrow Network |
$526.98
|
| Rate for Payer: Railroad Medicare Medicare |
$217.34
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.34
|
| Rate for Payer: UHC Medicare Advantage |
$223.86
|
| Rate for Payer: VA VA |
$217.34
|
|
|
UNLISTED PROCEDURE, RECTUM
|
Facility
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 45999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.54 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$845.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,016.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,016.54
|
| Rate for Payer: BCBS Complete |
$467.12
|
| Rate for Payer: BCBS MAPPO |
$813.23
|
| Rate for Payer: BCBS Trust/PPO |
$347.54
|
| Rate for Payer: BCN Medicare Advantage |
$813.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.23
|
| Rate for Payer: Mclaren Medicaid |
$444.84
|
| Rate for Payer: Mclaren Medicare |
$813.23
|
| Rate for Payer: Meridian Medicaid |
$467.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$935.21
|
| Rate for Payer: PACE Medicare |
$772.57
|
| Rate for Payer: PACE SWMI |
$813.23
|
| Rate for Payer: PHP Medicare Advantage |
$813.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.84
|
| Rate for Payer: Priority Health Medicare |
$813.23
|
| Rate for Payer: Railroad Medicare Medicare |
$813.23
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.23
|
| Rate for Payer: UHC Medicare Advantage |
$837.63
|
| Rate for Payer: VA VA |
$813.23
|
|
|
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 17999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$79.71 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
UNLISTED PROCEDURE, URINARY SYSTEM
|
Facility
OP
|
$878.00
|
|
|
Service Code
|
CPT 53899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$112.46 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$228.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.89
|
| Rate for Payer: BCBS Complete |
$126.32
|
| Rate for Payer: BCBS MAPPO |
$219.91
|
| Rate for Payer: BCBS Trust/PPO |
$112.46
|
| Rate for Payer: BCN Medicare Advantage |
$219.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.91
|
| Rate for Payer: Mclaren Medicaid |
$120.29
|
| Rate for Payer: Mclaren Medicare |
$219.91
|
| Rate for Payer: Meridian Medicaid |
$126.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.90
|
| Rate for Payer: PACE Medicare |
$208.91
|
| Rate for Payer: PACE SWMI |
$219.91
|
| Rate for Payer: PHP Medicare Advantage |
$219.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.30
|
| Rate for Payer: Priority Health Medicare |
$219.91
|
| Rate for Payer: Priority Health Narrow Network |
$515.44
|
| Rate for Payer: Railroad Medicare Medicare |
$219.91
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.91
|
| Rate for Payer: UHC Medicare Advantage |
$226.51
|
| Rate for Payer: VA VA |
$219.91
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
IP
|
$33,942.03
|
|
|
Service Code
|
MS-DRG 256
|
| Min. Negotiated Rate |
$11,686.43 |
| Max. Negotiated Rate |
$33,942.03 |
| Rate for Payer: Aetna Medicare |
$12,793.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,376.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,376.89
|
| Rate for Payer: BCBS MAPPO |
$12,301.51
|
| Rate for Payer: BCBS Trust/PPO |
$33,942.03
|
| Rate for Payer: BCN Medicare Advantage |
$12,301.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,301.51
|
| Rate for Payer: Mclaren Medicare |
$12,301.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,916.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,146.74
|
| Rate for Payer: PACE Medicare |
$11,686.43
|
| Rate for Payer: PACE SWMI |
$12,301.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,301.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,529.56
|
| Rate for Payer: Priority Health Medicare |
$12,301.51
|
| Rate for Payer: Priority Health Narrow Network |
$18,823.65
|
| Rate for Payer: Railroad Medicare Medicare |
$12,301.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,011.98
|
| Rate for Payer: UHC Core |
$15,347.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,301.51
|
| Rate for Payer: UHC Exchange |
$16,437.99
|
| Rate for Payer: UHC Medicare Advantage |
$12,670.56
|
| Rate for Payer: VA VA |
$12,301.51
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$41,908.84
|
|
|
Service Code
|
MS-DRG 255
|
| Min. Negotiated Rate |
$19,264.98 |
| Max. Negotiated Rate |
$41,908.84 |
| Rate for Payer: Aetna Medicare |
$21,090.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,348.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,348.66
|
| Rate for Payer: BCBS MAPPO |
$20,278.93
|
| Rate for Payer: BCBS Trust/PPO |
$37,556.48
|
| Rate for Payer: BCN Medicare Advantage |
$20,278.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,278.93
|
| Rate for Payer: Mclaren Medicare |
$20,278.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21,292.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,320.77
|
| Rate for Payer: PACE Medicare |
$19,264.98
|
| Rate for Payer: PACE SWMI |
$20,278.93
|
| Rate for Payer: PHP Medicare Advantage |
$20,278.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,424.97
|
| Rate for Payer: Priority Health Medicare |
$20,278.93
|
| Rate for Payer: Priority Health Narrow Network |
$31,539.98
|
| Rate for Payer: Railroad Medicare Medicare |
$20,278.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,908.84
|
| Rate for Payer: UHC Core |
$25,715.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$20,278.93
|
| Rate for Payer: UHC Exchange |
$27,542.69
|
| Rate for Payer: UHC Medicare Advantage |
$20,887.30
|
| Rate for Payer: VA VA |
$20,278.93
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$17,453.01
|
|
|
Service Code
|
MS-DRG 257
|
| Min. Negotiated Rate |
$7,248.22 |
| Max. Negotiated Rate |
$17,453.01 |
| Rate for Payer: Aetna Medicare |
$7,934.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,537.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,537.14
|
| Rate for Payer: BCBS MAPPO |
$7,629.71
|
| Rate for Payer: BCBS Trust/PPO |
$17,453.01
|
| Rate for Payer: BCN Medicare Advantage |
$7,629.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,629.71
|
| Rate for Payer: Mclaren Medicare |
$7,629.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,011.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,774.17
|
| Rate for Payer: PACE Medicare |
$7,248.22
|
| Rate for Payer: PACE SWMI |
$7,629.71
|
| Rate for Payer: PHP Medicare Advantage |
$7,629.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,220.77
|
| Rate for Payer: Priority Health Medicare |
$7,629.71
|
| Rate for Payer: Priority Health Narrow Network |
$11,376.62
|
| Rate for Payer: Railroad Medicare Medicare |
$7,629.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,116.71
|
| Rate for Payer: UHC Core |
$9,275.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,629.71
|
| Rate for Payer: UHC Exchange |
$9,934.78
|
| Rate for Payer: UHC Medicare Advantage |
$7,858.60
|
| Rate for Payer: VA VA |
$7,629.71
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
IP
|
$39,383.47
|
|
|
Service Code
|
MS-DRG 671
|
| Min. Negotiated Rate |
$12,180.40 |
| Max. Negotiated Rate |
$39,383.47 |
| Rate for Payer: Aetna Medicare |
$13,334.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,026.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,026.84
|
| Rate for Payer: BCBS MAPPO |
$12,821.47
|
| Rate for Payer: BCBS Trust/PPO |
$39,383.47
|
| Rate for Payer: BCN Medicare Advantage |
$12,821.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,821.47
|
| Rate for Payer: Mclaren Medicare |
$12,821.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,462.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,744.69
|
| Rate for Payer: PACE Medicare |
$12,180.40
|
| Rate for Payer: PACE SWMI |
$12,821.47
|
| Rate for Payer: PHP Medicare Advantage |
$12,821.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,565.63
|
| Rate for Payer: Priority Health Medicare |
$12,821.47
|
| Rate for Payer: Priority Health Narrow Network |
$19,652.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12,821.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,113.32
|
| Rate for Payer: UHC Core |
$16,023.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,821.47
|
| Rate for Payer: UHC Exchange |
$17,161.80
|
| Rate for Payer: UHC Medicare Advantage |
$13,206.11
|
| Rate for Payer: VA VA |
$12,821.47
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$15,202.22
|
|
|
Service Code
|
MS-DRG 672
|
| Min. Negotiated Rate |
$6,882.19 |
| Max. Negotiated Rate |
$15,202.22 |
| Rate for Payer: Aetna Medicare |
$7,534.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,055.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,055.51
|
| Rate for Payer: BCBS MAPPO |
$7,244.41
|
| Rate for Payer: BCBS Trust/PPO |
$15,202.22
|
| Rate for Payer: BCN Medicare Advantage |
$7,244.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,244.41
|
| Rate for Payer: Mclaren Medicare |
$7,244.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,606.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,331.07
|
| Rate for Payer: PACE Medicare |
$6,882.19
|
| Rate for Payer: PACE SWMI |
$7,244.41
|
| Rate for Payer: PHP Medicare Advantage |
$7,244.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,240.67
|
| Rate for Payer: Priority Health Medicare |
$7,244.41
|
| Rate for Payer: Priority Health Narrow Network |
$10,592.54
|
| Rate for Payer: Railroad Medicare Medicare |
$7,244.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,074.87
|
| Rate for Payer: UHC Core |
$8,636.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,244.41
|
| Rate for Payer: UHC Exchange |
$9,250.07
|
| Rate for Payer: UHC Medicare Advantage |
$7,461.74
|
| Rate for Payer: VA VA |
$7,244.41
|
|
|
URETHRAL STRICTURE
|
Facility
IP
|
$16,979.23
|
|
|
Service Code
|
MS-DRG 697
|
| Min. Negotiated Rate |
$8,083.60 |
| Max. Negotiated Rate |
$16,979.23 |
| Rate for Payer: Aetna Medicare |
$8,849.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,636.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,636.31
|
| Rate for Payer: BCBS MAPPO |
$8,509.05
|
| Rate for Payer: BCBS Trust/PPO |
$12,510.04
|
| Rate for Payer: BCN Medicare Advantage |
$8,509.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,509.05
|
| Rate for Payer: Mclaren Medicare |
$8,509.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,934.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,785.41
|
| Rate for Payer: PACE Medicare |
$8,083.60
|
| Rate for Payer: PACE SWMI |
$8,509.05
|
| Rate for Payer: PHP Medicare Advantage |
$8,509.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,972.90
|
| Rate for Payer: Priority Health Medicare |
$8,509.05
|
| Rate for Payer: Priority Health Narrow Network |
$12,778.32
|
| Rate for Payer: Railroad Medicare Medicare |
$8,509.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,979.23
|
| Rate for Payer: UHC Core |
$10,418.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,509.05
|
| Rate for Payer: UHC Exchange |
$11,158.83
|
| Rate for Payer: UHC Medicare Advantage |
$8,764.32
|
| Rate for Payer: VA VA |
$8,509.05
|
|
|
URETHROLYSIS, TRANSVAGINAL, SECONDARY, OPEN, INCLUDING CYSTOURETHROSCOPY (EG, POSTSURGICAL OBSTRUCTION, SCARRING)
|
Facility
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 53500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$734.12 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.53
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$734.12
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE PROCEDURE)
|
Facility
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 53460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$450.56 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$906.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$495.62
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$450.56
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
|
Facility
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 53502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.39 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.23
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$478.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
URINARY STONES WITH MCC
|
Facility
IP
|
$21,604.24
|
|
|
Service Code
|
MS-DRG 693
|
| Min. Negotiated Rate |
$10,157.99 |
| Max. Negotiated Rate |
$21,604.24 |
| Rate for Payer: Aetna Medicare |
$11,120.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,365.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,365.78
|
| Rate for Payer: BCBS MAPPO |
$10,692.62
|
| Rate for Payer: BCBS Trust/PPO |
$14,273.35
|
| Rate for Payer: BCN Medicare Advantage |
$10,692.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,692.62
|
| Rate for Payer: Mclaren Medicare |
$10,692.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,227.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,296.51
|
| Rate for Payer: PACE Medicare |
$10,157.99
|
| Rate for Payer: PACE SWMI |
$10,692.62
|
| Rate for Payer: PHP Medicare Advantage |
$10,692.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,323.79
|
| Rate for Payer: Priority Health Medicare |
$10,692.62
|
| Rate for Payer: Priority Health Narrow Network |
$16,259.03
|
| Rate for Payer: Railroad Medicare Medicare |
$10,692.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,604.24
|
| Rate for Payer: UHC Core |
$13,256.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,692.62
|
| Rate for Payer: UHC Exchange |
$14,198.41
|
| Rate for Payer: UHC Medicare Advantage |
$11,013.40
|
| Rate for Payer: VA VA |
$10,692.62
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
IP
|
$11,939.31
|
|
|
Service Code
|
MS-DRG 694
|
| Min. Negotiated Rate |
$5,823.09 |
| Max. Negotiated Rate |
$11,939.31 |
| Rate for Payer: Aetna Medicare |
$6,374.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,661.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,661.96
|
| Rate for Payer: BCBS MAPPO |
$6,129.57
|
| Rate for Payer: BCBS Trust/PPO |
$11,104.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,129.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,129.57
|
| Rate for Payer: Mclaren Medicare |
$6,129.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,436.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,049.01
|
| Rate for Payer: PACE Medicare |
$5,823.09
|
| Rate for Payer: PACE SWMI |
$6,129.57
|
| Rate for Payer: PHP Medicare Advantage |
$6,129.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,231.68
|
| Rate for Payer: Priority Health Medicare |
$6,129.57
|
| Rate for Payer: Priority Health Narrow Network |
$8,985.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,129.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,939.31
|
| Rate for Payer: UHC Core |
$7,326.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,129.57
|
| Rate for Payer: UHC Exchange |
$7,846.57
|
| Rate for Payer: UHC Medicare Advantage |
$6,313.46
|
| Rate for Payer: VA VA |
$6,129.57
|
|
|
URINARY SUSPENSORY
|
Professional
|
$65.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$37.97
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
|
|
URSODIOL 250 MG TABLET
|
Facility
IP
|
$226.78
|
|
|
Service Code
|
NDC 0904-6890-04
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.87 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna Commercial |
$192.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.41
|
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$195.03
|
| Rate for Payer: Healthscope Commercial |
$204.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$192.76
|
| Rate for Payer: PHP Commercial |
$192.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.75
|
| Rate for Payer: Priority Health SBD |
$142.87
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
IP
|
$419.76
|
|
|
Service Code
|
NDC 50268-797-15
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.45 |
| Max. Negotiated Rate |
$377.78 |
| Rate for Payer: Aetna Commercial |
$356.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.84
|
| Rate for Payer: Cash Price |
$335.81
|
| Rate for Payer: Cofinity Commercial |
$293.83
|
| Rate for Payer: Cofinity Commercial |
$360.99
|
| Rate for Payer: Healthscope Commercial |
$377.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$356.80
|
| Rate for Payer: PHP Commercial |
$356.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.83
|
| Rate for Payer: Priority Health SBD |
$264.45
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
IP
|
$568.88
|
|
|
Service Code
|
NDC 0904-6221-06
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.39 |
| Max. Negotiated Rate |
$511.99 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.77
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cofinity Commercial |
$398.22
|
| Rate for Payer: Cofinity Commercial |
$489.24
|
| Rate for Payer: Healthscope Commercial |
$511.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$483.55
|
| Rate for Payer: PHP Commercial |
$483.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.22
|
| Rate for Payer: Priority Health SBD |
$358.39
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
IP
|
$558.24
|
|
|
Service Code
|
NDC 0527-1326-01
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.69 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Commercial |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$474.50
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.77
|
| Rate for Payer: Priority Health SBD |
$351.69
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
IP
|
$558.24
|
|
|
Service Code
|
NDC 42806-503-01
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.69 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Commercial |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$474.50
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.77
|
| Rate for Payer: Priority Health SBD |
$351.69
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
IP
|
$8.40
|
|
|
Service Code
|
NDC 50268-797-11
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$7.56 |
| Rate for Payer: Aetna Commercial |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.46
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$5.88
|
| Rate for Payer: Cofinity Commercial |
$7.22
|
| Rate for Payer: Healthscope Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.14
|
| Rate for Payer: PHP Commercial |
$7.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.88
|
| Rate for Payer: Priority Health SBD |
$5.29
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$6,166.87
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
180872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,885.13 |
| Max. Negotiated Rate |
$5,550.18 |
| Rate for Payer: Aetna Commercial |
$5,241.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,008.47
|
| Rate for Payer: Cash Price |
$4,933.50
|
| Rate for Payer: Cofinity Commercial |
$4,316.81
|
| Rate for Payer: Cofinity Commercial |
$5,303.51
|
| Rate for Payer: Healthscope Commercial |
$5,550.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,241.84
|
| Rate for Payer: PHP Commercial |
$5,241.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,316.81
|
| Rate for Payer: Priority Health SBD |
$3,885.13
|
|
|
USTEKINUMAB 45 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
IP
|
$32,059.07
|
|
|
Service Code
|
HCPCS J3357
|
| Hospital Charge Code |
119468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20,197.21 |
| Max. Negotiated Rate |
$28,853.16 |
| Rate for Payer: Aetna Commercial |
$27,250.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20,838.40
|
| Rate for Payer: Cash Price |
$25,647.26
|
| Rate for Payer: Cofinity Commercial |
$22,441.35
|
| Rate for Payer: Cofinity Commercial |
$27,570.80
|
| Rate for Payer: Healthscope Commercial |
$28,853.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27,250.21
|
| Rate for Payer: PHP Commercial |
$27,250.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,441.35
|
| Rate for Payer: Priority Health SBD |
$20,197.21
|
|
