|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$232.42
|
|
|
Service Code
|
NDC 49281-752-78
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.32
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$232.42
|
|
|
Service Code
|
NDC 49281-752-21
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$209.18 |
| Rate for Payer: Aetna American Axle |
$151.07
|
| Rate for Payer: Aetna Commercial |
$197.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.07
|
| Rate for Payer: Cash Price |
$185.94
|
| Rate for Payer: Cofinity Commercial |
$162.69
|
| Rate for Payer: Cofinity Commercial |
$199.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$185.94
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$197.56
|
| Rate for Payer: PHP Commercial |
$197.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$162.69
|
| Rate for Payer: Priority Health SBD |
$146.42
|
| Rate for Payer: UMR Bronson Commercial |
$102.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.32
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$267.99
|
|
|
Service Code
|
NDC 42023-104-01
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.92 |
| Max. Negotiated Rate |
$241.19 |
| Rate for Payer: Aetna American Axle |
$174.19
|
| Rate for Payer: Aetna Commercial |
$227.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.19
|
| Rate for Payer: Cash Price |
$214.39
|
| Rate for Payer: Cofinity Commercial |
$187.59
|
| Rate for Payer: Cofinity Commercial |
$230.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.39
|
| Rate for Payer: Healthscope Commercial |
$241.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.79
|
| Rate for Payer: PHP Commercial |
$227.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.59
|
| Rate for Payer: Priority Health SBD |
$168.83
|
| Rate for Payer: UMR Bronson Commercial |
$117.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.99
|
|
|
TUBERCULIN PPD 5 TUB. UNIT/0.1 ML INTRADERMAL INJECTION SOLUTION
|
Facility
IP
|
$1,054.50
|
|
|
Service Code
|
NDC 42023-104-05
|
| Hospital Charge Code |
8259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$463.98 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Aetna American Axle |
$685.42
|
| Rate for Payer: Aetna Commercial |
$896.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$685.42
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cofinity Commercial |
$738.15
|
| Rate for Payer: Cofinity Commercial |
$906.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$843.60
|
| Rate for Payer: Healthscope Commercial |
$949.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$738.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$790.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$896.32
|
| Rate for Payer: PHP Commercial |
$896.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.15
|
| Rate for Payer: Priority Health SBD |
$664.34
|
| Rate for Payer: UMR Bronson Commercial |
$463.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$790.88
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
OP
|
$4,481.48
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.30 |
| Max. Negotiated Rate |
$4,481.48 |
| Rate for Payer: Aetna Medicare |
$1,480.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,779.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,779.46
|
| Rate for Payer: BCBS Complete |
$817.70
|
| Rate for Payer: BCBS MAPPO |
$1,423.57
|
| Rate for Payer: BCBS Trust/PPO |
$833.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.57
|
| Rate for Payer: Mclaren Medicaid |
$778.69
|
| Rate for Payer: Mclaren Medicare |
$1,423.57
|
| Rate for Payer: Meridian Medicaid |
$817.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,637.11
|
| Rate for Payer: PACE Medicare |
$1,352.39
|
| Rate for Payer: PACE SWMI |
$1,423.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,481.48
|
| Rate for Payer: Priority Health Medicare |
$1,423.57
|
| Rate for Payer: Priority Health Narrow Network |
$3,585.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,423.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.33
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.57
|
| Rate for Payer: UHC Exchange |
$150.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.28
|
| Rate for Payer: VA VA |
$1,423.57
|
|
|
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATION OF PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH
|
Facility
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 69610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$263.05 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$263.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.28
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$283.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,483.31 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,783.79
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,631.64
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,483.31
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,206.95 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,657.65
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,327.64
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,206.95
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,320.90 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$7,442.24
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.99
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,320.90
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,029.15 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$7,046.54
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,132.06
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,029.15
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS [PORP], TOTAL OSSICULAR REPLACEMENT PROSTHESIS [TORP])
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,040.28 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,287.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.31
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,040.28
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$880.49 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,752.74
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$968.54
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$880.49
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
OP
|
$4,267.42
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$4,267.42 |
| Rate for Payer: Aetna Medicare |
$1,409.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,694.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,694.48
|
| Rate for Payer: BCBS Complete |
$778.65
|
| Rate for Payer: BCBS MAPPO |
$1,355.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,745.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,355.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,355.58
|
| Rate for Payer: Mclaren Medicaid |
$741.50
|
| Rate for Payer: Mclaren Medicare |
$1,355.58
|
| Rate for Payer: Meridian Medicaid |
$778.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,423.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,558.92
|
| Rate for Payer: PACE Medicare |
$1,287.80
|
| Rate for Payer: PACE SWMI |
$1,355.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,355.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$741.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,267.42
|
| Rate for Payer: Priority Health Medicare |
$1,355.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,413.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,355.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,355.58
|
| Rate for Payer: UHC Exchange |
$158.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,396.25
|
| Rate for Payer: VA VA |
$1,355.58
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$25,566.66
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,249.33 |
| Max. Negotiated Rate |
$23,009.99 |
| Rate for Payer: Aetna American Axle |
$16,618.33
|
| Rate for Payer: Aetna Commercial |
$21,731.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,618.33
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cofinity Commercial |
$17,896.66
|
| Rate for Payer: Cofinity Commercial |
$21,987.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,453.33
|
| Rate for Payer: Healthscope Commercial |
$23,009.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,896.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,175.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,731.66
|
| Rate for Payer: PHP Commercial |
$21,731.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,896.66
|
| Rate for Payer: Priority Health SBD |
$16,107.00
|
| Rate for Payer: UMR Bronson Commercial |
$11,249.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,175.00
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$25,566.66
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$23,009.99 |
| Rate for Payer: Aetna American Axle |
$16,618.33
|
| Rate for Payer: Aetna Commercial |
$21,731.66
|
| Rate for Payer: Aetna Medicare |
$70.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,618.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$84.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$84.58
|
| Rate for Payer: BCBS Complete |
$38.87
|
| Rate for Payer: BCBS MAPPO |
$67.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.63
|
| Rate for Payer: BCN Medicare Advantage |
$67.66
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cash Price |
$20,453.33
|
| Rate for Payer: Cofinity Commercial |
$21,987.33
|
| Rate for Payer: Cofinity Commercial |
$17,896.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20,453.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$23,009.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,896.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19,175.00
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Mclaren Medicare |
$67.66
|
| Rate for Payer: Meridian Medicaid |
$38.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21,731.66
|
| Rate for Payer: PACE Medicare |
$64.28
|
| Rate for Payer: PACE SWMI |
$67.66
|
| Rate for Payer: PHP Commercial |
$21,731.66
|
| Rate for Payer: PHP Medicare Advantage |
$67.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,896.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$196.99
|
| Rate for Payer: Priority Health Medicare |
$67.66
|
| Rate for Payer: Priority Health Narrow Network |
$157.59
|
| Rate for Payer: Priority Health SBD |
$16,107.00
|
| Rate for Payer: Railroad Medicare Medicare |
$67.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.66
|
| Rate for Payer: UHC Medicare Advantage |
$69.69
|
| Rate for Payer: UMR Bronson Commercial |
$9,459.66
|
| Rate for Payer: VA VA |
$67.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19,175.00
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
IP
|
$133.35
|
|
|
Service Code
|
NDC 73302-456-01
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.67 |
| Max. Negotiated Rate |
$120.02 |
| Rate for Payer: Aetna American Axle |
$86.68
|
| Rate for Payer: Aetna Commercial |
$113.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.68
|
| Rate for Payer: Cash Price |
$106.68
|
| Rate for Payer: Cofinity Commercial |
$114.68
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.68
|
| Rate for Payer: Healthscope Commercial |
$120.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.35
|
| Rate for Payer: PHP Commercial |
$113.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.34
|
| Rate for Payer: Priority Health SBD |
$84.01
|
| Rate for Payer: UMR Bronson Commercial |
$58.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.01
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
IP
|
$123.70
|
|
|
Service Code
|
NDC 50102-911-01
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$111.33 |
| Rate for Payer: Aetna American Axle |
$80.40
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.40
|
| Rate for Payer: Cash Price |
$98.96
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$106.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.96
|
| Rate for Payer: Healthscope Commercial |
$111.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$105.14
|
| Rate for Payer: PHP Commercial |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.59
|
| Rate for Payer: Priority Health SBD |
$77.93
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.78
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
IP
|
$98,935.39
|
|
|
Service Code
|
MS-DRG 278
|
| Min. Negotiated Rate |
$33,140.13 |
| Max. Negotiated Rate |
$98,935.39 |
| Rate for Payer: Aetna Medicare |
$36,279.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,605.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,605.44
|
| Rate for Payer: BCBS MAPPO |
$34,884.35
|
| Rate for Payer: BCBS Trust/PPO |
$98,935.39
|
| Rate for Payer: BCN Medicare Advantage |
$34,884.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34,884.35
|
| Rate for Payer: Mclaren Medicare |
$34,884.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36,628.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,117.00
|
| Rate for Payer: PACE Medicare |
$33,140.13
|
| Rate for Payer: PACE SWMI |
$34,884.35
|
| Rate for Payer: PHP Medicare Advantage |
$34,884.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64,006.38
|
| Rate for Payer: Priority Health Medicare |
$34,884.35
|
| Rate for Payer: Priority Health Narrow Network |
$51,205.10
|
| Rate for Payer: Railroad Medicare Medicare |
$34,884.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68,038.94
|
| Rate for Payer: UHC Core |
$55,790.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$34,884.35
|
| Rate for Payer: UHC Exchange |
$44,354.22
|
| Rate for Payer: UHC Medicare Advantage |
$35,930.88
|
| Rate for Payer: VA VA |
$34,884.35
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
IP
|
$56,022.59
|
|
|
Service Code
|
MS-DRG 279
|
| Min. Negotiated Rate |
$23,917.48 |
| Max. Negotiated Rate |
$56,022.59 |
| Rate for Payer: Aetna Medicare |
$26,183.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,470.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,470.36
|
| Rate for Payer: BCBS MAPPO |
$25,176.29
|
| Rate for Payer: BCBS Trust/PPO |
$56,022.59
|
| Rate for Payer: BCN Medicare Advantage |
$25,176.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,176.29
|
| Rate for Payer: Mclaren Medicare |
$25,176.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,435.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,952.73
|
| Rate for Payer: PACE Medicare |
$23,917.48
|
| Rate for Payer: PACE SWMI |
$25,176.29
|
| Rate for Payer: PHP Medicare Advantage |
$25,176.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45,928.35
|
| Rate for Payer: Priority Health Medicare |
$25,176.29
|
| Rate for Payer: Priority Health Narrow Network |
$36,742.68
|
| Rate for Payer: Railroad Medicare Medicare |
$25,176.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,821.95
|
| Rate for Payer: UHC Core |
$40,033.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,176.29
|
| Rate for Payer: UHC Exchange |
$31,826.77
|
| Rate for Payer: UHC Medicare Advantage |
$25,931.58
|
| Rate for Payer: VA VA |
$25,176.29
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
IP
|
$54,225.87
|
|
|
Service Code
|
MS-DRG 173
|
| Min. Negotiated Rate |
$22,997.99 |
| Max. Negotiated Rate |
$54,225.87 |
| Rate for Payer: Aetna Medicare |
$25,176.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,260.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,260.51
|
| Rate for Payer: BCBS MAPPO |
$24,208.41
|
| Rate for Payer: BCBS Trust/PPO |
$54,225.87
|
| Rate for Payer: BCN Medicare Advantage |
$24,208.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,208.41
|
| Rate for Payer: Mclaren Medicare |
$24,208.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25,418.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,839.67
|
| Rate for Payer: PACE Medicare |
$22,997.99
|
| Rate for Payer: PACE SWMI |
$24,208.41
|
| Rate for Payer: PHP Medicare Advantage |
$24,208.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44,126.00
|
| Rate for Payer: Priority Health Medicare |
$24,208.41
|
| Rate for Payer: Priority Health Narrow Network |
$35,300.80
|
| Rate for Payer: Railroad Medicare Medicare |
$24,208.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46,906.05
|
| Rate for Payer: UHC Core |
$38,462.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$24,208.41
|
| Rate for Payer: UHC Exchange |
$30,577.80
|
| Rate for Payer: UHC Medicare Advantage |
$24,934.66
|
| Rate for Payer: VA VA |
$24,208.41
|
|
|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
OP
|
$9,680.93
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$588.09 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.90
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$588.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
IP
|
$108.71
|
|
|
Service Code
|
NDC 0173-0873-06
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna American Axle |
$70.66
|
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.66
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.40
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.10
|
| Rate for Payer: Priority Health SBD |
$68.49
|
| Rate for Payer: UMR Bronson Commercial |
$47.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.53
|
|
|
UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION
|
Facility
IP
|
$211.30
|
|
|
Service Code
|
NDC 0173-0869-06
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.97 |
| Max. Negotiated Rate |
$190.17 |
| Rate for Payer: Aetna American Axle |
$137.34
|
| Rate for Payer: Aetna Commercial |
$179.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.34
|
| Rate for Payer: Cash Price |
$169.04
|
| Rate for Payer: Cofinity Commercial |
$147.91
|
| Rate for Payer: Cofinity Commercial |
$181.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.04
|
| Rate for Payer: Healthscope Commercial |
$190.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.60
|
| Rate for Payer: PHP Commercial |
$179.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.91
|
| Rate for Payer: Priority Health SBD |
$133.12
|
| Rate for Payer: UMR Bronson Commercial |
$92.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.48
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
IP
|
$22,281.88
|
|
|
Service Code
|
MS-DRG 383
|
| Min. Negotiated Rate |
$10,722.57 |
| Max. Negotiated Rate |
$22,281.88 |
| Rate for Payer: Aetna Medicare |
$11,738.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,108.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,108.65
|
| Rate for Payer: BCBS MAPPO |
$11,286.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,281.88
|
| Rate for Payer: BCN Medicare Advantage |
$11,286.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,286.92
|
| Rate for Payer: Mclaren Medicare |
$11,286.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,851.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,979.96
|
| Rate for Payer: PACE Medicare |
$10,722.57
|
| Rate for Payer: PACE SWMI |
$11,286.92
|
| Rate for Payer: PHP Medicare Advantage |
$11,286.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,064.06
|
| Rate for Payer: Priority Health Medicare |
$11,286.92
|
| Rate for Payer: Priority Health Narrow Network |
$16,051.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11,286.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,328.14
|
| Rate for Payer: UHC Core |
$17,488.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,286.92
|
| Rate for Payer: UHC Exchange |
$13,903.70
|
| Rate for Payer: UHC Medicare Advantage |
$11,625.53
|
| Rate for Payer: VA VA |
$11,286.92
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
IP
|
$13,954.13
|
|
|
Service Code
|
MS-DRG 384
|
| Min. Negotiated Rate |
$6,897.50 |
| Max. Negotiated Rate |
$13,954.13 |
| Rate for Payer: Aetna Medicare |
$7,550.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,075.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,075.66
|
| Rate for Payer: BCBS MAPPO |
$7,260.53
|
| Rate for Payer: BCBS Trust/PPO |
$13,954.13
|
| Rate for Payer: BCN Medicare Advantage |
$7,260.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,260.53
|
| Rate for Payer: Mclaren Medicare |
$7,260.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,623.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,349.61
|
| Rate for Payer: PACE Medicare |
$6,897.50
|
| Rate for Payer: PACE SWMI |
$7,260.53
|
| Rate for Payer: PHP Medicare Advantage |
$7,260.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,566.22
|
| Rate for Payer: Priority Health Medicare |
$7,260.53
|
| Rate for Payer: Priority Health Narrow Network |
$10,052.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,260.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,357.93
|
| Rate for Payer: UHC Core |
$10,953.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,260.53
|
| Rate for Payer: UHC Exchange |
$8,707.96
|
| Rate for Payer: UHC Medicare Advantage |
$7,478.35
|
| Rate for Payer: VA VA |
$7,260.53
|
|
