|
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
|
Facility
|
OP
|
$794.84
|
|
|
Service Code
|
CPT 27299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$128.54 |
| Max. Negotiated Rate |
$794.84 |
| Rate for Payer: Aetna Medicare |
$255.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$307.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$307.23
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: BCBS MAPPO |
$245.78
|
| Rate for Payer: BCBS Trust/PPO |
$225.47
|
| Rate for Payer: BCN Commercial |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$245.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.78
|
| Rate for Payer: Mclaren Medicaid |
$245.78
|
| Rate for Payer: Mclaren Medicare |
$245.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.07
|
| Rate for Payer: Meridian Medicaid |
$258.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$270.36
|
| Rate for Payer: Nomi Health Commercial |
$737.34
|
| Rate for Payer: PACE Medicare |
$233.49
|
| Rate for Payer: PACE SWMI |
$245.78
|
| Rate for Payer: PHP Medicare Advantage |
$245.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$794.84
|
| Rate for Payer: Priority Health Medicare |
$245.78
|
| Rate for Payer: Priority Health Tiered Network |
$635.87
|
| Rate for Payer: Railroad Medicare Medicare |
$245.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$245.78
|
| Rate for Payer: UHC Medicaid |
$128.54
|
| Rate for Payer: UHCCP Medicaid |
$128.54
|
| Rate for Payer: VA VA |
$245.78
|
|
|
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 17999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$172.78
|
| Rate for Payer: BCN Commercial |
$172.78
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
UNLISTED PROCEDURE, TRACHEA, BRONCHI
|
Facility
|
OP
|
$643.18
|
|
|
Service Code
|
CPT 31899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.02 |
| Max. Negotiated Rate |
$643.18 |
| Rate for Payer: Aetna Medicare |
$206.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$248.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$248.61
|
| Rate for Payer: BCBS Complete |
$109.23
|
| Rate for Payer: BCBS MAPPO |
$198.89
|
| Rate for Payer: BCBS Trust/PPO |
$164.96
|
| Rate for Payer: BCN Commercial |
$164.96
|
| Rate for Payer: BCN Medicare Advantage |
$198.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.89
|
| Rate for Payer: Mclaren Medicaid |
$198.89
|
| Rate for Payer: Mclaren Medicare |
$198.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$208.83
|
| Rate for Payer: Meridian Medicaid |
$208.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$228.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$218.78
|
| Rate for Payer: Nomi Health Commercial |
$596.67
|
| Rate for Payer: PACE Medicare |
$188.95
|
| Rate for Payer: PACE SWMI |
$198.89
|
| Rate for Payer: PHP Medicare Advantage |
$198.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$643.18
|
| Rate for Payer: Priority Health Medicare |
$198.89
|
| Rate for Payer: Priority Health Tiered Network |
$514.54
|
| Rate for Payer: Railroad Medicare Medicare |
$198.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$198.89
|
| Rate for Payer: UHC Medicaid |
$104.02
|
| Rate for Payer: UHCCP Medicaid |
$104.02
|
| Rate for Payer: VA VA |
$198.89
|
|
|
UNLISTED PROCEDURE, URINARY SYSTEM
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 53899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$243.78
|
| Rate for Payer: BCN Commercial |
$243.78
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$248.95
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
UNLISTED PROCEDURE, VASCULAR SURGERY
|
Facility
|
OP
|
$2,021.35
|
|
|
Service Code
|
CPT 37799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$326.90 |
| Max. Negotiated Rate |
$2,021.35 |
| Rate for Payer: Aetna Medicare |
$650.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.31
|
| Rate for Payer: BCBS Complete |
$343.28
|
| Rate for Payer: BCBS MAPPO |
$625.05
|
| Rate for Payer: BCBS Trust/PPO |
$771.92
|
| Rate for Payer: BCN Commercial |
$771.92
|
| Rate for Payer: BCN Medicare Advantage |
$625.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.05
|
| Rate for Payer: Mclaren Medicaid |
$625.05
|
| Rate for Payer: Mclaren Medicare |
$625.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.30
|
| Rate for Payer: Meridian Medicaid |
$656.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$718.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.55
|
| Rate for Payer: Nomi Health Commercial |
$1,875.15
|
| Rate for Payer: PACE Medicare |
$593.80
|
| Rate for Payer: PACE SWMI |
$625.05
|
| Rate for Payer: PHP Medicare Advantage |
$625.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$326.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,021.35
|
| Rate for Payer: Priority Health Medicare |
$625.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.08
|
| Rate for Payer: Railroad Medicare Medicare |
$625.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.05
|
| Rate for Payer: UHC Medicaid |
$326.90
|
| Rate for Payer: UHCCP Medicaid |
$326.90
|
| Rate for Payer: VA VA |
$625.05
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$42,431.01
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$14,052.39 |
| Max. Negotiated Rate |
$42,431.01 |
| Rate for Payer: Aetna Medicare |
$15,383.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,489.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,489.99
|
| Rate for Payer: BCBS MAPPO |
$14,791.99
|
| Rate for Payer: BCBS Trust/PPO |
$42,431.01
|
| Rate for Payer: BCN Commercial |
$42,431.01
|
| Rate for Payer: BCN Medicare Advantage |
$14,791.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,791.99
|
| Rate for Payer: Mclaren Medicare |
$14,791.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,531.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,010.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,271.19
|
| Rate for Payer: Nomi Health Commercial |
$21,902.91
|
| Rate for Payer: PACE Medicare |
$14,052.39
|
| Rate for Payer: PACE SWMI |
$14,791.99
|
| Rate for Payer: PHP Medicare Advantage |
$14,791.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,373.78
|
| Rate for Payer: Priority Health Medicare |
$14,791.99
|
| Rate for Payer: Priority Health Tiered Network |
$21,899.02
|
| Rate for Payer: Railroad Medicare Medicare |
$14,791.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,675.77
|
| Rate for Payer: UHC Core |
$23,154.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,791.99
|
| Rate for Payer: UHC Exchange |
$18,909.51
|
| Rate for Payer: VA VA |
$14,791.99
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$46,949.45
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$21,992.98 |
| Max. Negotiated Rate |
$46,949.45 |
| Rate for Payer: Aetna Medicare |
$24,076.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,938.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,938.14
|
| Rate for Payer: BCBS MAPPO |
$23,150.51
|
| Rate for Payer: BCBS Trust/PPO |
$46,949.45
|
| Rate for Payer: BCN Commercial |
$46,949.45
|
| Rate for Payer: BCN Medicare Advantage |
$23,150.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,150.51
|
| Rate for Payer: Mclaren Medicare |
$23,150.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,308.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,623.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,465.56
|
| Rate for Payer: Nomi Health Commercial |
$34,796.46
|
| Rate for Payer: PACE Medicare |
$21,992.98
|
| Rate for Payer: PACE SWMI |
$23,150.51
|
| Rate for Payer: PHP Medicare Advantage |
$23,150.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,487.86
|
| Rate for Payer: Priority Health Medicare |
$23,150.51
|
| Rate for Payer: Priority Health Tiered Network |
$34,790.28
|
| Rate for Payer: Railroad Medicare Medicare |
$23,150.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,967.62
|
| Rate for Payer: UHC Core |
$36,784.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,150.51
|
| Rate for Payer: UHC Exchange |
$30,040.94
|
| Rate for Payer: VA VA |
$23,150.51
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,818.05
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$9,240.36 |
| Max. Negotiated Rate |
$21,818.05 |
| Rate for Payer: Aetna Medicare |
$10,115.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,158.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,158.38
|
| Rate for Payer: BCBS MAPPO |
$9,726.70
|
| Rate for Payer: BCBS Trust/PPO |
$21,818.05
|
| Rate for Payer: BCN Commercial |
$21,818.05
|
| Rate for Payer: BCN Medicare Advantage |
$9,726.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,726.70
|
| Rate for Payer: Mclaren Medicare |
$9,726.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,213.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,185.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,699.37
|
| Rate for Payer: Nomi Health Commercial |
$14,089.38
|
| Rate for Payer: PACE Medicare |
$9,240.36
|
| Rate for Payer: PACE SWMI |
$9,726.70
|
| Rate for Payer: PHP Medicare Advantage |
$9,726.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,608.60
|
| Rate for Payer: Priority Health Medicare |
$9,726.70
|
| Rate for Payer: Priority Health Tiered Network |
$14,086.88
|
| Rate for Payer: Railroad Medicare Medicare |
$9,726.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,802.86
|
| Rate for Payer: UHC Core |
$14,894.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,726.70
|
| Rate for Payer: UHC Exchange |
$12,163.83
|
| Rate for Payer: VA VA |
$9,726.70
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$18,142.20
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$17,278.28 |
| Max. Negotiated Rate |
$18,142.20 |
| Rate for Payer: BCBS Complete |
$18,142.20
|
| Rate for Payer: Mclaren Medicaid |
$17,278.28
|
| Rate for Payer: Meridian Medicaid |
$18,142.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,278.28
|
| Rate for Payer: UHC Medicaid |
$17,278.28
|
| Rate for Payer: UHCCP Medicaid |
$17,278.28
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$7,125.28
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$6,785.98 |
| Max. Negotiated Rate |
$7,125.28 |
| Rate for Payer: BCBS Complete |
$7,125.28
|
| Rate for Payer: Mclaren Medicaid |
$6,785.98
|
| Rate for Payer: Meridian Medicaid |
$7,125.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,785.98
|
| Rate for Payer: UHC Medicaid |
$6,785.98
|
| Rate for Payer: UHCCP Medicaid |
$6,785.98
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$8,005.42
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$7,624.21 |
| Max. Negotiated Rate |
$8,005.42 |
| Rate for Payer: BCBS Complete |
$8,005.42
|
| Rate for Payer: Mclaren Medicaid |
$7,624.21
|
| Rate for Payer: Meridian Medicaid |
$8,005.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,624.21
|
| Rate for Payer: UHC Medicaid |
$7,624.21
|
| Rate for Payer: UHCCP Medicaid |
$7,624.21
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$11,766.31
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$11,206.01 |
| Max. Negotiated Rate |
$11,766.31 |
| Rate for Payer: BCBS Complete |
$11,766.31
|
| Rate for Payer: Mclaren Medicaid |
$11,206.01
|
| Rate for Payer: Meridian Medicaid |
$11,766.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,206.01
|
| Rate for Payer: UHC Medicaid |
$11,206.01
|
| Rate for Payer: UHCCP Medicaid |
$11,206.01
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$49,233.37
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$14,823.79 |
| Max. Negotiated Rate |
$49,233.37 |
| Rate for Payer: Aetna Medicare |
$16,228.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,504.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,504.99
|
| Rate for Payer: BCBS MAPPO |
$15,603.99
|
| Rate for Payer: BCBS Trust/PPO |
$49,233.37
|
| Rate for Payer: BCN Commercial |
$49,233.37
|
| Rate for Payer: BCN Medicare Advantage |
$15,603.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,603.99
|
| Rate for Payer: Mclaren Medicare |
$15,603.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,384.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,944.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,164.39
|
| Rate for Payer: Nomi Health Commercial |
$23,155.50
|
| Rate for Payer: PACE Medicare |
$14,823.79
|
| Rate for Payer: PACE SWMI |
$15,603.99
|
| Rate for Payer: PHP Medicare Advantage |
$15,603.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,939.24
|
| Rate for Payer: Priority Health Medicare |
$15,603.99
|
| Rate for Payer: Priority Health Tiered Network |
$23,151.39
|
| Rate for Payer: Railroad Medicare Medicare |
$15,603.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,258.50
|
| Rate for Payer: UHC Core |
$24,478.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,603.99
|
| Rate for Payer: UHC Exchange |
$19,990.92
|
| Rate for Payer: VA VA |
$15,603.99
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,004.33
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$9,139.48 |
| Max. Negotiated Rate |
$19,004.33 |
| Rate for Payer: Aetna Medicare |
$10,005.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,025.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,025.62
|
| Rate for Payer: BCBS MAPPO |
$9,620.50
|
| Rate for Payer: BCBS Trust/PPO |
$19,004.33
|
| Rate for Payer: BCN Commercial |
$19,004.33
|
| Rate for Payer: BCN Medicare Advantage |
$9,620.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,620.50
|
| Rate for Payer: Mclaren Medicare |
$9,620.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,101.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,063.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,582.55
|
| Rate for Payer: Nomi Health Commercial |
$13,925.55
|
| Rate for Payer: PACE Medicare |
$9,139.48
|
| Rate for Payer: PACE SWMI |
$9,620.50
|
| Rate for Payer: PHP Medicare Advantage |
$9,620.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,403.85
|
| Rate for Payer: Priority Health Medicare |
$9,620.50
|
| Rate for Payer: Priority Health Tiered Network |
$13,923.08
|
| Rate for Payer: Railroad Medicare Medicare |
$9,620.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,595.85
|
| Rate for Payer: UHC Core |
$14,721.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,620.50
|
| Rate for Payer: UHC Exchange |
$12,022.39
|
| Rate for Payer: VA VA |
$9,620.50
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$17,568.14
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$9,125.96 |
| Max. Negotiated Rate |
$17,568.14 |
| Rate for Payer: Aetna Medicare |
$9,990.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,007.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,007.84
|
| Rate for Payer: BCBS MAPPO |
$9,606.27
|
| Rate for Payer: BCBS Trust/PPO |
$15,638.83
|
| Rate for Payer: BCN Commercial |
$15,638.83
|
| Rate for Payer: BCN Medicare Advantage |
$9,606.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,606.27
|
| Rate for Payer: Mclaren Medicare |
$9,606.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,086.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,047.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,566.90
|
| Rate for Payer: Nomi Health Commercial |
$13,903.62
|
| Rate for Payer: PACE Medicare |
$9,125.96
|
| Rate for Payer: PACE SWMI |
$9,606.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,606.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,376.44
|
| Rate for Payer: Priority Health Medicare |
$9,606.27
|
| Rate for Payer: Priority Health Tiered Network |
$13,901.15
|
| Rate for Payer: Railroad Medicare Medicare |
$9,606.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,568.14
|
| Rate for Payer: UHC Core |
$14,697.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,606.27
|
| Rate for Payer: UHC Exchange |
$12,003.46
|
| Rate for Payer: VA VA |
$9,606.27
|
|
|
URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 53430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,820.33
|
| Rate for Payer: BCN Commercial |
$3,820.33
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
OP
|
$68,760.80
|
|
|
Service Code
|
NDC 50633022004
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25,441.50 |
| Max. Negotiated Rate |
$61,884.72 |
| Rate for Payer: Aetna American Axle |
$44,694.52
|
| Rate for Payer: Aetna Commercial |
$58,446.68
|
| Rate for Payer: Aetna Medicare |
$34,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44,694.52
|
| Rate for Payer: BCBS Complete |
$27,504.32
|
| Rate for Payer: Cash Price |
$55,008.64
|
| Rate for Payer: Cofinity Advantage |
$48,132.56
|
| Rate for Payer: Cofinity Commercial |
$59,134.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,008.64
|
| Rate for Payer: Healthscope Commercial |
$61,884.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51,570.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55,008.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,446.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51,570.60
|
| Rate for Payer: PHP Commercial |
$58,446.68
|
| Rate for Payer: Priority Health SBD |
$43,319.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,694.52
|
| Rate for Payer: UHC Core |
$35,824.38
|
| Rate for Payer: UHC Exchange |
$27,022.99
|
| Rate for Payer: UMR Bronson Commercial |
$25,441.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51,570.60
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
IP
|
$62,367.20
|
|
|
Service Code
|
NDC 69468015104
|
| 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 Advantage |
$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 Commercial |
$53,012.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46,775.40
|
| Rate for Payer: PHP Commercial |
$53,012.12
|
| 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
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
IP
|
$17,190.20
|
|
|
Service Code
|
NDC 50633022010
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,563.69 |
| Max. Negotiated Rate |
$15,471.18 |
| Rate for Payer: Aetna American Axle |
$11,173.63
|
| Rate for Payer: Aetna Commercial |
$14,611.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,173.63
|
| Rate for Payer: Cash Price |
$13,752.16
|
| Rate for Payer: Cofinity Advantage |
$12,033.14
|
| Rate for Payer: Cofinity Commercial |
$14,783.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,752.16
|
| Rate for Payer: Healthscope Commercial |
$15,471.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,033.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,892.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,611.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,892.65
|
| Rate for Payer: PHP Commercial |
$14,611.67
|
| Rate for Payer: Priority Health SBD |
$10,829.83
|
| Rate for Payer: UMR Bronson Commercial |
$7,563.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,892.65
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
OP
|
$17,190.20
|
|
|
Service Code
|
NDC 50633022010
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,360.37 |
| Max. Negotiated Rate |
$15,471.18 |
| Rate for Payer: Aetna American Axle |
$11,173.63
|
| Rate for Payer: Aetna Commercial |
$14,611.67
|
| Rate for Payer: Aetna Medicare |
$8,595.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,173.63
|
| Rate for Payer: BCBS Complete |
$6,876.08
|
| Rate for Payer: Cash Price |
$13,752.16
|
| Rate for Payer: Cofinity Advantage |
$12,033.14
|
| Rate for Payer: Cofinity Commercial |
$14,783.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,752.16
|
| Rate for Payer: Healthscope Commercial |
$15,471.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,033.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,892.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,752.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,611.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12,892.65
|
| Rate for Payer: PHP Commercial |
$14,611.67
|
| Rate for Payer: Priority Health SBD |
$10,829.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,173.63
|
| Rate for Payer: UHC Core |
$8,956.09
|
| Rate for Payer: UHC Exchange |
$6,755.75
|
| Rate for Payer: UMR Bronson Commercial |
$6,360.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,892.65
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
IP
|
$68,760.80
|
|
|
Service Code
|
NDC 50633022004
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30,254.75 |
| Max. Negotiated Rate |
$61,884.72 |
| Rate for Payer: Aetna American Axle |
$44,694.52
|
| Rate for Payer: Aetna Commercial |
$58,446.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44,694.52
|
| Rate for Payer: Cash Price |
$55,008.64
|
| Rate for Payer: Cofinity Advantage |
$48,132.56
|
| Rate for Payer: Cofinity Commercial |
$59,134.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,008.64
|
| Rate for Payer: Healthscope Commercial |
$61,884.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,132.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51,570.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,446.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51,570.60
|
| Rate for Payer: PHP Commercial |
$58,446.68
|
| Rate for Payer: Priority Health SBD |
$43,319.30
|
| Rate for Payer: UMR Bronson Commercial |
$30,254.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51,570.60
|
|
|
URIDINE TRIACETATE 10 GRAM ORAL GRANULES IN PACKET
|
Facility
|
OP
|
$62,367.20
|
|
|
Service Code
|
NDC 69468015104
|
| Hospital Charge Code |
177130
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23,075.86 |
| 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 Medicare |
$31,183.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40,538.68
|
| Rate for Payer: BCBS Complete |
$24,946.88
|
| Rate for Payer: Cash Price |
$49,893.76
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$49,893.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53,012.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$46,775.40
|
| Rate for Payer: PHP Commercial |
$53,012.12
|
| Rate for Payer: Priority Health SBD |
$39,291.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,538.68
|
| Rate for Payer: UHC Core |
$32,493.31
|
| Rate for Payer: UHC Exchange |
$24,510.31
|
| Rate for Payer: UMR Bronson Commercial |
$23,075.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46,775.40
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$5,476.38
|
|
|
Service Code
|
APR-DRG 4652
|
| Min. Negotiated Rate |
$5,215.60 |
| Max. Negotiated Rate |
$5,476.38 |
| Rate for Payer: BCBS Complete |
$5,476.38
|
| Rate for Payer: Mclaren Medicaid |
$5,215.60
|
| Rate for Payer: Meridian Medicaid |
$5,476.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,215.60
|
| Rate for Payer: UHC Medicaid |
$5,215.60
|
| Rate for Payer: UHCCP Medicaid |
$5,215.60
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$3,579.29
|
|
|
Service Code
|
APR-DRG 4651
|
| Min. Negotiated Rate |
$3,408.84 |
| Max. Negotiated Rate |
$3,579.29 |
| Rate for Payer: BCBS Complete |
$3,579.29
|
| Rate for Payer: Mclaren Medicaid |
$3,408.84
|
| Rate for Payer: Meridian Medicaid |
$3,579.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,408.84
|
| Rate for Payer: UHC Medicaid |
$3,408.84
|
| Rate for Payer: UHCCP Medicaid |
$3,408.84
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$7,087.75
|
|
|
Service Code
|
APR-DRG 4653
|
| Min. Negotiated Rate |
$6,750.24 |
| Max. Negotiated Rate |
$7,087.75 |
| Rate for Payer: BCBS Complete |
$7,087.75
|
| Rate for Payer: Mclaren Medicaid |
$6,750.24
|
| Rate for Payer: Meridian Medicaid |
$7,087.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,750.24
|
| Rate for Payer: UHC Medicaid |
$6,750.24
|
| Rate for Payer: UHCCP Medicaid |
$6,750.24
|
|
