|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 4390035980
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.29
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$19,062.86
|
|
|
Service Code
|
MS-DRG 178
|
| Min. Negotiated Rate |
$7,710.10 |
| Max. Negotiated Rate |
$19,062.86 |
| Rate for Payer: Aetna Medicare |
$8,440.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,144.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,144.86
|
| Rate for Payer: BCBS MAPPO |
$8,115.89
|
| Rate for Payer: BCBS Trust/PPO |
$19,062.86
|
| Rate for Payer: BCN Medicare Advantage |
$8,115.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,115.89
|
| Rate for Payer: Mclaren Medicare |
$8,115.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,521.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,333.27
|
| Rate for Payer: PACE Medicare |
$7,710.10
|
| Rate for Payer: PACE SWMI |
$8,115.89
|
| Rate for Payer: PHP Medicare Advantage |
$8,115.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,159.07
|
| Rate for Payer: Priority Health Medicare |
$8,115.89
|
| Rate for Payer: Priority Health Narrow Network |
$11,327.26
|
| Rate for Payer: Railroad Medicare Medicare |
$8,115.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,051.12
|
| Rate for Payer: UHC Core |
$12,341.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,115.89
|
| Rate for Payer: UHC Exchange |
$9,811.74
|
| Rate for Payer: UHC Medicare Advantage |
$8,359.37
|
| Rate for Payer: VA VA |
$8,115.89
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$25,876.89
|
|
|
Service Code
|
MS-DRG 177
|
| Min. Negotiated Rate |
$12,905.62 |
| Max. Negotiated Rate |
$25,876.89 |
| Rate for Payer: Aetna Medicare |
$14,128.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,981.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,981.08
|
| Rate for Payer: BCBS MAPPO |
$13,584.86
|
| Rate for Payer: BCBS Trust/PPO |
$25,015.92
|
| Rate for Payer: BCN Medicare Advantage |
$13,584.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,584.86
|
| Rate for Payer: Mclaren Medicare |
$13,584.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,264.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,622.59
|
| Rate for Payer: PACE Medicare |
$12,905.62
|
| Rate for Payer: PACE SWMI |
$13,584.86
|
| Rate for Payer: PHP Medicare Advantage |
$13,584.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,343.20
|
| Rate for Payer: Priority Health Medicare |
$13,584.86
|
| Rate for Payer: Priority Health Narrow Network |
$19,474.56
|
| Rate for Payer: Railroad Medicare Medicare |
$13,584.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,876.89
|
| Rate for Payer: UHC Core |
$21,218.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,584.86
|
| Rate for Payer: UHC Exchange |
$16,869.00
|
| Rate for Payer: UHC Medicare Advantage |
$13,992.41
|
| Rate for Payer: VA VA |
$13,584.86
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$14,861.29
|
|
|
Service Code
|
MS-DRG 179
|
| Min. Negotiated Rate |
$6,074.64 |
| Max. Negotiated Rate |
$14,861.29 |
| Rate for Payer: Aetna Medicare |
$6,650.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,992.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,992.95
|
| Rate for Payer: BCBS MAPPO |
$6,394.36
|
| Rate for Payer: BCBS Trust/PPO |
$14,861.29
|
| Rate for Payer: BCN Medicare Advantage |
$6,394.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,394.36
|
| Rate for Payer: Mclaren Medicare |
$6,394.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,714.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,353.51
|
| Rate for Payer: PACE Medicare |
$6,074.64
|
| Rate for Payer: PACE SWMI |
$6,394.36
|
| Rate for Payer: PHP Medicare Advantage |
$6,394.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,953.29
|
| Rate for Payer: Priority Health Medicare |
$6,394.36
|
| Rate for Payer: Priority Health Narrow Network |
$8,762.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,394.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,643.38
|
| Rate for Payer: UHC Core |
$9,547.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,394.36
|
| Rate for Payer: UHC Exchange |
$7,590.26
|
| Rate for Payer: UHC Medicare Advantage |
$6,586.19
|
| Rate for Payer: VA VA |
$6,394.36
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$20,470.08
|
|
|
Service Code
|
MS-DRG 181
|
| Min. Negotiated Rate |
$8,547.60 |
| Max. Negotiated Rate |
$20,470.08 |
| Rate for Payer: Aetna Medicare |
$9,357.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,246.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,246.84
|
| Rate for Payer: BCBS MAPPO |
$8,997.47
|
| Rate for Payer: BCBS Trust/PPO |
$20,470.08
|
| Rate for Payer: BCN Medicare Advantage |
$8,997.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,997.47
|
| Rate for Payer: Mclaren Medicare |
$8,997.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,447.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,347.09
|
| Rate for Payer: PACE Medicare |
$8,547.60
|
| Rate for Payer: PACE SWMI |
$8,997.47
|
| Rate for Payer: PHP Medicare Advantage |
$8,997.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,800.70
|
| Rate for Payer: Priority Health Medicare |
$8,997.47
|
| Rate for Payer: Priority Health Narrow Network |
$12,640.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,997.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,796.18
|
| Rate for Payer: UHC Core |
$13,772.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,997.47
|
| Rate for Payer: UHC Exchange |
$10,949.34
|
| Rate for Payer: UHC Medicare Advantage |
$9,267.39
|
| Rate for Payer: VA VA |
$8,997.47
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$32,898.89
|
|
|
Service Code
|
MS-DRG 180
|
| Min. Negotiated Rate |
$13,211.61 |
| Max. Negotiated Rate |
$32,898.89 |
| Rate for Payer: Aetna Medicare |
$14,463.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,383.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,383.70
|
| Rate for Payer: BCBS MAPPO |
$13,906.96
|
| Rate for Payer: BCBS Trust/PPO |
$32,898.89
|
| Rate for Payer: BCN Medicare Advantage |
$13,906.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,906.96
|
| Rate for Payer: Mclaren Medicare |
$13,906.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,602.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,993.00
|
| Rate for Payer: PACE Medicare |
$13,211.61
|
| Rate for Payer: PACE SWMI |
$13,906.96
|
| Rate for Payer: PHP Medicare Advantage |
$13,906.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,943.03
|
| Rate for Payer: Priority Health Medicare |
$13,906.96
|
| Rate for Payer: Priority Health Narrow Network |
$19,954.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13,906.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,514.50
|
| Rate for Payer: UHC Core |
$21,741.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,906.96
|
| Rate for Payer: UHC Exchange |
$17,284.66
|
| Rate for Payer: UHC Medicare Advantage |
$14,324.17
|
| Rate for Payer: VA VA |
$13,906.96
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,577.79
|
|
|
Service Code
|
MS-DRG 182
|
| Min. Negotiated Rate |
$6,334.53 |
| Max. Negotiated Rate |
$11,577.79 |
| Rate for Payer: Aetna Medicare |
$6,934.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,334.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,334.91
|
| Rate for Payer: BCBS MAPPO |
$6,667.93
|
| Rate for Payer: BCBS Trust/PPO |
$10,074.22
|
| Rate for Payer: BCN Medicare Advantage |
$6,667.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,667.93
|
| Rate for Payer: Mclaren Medicare |
$6,667.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,001.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,668.12
|
| Rate for Payer: PACE Medicare |
$6,334.53
|
| Rate for Payer: PACE SWMI |
$6,667.93
|
| Rate for Payer: PHP Medicare Advantage |
$6,667.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,891.59
|
| Rate for Payer: Priority Health Medicare |
$6,667.93
|
| Rate for Payer: Priority Health Narrow Network |
$8,713.27
|
| Rate for Payer: Railroad Medicare Medicare |
$6,667.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,577.79
|
| Rate for Payer: UHC Core |
$9,493.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,667.93
|
| Rate for Payer: UHC Exchange |
$7,547.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,867.97
|
| Rate for Payer: VA VA |
$6,667.93
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$15,770.96
|
|
|
Service Code
|
MS-DRG 204
|
| Min. Negotiated Rate |
$6,510.97 |
| Max. Negotiated Rate |
$15,770.96 |
| Rate for Payer: Aetna Medicare |
$7,127.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,567.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,567.06
|
| Rate for Payer: BCBS MAPPO |
$6,853.65
|
| Rate for Payer: BCBS Trust/PPO |
$15,770.96
|
| Rate for Payer: BCN Medicare Advantage |
$6,853.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,853.65
|
| Rate for Payer: Mclaren Medicare |
$6,853.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,196.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,881.70
|
| Rate for Payer: PACE Medicare |
$6,510.97
|
| Rate for Payer: PACE SWMI |
$6,853.65
|
| Rate for Payer: PHP Medicare Advantage |
$6,853.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,808.55
|
| Rate for Payer: Priority Health Medicare |
$6,853.65
|
| Rate for Payer: Priority Health Narrow Network |
$9,446.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6,853.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,552.52
|
| Rate for Payer: UHC Core |
$10,292.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,853.65
|
| Rate for Payer: UHC Exchange |
$8,182.92
|
| Rate for Payer: UHC Medicare Advantage |
$7,059.26
|
| Rate for Payer: VA VA |
$6,853.65
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$44,538.64
|
|
|
Service Code
|
MS-DRG 208
|
| Min. Negotiated Rate |
$20,280.53 |
| Max. Negotiated Rate |
$44,538.64 |
| Rate for Payer: Aetna Medicare |
$22,201.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,684.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,684.91
|
| Rate for Payer: BCBS MAPPO |
$21,347.93
|
| Rate for Payer: BCBS Trust/PPO |
$44,538.64
|
| Rate for Payer: BCN Medicare Advantage |
$21,347.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,347.93
|
| Rate for Payer: Mclaren Medicare |
$21,347.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,415.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,550.12
|
| Rate for Payer: PACE Medicare |
$20,280.53
|
| Rate for Payer: PACE SWMI |
$21,347.93
|
| Rate for Payer: PHP Medicare Advantage |
$21,347.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,799.31
|
| Rate for Payer: Priority Health Medicare |
$21,347.93
|
| Rate for Payer: Priority Health Narrow Network |
$31,039.45
|
| Rate for Payer: Railroad Medicare Medicare |
$21,347.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,243.77
|
| Rate for Payer: UHC Core |
$33,819.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,347.93
|
| Rate for Payer: UHC Exchange |
$26,886.59
|
| Rate for Payer: UHC Medicare Advantage |
$21,988.37
|
| Rate for Payer: VA VA |
$21,347.93
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$138,621.62
|
|
|
Service Code
|
MS-DRG 207
|
| Min. Negotiated Rate |
$51,058.36 |
| Max. Negotiated Rate |
$138,621.62 |
| Rate for Payer: Aetna Medicare |
$55,895.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67,182.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67,182.05
|
| Rate for Payer: BCBS MAPPO |
$53,745.64
|
| Rate for Payer: BCBS Trust/PPO |
$138,621.62
|
| Rate for Payer: BCN Medicare Advantage |
$53,745.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,745.64
|
| Rate for Payer: Mclaren Medicare |
$53,745.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56,432.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,807.49
|
| Rate for Payer: PACE Medicare |
$51,058.36
|
| Rate for Payer: PACE SWMI |
$53,745.64
|
| Rate for Payer: PHP Medicare Advantage |
$53,745.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99,129.25
|
| Rate for Payer: Priority Health Medicare |
$53,745.64
|
| Rate for Payer: Priority Health Narrow Network |
$79,303.40
|
| Rate for Payer: Railroad Medicare Medicare |
$53,745.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105,374.63
|
| Rate for Payer: UHC Core |
$86,405.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$53,745.64
|
| Rate for Payer: UHC Exchange |
$68,693.15
|
| Rate for Payer: UHC Medicare Advantage |
$55,358.01
|
| Rate for Payer: VA VA |
$53,745.64
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$18,231.09
|
|
|
Service Code
|
MS-DRG 815
|
| Min. Negotiated Rate |
$7,765.01 |
| Max. Negotiated Rate |
$18,231.09 |
| Rate for Payer: Aetna Medicare |
$8,500.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,217.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,217.11
|
| Rate for Payer: BCBS MAPPO |
$8,173.69
|
| Rate for Payer: BCBS Trust/PPO |
$18,231.09
|
| Rate for Payer: BCN Medicare Advantage |
$8,173.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,173.69
|
| Rate for Payer: Mclaren Medicare |
$8,173.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,582.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,399.74
|
| Rate for Payer: PACE Medicare |
$7,765.01
|
| Rate for Payer: PACE SWMI |
$8,173.69
|
| Rate for Payer: PHP Medicare Advantage |
$8,173.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,266.69
|
| Rate for Payer: Priority Health Medicare |
$8,173.69
|
| Rate for Payer: Priority Health Narrow Network |
$11,413.35
|
| Rate for Payer: Railroad Medicare Medicare |
$8,173.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,165.53
|
| Rate for Payer: UHC Core |
$12,435.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,173.69
|
| Rate for Payer: UHC Exchange |
$9,886.32
|
| Rate for Payer: UHC Medicare Advantage |
$8,418.90
|
| Rate for Payer: VA VA |
$8,173.69
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$42,005.64
|
|
|
Service Code
|
MS-DRG 814
|
| Min. Negotiated Rate |
$16,065.98 |
| Max. Negotiated Rate |
$42,005.64 |
| Rate for Payer: Aetna Medicare |
$17,588.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,139.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,139.45
|
| Rate for Payer: BCBS MAPPO |
$16,911.56
|
| Rate for Payer: BCBS Trust/PPO |
$42,005.64
|
| Rate for Payer: BCN Medicare Advantage |
$16,911.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,911.56
|
| Rate for Payer: Mclaren Medicare |
$16,911.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,757.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,448.29
|
| Rate for Payer: PACE Medicare |
$16,065.98
|
| Rate for Payer: PACE SWMI |
$16,911.56
|
| Rate for Payer: PHP Medicare Advantage |
$16,911.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,538.06
|
| Rate for Payer: Priority Health Medicare |
$16,911.56
|
| Rate for Payer: Priority Health Narrow Network |
$24,430.45
|
| Rate for Payer: Railroad Medicare Medicare |
$16,911.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,462.04
|
| Rate for Payer: UHC Core |
$26,618.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,911.56
|
| Rate for Payer: UHC Exchange |
$21,161.83
|
| Rate for Payer: UHC Medicare Advantage |
$17,418.91
|
| Rate for Payer: VA VA |
$16,911.56
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,270.49
|
|
|
Service Code
|
MS-DRG 816
|
| Min. Negotiated Rate |
$5,685.91 |
| Max. Negotiated Rate |
$12,270.49 |
| Rate for Payer: Aetna Medicare |
$6,224.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,481.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,481.46
|
| Rate for Payer: BCBS MAPPO |
$5,985.17
|
| Rate for Payer: BCBS Trust/PPO |
$12,270.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,985.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,985.17
|
| Rate for Payer: Mclaren Medicare |
$5,985.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,284.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,882.95
|
| Rate for Payer: PACE Medicare |
$5,685.91
|
| Rate for Payer: PACE SWMI |
$5,985.17
|
| Rate for Payer: PHP Medicare Advantage |
$5,985.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,191.31
|
| Rate for Payer: Priority Health Medicare |
$5,985.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,153.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,985.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,833.39
|
| Rate for Payer: UHC Core |
$8,883.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,985.17
|
| Rate for Payer: UHC Exchange |
$7,062.23
|
| Rate for Payer: UHC Medicare Advantage |
$6,164.73
|
| Rate for Payer: VA VA |
$5,985.17
|
|
|
RETRIEVAL (REMOVAL) OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED
|
Facility
|
OP
|
$8,919.33
|
|
|
Service Code
|
CPT 37193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.39 |
| Max. Negotiated Rate |
$8,919.33 |
| Rate for Payer: Aetna Medicare |
$2,946.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,541.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,541.61
|
| Rate for Payer: BCBS Complete |
$1,627.44
|
| Rate for Payer: BCBS MAPPO |
$2,833.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.08
|
| Rate for Payer: BCN Medicare Advantage |
$2,833.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,833.29
|
| Rate for Payer: Mclaren Medicaid |
$1,549.81
|
| Rate for Payer: Mclaren Medicare |
$2,833.29
|
| Rate for Payer: Meridian Medicaid |
$1,627.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,974.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,258.28
|
| Rate for Payer: PACE Medicare |
$2,691.63
|
| Rate for Payer: PACE SWMI |
$2,833.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,833.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,549.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,919.33
|
| Rate for Payer: Priority Health Medicare |
$2,833.29
|
| Rate for Payer: Priority Health Narrow Network |
$7,135.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2,833.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.43
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,833.29
|
| Rate for Payer: UHC Exchange |
$330.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,918.29
|
| Rate for Payer: VA VA |
$2,833.29
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$49,067.27
|
|
|
Service Code
|
CPT 37225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.08 |
| Max. Negotiated Rate |
$49,067.27 |
| Rate for Payer: Aetna Medicare |
$16,210.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$10,620.06
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,067.27
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$39,253.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.09
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,586.58
|
| Rate for Payer: UHC Exchange |
$570.08
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 37224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.71 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$6,331.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.08
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$423.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$49,067.27
|
|
|
Service Code
|
CPT 37227
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$682.06 |
| Max. Negotiated Rate |
$49,067.27 |
| Rate for Payer: Aetna Medicare |
$16,210.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$14,890.90
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,067.27
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$39,253.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.27
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,586.58
|
| Rate for Payer: UHC Exchange |
$682.06
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,596.00
|
|
|
Service Code
|
CPT 37222
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$176.16 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: BCBS Trust/PPO |
$2,933.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.78
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$176.16
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,695.32
|
|
|
Service Code
|
CPT 37223
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.70 |
| Max. Negotiated Rate |
$8,695.32 |
| Rate for Payer: BCBS Trust/PPO |
$8,695.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.87
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$201.70
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 37220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$381.14 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,395.21
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.25
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$381.14
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 37221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$469.55 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$8,156.24
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.50
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$469.55
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,596.00
|
|
|
Service Code
|
CPT 37232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$189.59 |
| Max. Negotiated Rate |
$8,596.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,051.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.55
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$189.59
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 37228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.07 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,577.90
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.58
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$515.07
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, LAPAROSCOPIC APPROACH
|
Facility
|
OP
|
$21,144.90
|
|
|
Service Code
|
CPT 57426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$862.15 |
| Max. Negotiated Rate |
$21,144.90 |
| Rate for Payer: Aetna Medicare |
$6,985.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,396.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,396.05
|
| Rate for Payer: BCBS Complete |
$3,858.15
|
| Rate for Payer: BCBS MAPPO |
$6,716.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,864.10
|
| Rate for Payer: BCN Medicare Advantage |
$6,716.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,716.84
|
| Rate for Payer: Mclaren Medicaid |
$3,674.11
|
| Rate for Payer: Mclaren Medicare |
$6,716.84
|
| Rate for Payer: Meridian Medicaid |
$3,858.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,052.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,724.37
|
| Rate for Payer: PACE Medicare |
$6,381.00
|
| Rate for Payer: PACE SWMI |
$6,716.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,716.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,674.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,144.90
|
| Rate for Payer: Priority Health Medicare |
$6,716.84
|
| Rate for Payer: Priority Health Narrow Network |
$16,915.92
|
| Rate for Payer: Railroad Medicare Medicare |
$6,716.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$948.36
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,716.84
|
| Rate for Payer: UHC Exchange |
$862.15
|
| Rate for Payer: UHC Medicare Advantage |
$6,918.35
|
| Rate for Payer: VA VA |
$6,716.84
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.40 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.04
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$496.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
