|
UNLISTED PROCEDURE, SMALL INTESTINE
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 44799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$623.16
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
UNLISTED PROCEDURE, STOMACH
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43999
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$623.16
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
UNLISTED PROCEDURE, STOMACH
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 43999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$623.16
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 41599
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$225.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$157.70
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.51
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$546.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.12
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
UNLISTED PROCEDURE, TRACHEA, BRONCHI
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$183.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$220.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$220.09
|
| Rate for Payer: BCBS Complete |
$101.13
|
| Rate for Payer: BCBS MAPPO |
$176.07
|
| Rate for Payer: BCBS Trust/PPO |
$130.19
|
| Rate for Payer: BCN Medicare Advantage |
$176.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.07
|
| Rate for Payer: Mclaren Medicaid |
$96.31
|
| Rate for Payer: Mclaren Medicare |
$176.07
|
| Rate for Payer: Meridian Medicaid |
$101.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$184.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.48
|
| Rate for Payer: PACE Medicare |
$167.27
|
| Rate for Payer: PACE SWMI |
$176.07
|
| Rate for Payer: PHP Medicare Advantage |
$176.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.27
|
| Rate for Payer: Priority Health Medicare |
$176.07
|
| Rate for Payer: Priority Health Narrow Network |
$443.42
|
| Rate for Payer: Railroad Medicare Medicare |
$176.07
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.07
|
| Rate for Payer: UHC Medicare Advantage |
$181.35
|
| Rate for Payer: VA VA |
$176.07
|
|
|
UNLISTED PROCEDURE, URINARY SYSTEM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 53899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.16 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$228.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$274.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$274.60
|
| Rate for Payer: BCBS Complete |
$126.18
|
| Rate for Payer: BCBS MAPPO |
$219.68
|
| Rate for Payer: BCBS Trust/PPO |
$192.40
|
| Rate for Payer: BCN Medicare Advantage |
$219.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.68
|
| Rate for Payer: Mclaren Medicaid |
$120.16
|
| Rate for Payer: Mclaren Medicare |
$219.68
|
| Rate for Payer: Meridian Medicaid |
$126.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$230.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$252.63
|
| Rate for Payer: PACE Medicare |
$208.70
|
| Rate for Payer: PACE SWMI |
$219.68
|
| Rate for Payer: PHP Medicare Advantage |
$219.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.57
|
| Rate for Payer: Priority Health Medicare |
$219.68
|
| Rate for Payer: Priority Health Narrow Network |
$553.26
|
| Rate for Payer: Railroad Medicare Medicare |
$219.68
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.68
|
| Rate for Payer: UHC Medicare Advantage |
$226.27
|
| Rate for Payer: VA VA |
$219.68
|
|
|
UNLISTED PROCEDURE, VASCULAR SURGERY
|
Facility
|
OP
|
$1,757.86
|
|
|
Service Code
|
CPT 37799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$1,757.86 |
| Rate for Payer: Aetna Medicare |
$580.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.00
|
| Rate for Payer: BCBS Complete |
$320.74
|
| Rate for Payer: BCBS MAPPO |
$558.40
|
| Rate for Payer: BCBS Trust/PPO |
$609.22
|
| Rate for Payer: BCN Medicare Advantage |
$558.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.40
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Mclaren Medicare |
$558.40
|
| Rate for Payer: Meridian Medicaid |
$320.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.16
|
| Rate for Payer: PACE Medicare |
$530.48
|
| Rate for Payer: PACE SWMI |
$558.40
|
| Rate for Payer: PHP Medicare Advantage |
$558.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.86
|
| Rate for Payer: Priority Health Medicare |
$558.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,406.29
|
| Rate for Payer: Railroad Medicare Medicare |
$558.40
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.40
|
| Rate for Payer: UHC Medicare Advantage |
$575.15
|
| Rate for Payer: VA VA |
$558.40
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$38,841.90
|
|
|
Service Code
|
MS-DRG 256
|
| Min. Negotiated Rate |
$12,490.52 |
| Max. Negotiated Rate |
$38,841.90 |
| Rate for Payer: Aetna Medicare |
$13,673.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,434.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,434.90
|
| Rate for Payer: BCBS MAPPO |
$13,147.92
|
| Rate for Payer: BCBS Trust/PPO |
$38,841.90
|
| Rate for Payer: BCN Medicare Advantage |
$13,147.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,147.92
|
| Rate for Payer: Mclaren Medicare |
$13,147.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,805.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,120.11
|
| Rate for Payer: PACE Medicare |
$12,490.52
|
| Rate for Payer: PACE SWMI |
$13,147.92
|
| Rate for Payer: PHP Medicare Advantage |
$13,147.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,529.56
|
| Rate for Payer: Priority Health Medicare |
$13,147.92
|
| Rate for Payer: Priority Health Narrow Network |
$18,823.65
|
| Rate for Payer: Railroad Medicare Medicare |
$13,147.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,011.98
|
| Rate for Payer: UHC Core |
$20,509.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,147.92
|
| Rate for Payer: UHC Exchange |
$16,305.18
|
| Rate for Payer: UHC Medicare Advantage |
$13,542.36
|
| Rate for Payer: VA VA |
$13,147.92
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$42,978.13
|
|
|
Service Code
|
MS-DRG 255
|
| Min. Negotiated Rate |
$20,599.71 |
| Max. Negotiated Rate |
$42,978.13 |
| Rate for Payer: Aetna Medicare |
$22,551.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,104.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,104.89
|
| Rate for Payer: BCBS MAPPO |
$21,683.91
|
| Rate for Payer: BCBS Trust/PPO |
$42,978.13
|
| Rate for Payer: BCN Medicare Advantage |
$21,683.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,683.91
|
| Rate for Payer: Mclaren Medicare |
$21,683.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,768.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,936.50
|
| Rate for Payer: PACE Medicare |
$20,599.71
|
| Rate for Payer: PACE SWMI |
$21,683.91
|
| Rate for Payer: PHP Medicare Advantage |
$21,683.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,424.97
|
| Rate for Payer: Priority Health Medicare |
$21,683.91
|
| Rate for Payer: Priority Health Narrow Network |
$31,539.98
|
| Rate for Payer: Railroad Medicare Medicare |
$21,683.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,908.84
|
| Rate for Payer: UHC Core |
$34,364.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,683.91
|
| Rate for Payer: UHC Exchange |
$27,320.15
|
| Rate for Payer: UHC Medicare Advantage |
$22,334.43
|
| Rate for Payer: VA VA |
$21,683.91
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$19,972.53
|
|
|
Service Code
|
MS-DRG 257
|
| Min. Negotiated Rate |
$7,741.57 |
| Max. Negotiated Rate |
$19,972.53 |
| Rate for Payer: Aetna Medicare |
$8,474.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,186.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,186.28
|
| Rate for Payer: BCBS MAPPO |
$8,149.02
|
| Rate for Payer: BCBS Trust/PPO |
$19,972.53
|
| Rate for Payer: BCN Medicare Advantage |
$8,149.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,149.02
|
| Rate for Payer: Mclaren Medicare |
$8,149.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,556.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,371.37
|
| Rate for Payer: PACE Medicare |
$7,741.57
|
| Rate for Payer: PACE SWMI |
$8,149.02
|
| Rate for Payer: PHP Medicare Advantage |
$8,149.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,220.77
|
| Rate for Payer: Priority Health Medicare |
$8,149.02
|
| Rate for Payer: Priority Health Narrow Network |
$11,376.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8,149.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,116.71
|
| Rate for Payer: UHC Core |
$12,395.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,149.02
|
| Rate for Payer: UHC Exchange |
$9,854.50
|
| Rate for Payer: UHC Medicare Advantage |
$8,393.49
|
| Rate for Payer: VA VA |
$8,149.02
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$45,068.86
|
|
|
Service Code
|
MS-DRG 671
|
| Min. Negotiated Rate |
$13,019.09 |
| Max. Negotiated Rate |
$45,068.86 |
| Rate for Payer: Aetna Medicare |
$14,252.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,130.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,130.39
|
| Rate for Payer: BCBS MAPPO |
$13,704.31
|
| Rate for Payer: BCBS Trust/PPO |
$45,068.86
|
| Rate for Payer: BCN Medicare Advantage |
$13,704.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,704.31
|
| Rate for Payer: Mclaren Medicare |
$13,704.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,389.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,759.96
|
| Rate for Payer: PACE Medicare |
$13,019.09
|
| Rate for Payer: PACE SWMI |
$13,704.31
|
| Rate for Payer: PHP Medicare Advantage |
$13,704.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,565.63
|
| Rate for Payer: Priority Health Medicare |
$13,704.31
|
| Rate for Payer: Priority Health Narrow Network |
$19,652.50
|
| Rate for Payer: Railroad Medicare Medicare |
$13,704.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,113.32
|
| Rate for Payer: UHC Core |
$21,412.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,704.31
|
| Rate for Payer: UHC Exchange |
$17,023.13
|
| Rate for Payer: UHC Medicare Advantage |
$14,115.44
|
| Rate for Payer: VA VA |
$13,704.31
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$17,396.81
|
|
|
Service Code
|
MS-DRG 672
|
| Min. Negotiated Rate |
$7,349.91 |
| Max. Negotiated Rate |
$17,396.81 |
| Rate for Payer: Aetna Medicare |
$8,046.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,670.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,670.94
|
| Rate for Payer: BCBS MAPPO |
$7,736.75
|
| Rate for Payer: BCBS Trust/PPO |
$17,396.81
|
| Rate for Payer: BCN Medicare Advantage |
$7,736.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,736.75
|
| Rate for Payer: Mclaren Medicare |
$7,736.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,123.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,897.26
|
| Rate for Payer: PACE Medicare |
$7,349.91
|
| Rate for Payer: PACE SWMI |
$7,736.75
|
| Rate for Payer: PHP Medicare Advantage |
$7,736.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,240.67
|
| Rate for Payer: Priority Health Medicare |
$7,736.75
|
| Rate for Payer: Priority Health Narrow Network |
$10,592.54
|
| Rate for Payer: Railroad Medicare Medicare |
$7,736.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,074.87
|
| Rate for Payer: UHC Core |
$11,541.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,736.75
|
| Rate for Payer: UHC Exchange |
$9,175.33
|
| Rate for Payer: UHC Medicare Advantage |
$7,968.85
|
| Rate for Payer: VA VA |
$7,736.75
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$16,979.23
|
|
|
Service Code
|
MS-DRG 697
|
| Min. Negotiated Rate |
$8,635.44 |
| Max. Negotiated Rate |
$16,979.23 |
| Rate for Payer: Aetna Medicare |
$9,453.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,362.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,362.42
|
| Rate for Payer: BCBS MAPPO |
$9,089.94
|
| Rate for Payer: BCBS Trust/PPO |
$14,315.99
|
| Rate for Payer: BCN Medicare Advantage |
$9,089.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,089.94
|
| Rate for Payer: Mclaren Medicare |
$9,089.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,544.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,453.43
|
| Rate for Payer: PACE Medicare |
$8,635.44
|
| Rate for Payer: PACE SWMI |
$9,089.94
|
| Rate for Payer: PHP Medicare Advantage |
$9,089.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,972.90
|
| Rate for Payer: Priority Health Medicare |
$9,089.94
|
| Rate for Payer: Priority Health Narrow Network |
$12,778.32
|
| Rate for Payer: Railroad Medicare Medicare |
$9,089.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,979.23
|
| Rate for Payer: UHC Core |
$13,922.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,089.94
|
| Rate for Payer: UHC Exchange |
$11,068.67
|
| Rate for Payer: UHC Medicare Advantage |
$9,362.64
|
| Rate for Payer: VA VA |
$9,089.94
|
|
|
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 53450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$402.75 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,400.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.02
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$402.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE)
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 53400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$782.59 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,588.88
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$860.85
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$782.59
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
|
Facility
|
OP
|
$14,479.04
|
|
|
Service Code
|
CPT 53505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$478.07 |
| Max. Negotiated Rate |
$14,479.04 |
| Rate for Payer: Aetna Medicare |
$4,783.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,749.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,749.21
|
| Rate for Payer: BCBS Complete |
$2,641.88
|
| Rate for Payer: BCBS MAPPO |
$4,599.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,584.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,599.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,599.37
|
| Rate for Payer: Mclaren Medicaid |
$2,515.86
|
| Rate for Payer: Mclaren Medicare |
$4,599.37
|
| Rate for Payer: Meridian Medicaid |
$2,641.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,829.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,289.28
|
| Rate for Payer: PACE Medicare |
$4,369.40
|
| Rate for Payer: PACE SWMI |
$4,599.37
|
| Rate for Payer: PHP Medicare Advantage |
$4,599.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,515.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,479.04
|
| Rate for Payer: Priority Health Medicare |
$4,599.37
|
| Rate for Payer: Priority Health Narrow Network |
$11,583.23
|
| Rate for Payer: Railroad Medicare Medicare |
$4,599.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.88
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,599.37
|
| Rate for Payer: UHC Exchange |
$478.07
|
| Rate for Payer: UHC Medicare Advantage |
$4,737.35
|
| Rate for Payer: VA VA |
$4,599.37
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
IP
|
$62,367.20
|
|
|
Service Code
|
NDC 69468-151-04
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27,441.57 |
| Max. Negotiated Rate |
$56,130.48 |
| Rate for Payer: Aetna American Axle |
$40,538.68
|
| Rate for Payer: Aetna Commercial |
$53,012.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,538.68
|
| Rate for Payer: Cash Price |
$49,893.76
|
| Rate for Payer: Cofinity Commercial |
$43,657.04
|
| Rate for Payer: Cofinity Commercial |
$53,635.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49,893.76
|
| Rate for Payer: Healthscope Commercial |
$56,130.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43,657.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46,775.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53,012.12
|
| Rate for Payer: PHP Commercial |
$53,012.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43,657.04
|
| Rate for Payer: Priority Health SBD |
$39,291.34
|
| Rate for Payer: UMR Bronson Commercial |
$27,441.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,775.40
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$21,604.24
|
|
|
Service Code
|
MS-DRG 693
|
| Min. Negotiated Rate |
$10,855.09 |
| Max. Negotiated Rate |
$21,604.24 |
| Rate for Payer: Aetna Medicare |
$11,883.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,283.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,283.01
|
| Rate for Payer: BCBS MAPPO |
$11,426.41
|
| Rate for Payer: BCBS Trust/PPO |
$16,333.85
|
| Rate for Payer: BCN Medicare Advantage |
$11,426.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,426.41
|
| Rate for Payer: Mclaren Medicare |
$11,426.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,997.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,140.37
|
| Rate for Payer: PACE Medicare |
$10,855.09
|
| Rate for Payer: PACE SWMI |
$11,426.41
|
| Rate for Payer: PHP Medicare Advantage |
$11,426.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,323.79
|
| Rate for Payer: Priority Health Medicare |
$11,426.41
|
| Rate for Payer: Priority Health Narrow Network |
$16,259.03
|
| Rate for Payer: Railroad Medicare Medicare |
$11,426.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,604.24
|
| Rate for Payer: UHC Core |
$17,715.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,426.41
|
| Rate for Payer: UHC Exchange |
$14,083.69
|
| Rate for Payer: UHC Medicare Advantage |
$11,769.20
|
| Rate for Payer: VA VA |
$11,426.41
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$12,707.74
|
|
|
Service Code
|
MS-DRG 694
|
| Min. Negotiated Rate |
$6,216.68 |
| Max. Negotiated Rate |
$12,707.74 |
| Rate for Payer: Aetna Medicare |
$6,805.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,179.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,179.84
|
| Rate for Payer: BCBS MAPPO |
$6,543.87
|
| Rate for Payer: BCBS Trust/PPO |
$12,707.74
|
| Rate for Payer: BCN Medicare Advantage |
$6,543.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,543.87
|
| Rate for Payer: Mclaren Medicare |
$6,543.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,871.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,525.45
|
| Rate for Payer: PACE Medicare |
$6,216.68
|
| Rate for Payer: PACE SWMI |
$6,543.87
|
| Rate for Payer: PHP Medicare Advantage |
$6,543.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,231.68
|
| Rate for Payer: Priority Health Medicare |
$6,543.87
|
| Rate for Payer: Priority Health Narrow Network |
$8,985.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,543.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,939.31
|
| Rate for Payer: UHC Core |
$9,790.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,543.87
|
| Rate for Payer: UHC Exchange |
$7,783.17
|
| Rate for Payer: UHC Medicare Advantage |
$6,740.19
|
| Rate for Payer: VA VA |
$6,543.87
|
|
|
URINARY SUSPENSORY
|
Professional
|
Both
|
$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
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$632.64
|
|
|
Service Code
|
NDC 70710-1127-1
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.36 |
| Max. Negotiated Rate |
$569.38 |
| Rate for Payer: Aetna American Axle |
$411.22
|
| Rate for Payer: Aetna Commercial |
$537.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.22
|
| Rate for Payer: Cash Price |
$506.11
|
| Rate for Payer: Cofinity Commercial |
$442.85
|
| Rate for Payer: Cofinity Commercial |
$544.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.11
|
| Rate for Payer: Healthscope Commercial |
$569.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.74
|
| Rate for Payer: PHP Commercial |
$537.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.85
|
| Rate for Payer: Priority Health SBD |
$398.56
|
| Rate for Payer: UMR Bronson Commercial |
$278.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.48
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$632.64
|
|
|
Service Code
|
NDC 49884-412-01
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.36 |
| Max. Negotiated Rate |
$569.38 |
| Rate for Payer: Aetna American Axle |
$411.22
|
| Rate for Payer: Aetna Commercial |
$537.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.22
|
| Rate for Payer: Cash Price |
$506.11
|
| Rate for Payer: Cofinity Commercial |
$442.85
|
| Rate for Payer: Cofinity Commercial |
$544.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.11
|
| Rate for Payer: Healthscope Commercial |
$569.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$442.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$474.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.74
|
| Rate for Payer: PHP Commercial |
$537.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.85
|
| Rate for Payer: Priority Health SBD |
$398.56
|
| Rate for Payer: UMR Bronson Commercial |
$278.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$474.48
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$754.43
|
|
|
Service Code
|
NDC 0591-2998-01
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.95 |
| Max. Negotiated Rate |
$678.99 |
| Rate for Payer: Aetna American Axle |
$490.38
|
| Rate for Payer: Aetna Commercial |
$641.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.38
|
| Rate for Payer: Cash Price |
$603.54
|
| Rate for Payer: Cofinity Commercial |
$528.10
|
| Rate for Payer: Cofinity Commercial |
$648.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$603.54
|
| Rate for Payer: Healthscope Commercial |
$678.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$528.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$565.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$641.27
|
| Rate for Payer: PHP Commercial |
$641.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.10
|
| Rate for Payer: Priority Health SBD |
$475.29
|
| Rate for Payer: UMR Bronson Commercial |
$331.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$565.82
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$457.90
|
|
|
Service Code
|
NDC 64380-918-06
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.48 |
| Max. Negotiated Rate |
$412.11 |
| Rate for Payer: Aetna American Axle |
$297.64
|
| Rate for Payer: Aetna Commercial |
$389.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.64
|
| Rate for Payer: Cash Price |
$366.32
|
| Rate for Payer: Cofinity Commercial |
$320.53
|
| Rate for Payer: Cofinity Commercial |
$393.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.32
|
| Rate for Payer: Healthscope Commercial |
$412.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$389.22
|
| Rate for Payer: PHP Commercial |
$389.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.53
|
| Rate for Payer: Priority Health SBD |
$288.48
|
| Rate for Payer: UMR Bronson Commercial |
$201.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.42
|
|
|
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 |
$245.63 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna American Axle |
$362.86
|
| 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: Encore Health Key Benefits Commercial |
$446.59
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$390.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$418.68
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$245.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$418.68
|
|
