|
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 44394
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.07
|
| Rate for Payer: BCN Commercial |
$1,041.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$1,192.34
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT G0105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$948.50
|
| Rate for Payer: BCN Commercial |
$948.50
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT G0121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$948.50
|
| Rate for Payer: BCN Commercial |
$948.50
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT G0104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$948.50
|
| Rate for Payer: BCN Commercial |
$948.50
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$926.61
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
COLPOCLEISIS (LE FORT TYPE)
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,445.99
|
| Rate for Payer: BCN Commercial |
$4,445.99
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$8,137.36
|
| Rate for Payer: BCN Commercial |
$8,137.36
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$7,388.77
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$8,738.65
|
| Rate for Payer: BCN Commercial |
$8,738.65
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$7,388.77
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,794.09
|
| Rate for Payer: BCN Commercial |
$1,794.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;
|
Facility
|
OP
|
$651.46
|
|
|
Service Code
|
CPT 57452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$197.94
|
| Rate for Payer: BCCCP Commercial |
$122.41
|
| Rate for Payer: BCN Commercial |
$197.94
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$284.21
|
| Rate for Payer: BCCCP Commercial |
$164.88
|
| Rate for Payer: BCN Commercial |
$284.21
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$295.08 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.18
|
| Rate for Payer: BCCCP Commercial |
$295.08
|
| Rate for Payer: BCN Commercial |
$3,831.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$331.06 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.18
|
| Rate for Payer: BCCCP Commercial |
$331.06
|
| Rate for Payer: BCN Commercial |
$3,831.18
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
COLPOSCOPY OF THE VULVA; WITH BIOPSY(S)
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 56821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.69 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$106.69
|
| Rate for Payer: BCN Commercial |
$106.69
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$156,179.72
|
|
|
Service Code
|
MSDRG 429
|
| Min. Negotiated Rate |
$72,140.61 |
| Max. Negotiated Rate |
$156,179.72 |
| Rate for Payer: Aetna Medicare |
$78,974.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94,921.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94,921.85
|
| Rate for Payer: BCBS MAPPO |
$75,937.48
|
| Rate for Payer: BCBS Trust/PPO |
$156,179.72
|
| Rate for Payer: BCN Commercial |
$156,179.72
|
| Rate for Payer: BCN Medicare Advantage |
$75,937.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75,937.48
|
| Rate for Payer: Mclaren Medicare |
$75,937.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79,734.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87,328.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$83,531.23
|
| Rate for Payer: Nomi Health Commercial |
$116,223.84
|
| Rate for Payer: PACE Medicare |
$72,140.61
|
| Rate for Payer: PACE SWMI |
$75,937.48
|
| Rate for Payer: PHP Medicare Advantage |
$75,937.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145,254.03
|
| Rate for Payer: Priority Health Medicare |
$75,937.48
|
| Rate for Payer: Priority Health Tiered Network |
$116,203.21
|
| Rate for Payer: Railroad Medicare Medicare |
$75,937.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146,856.48
|
| Rate for Payer: UHC Core |
$122,863.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75,937.48
|
| Rate for Payer: UHC Exchange |
$100,339.92
|
| Rate for Payer: VA VA |
$75,937.48
|
|
|
COMBINED ANTERIOR AND POSTERIOR CERVICAL SPINAL FUSION WITHOUT MCC
|
Facility
|
IP
|
$109,779.29
|
|
|
Service Code
|
MSDRG 430
|
| Min. Negotiated Rate |
$46,380.40 |
| Max. Negotiated Rate |
$109,779.29 |
| Rate for Payer: Aetna Medicare |
$50,774.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61,026.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61,026.84
|
| Rate for Payer: BCBS MAPPO |
$48,821.47
|
| Rate for Payer: BCBS Trust/PPO |
$109,779.29
|
| Rate for Payer: BCN Commercial |
$109,779.29
|
| Rate for Payer: BCN Medicare Advantage |
$48,821.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48,821.47
|
| Rate for Payer: Mclaren Medicare |
$48,821.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51,262.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56,144.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$53,703.62
|
| Rate for Payer: Nomi Health Commercial |
$74,395.59
|
| Rate for Payer: PACE Medicare |
$46,380.40
|
| Rate for Payer: PACE SWMI |
$48,821.47
|
| Rate for Payer: PHP Medicare Advantage |
$48,821.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92,977.99
|
| Rate for Payer: Priority Health Medicare |
$48,821.47
|
| Rate for Payer: Priority Health Tiered Network |
$74,382.38
|
| Rate for Payer: Railroad Medicare Medicare |
$48,821.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94,003.73
|
| Rate for Payer: UHC Core |
$78,645.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48,821.47
|
| Rate for Payer: UHC Exchange |
$64,228.19
|
| Rate for Payer: VA VA |
$48,821.47
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$7,358.19
|
| Rate for Payer: BCN Commercial |
$7,358.19
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$16,119.31
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,606.87 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$3,766.66
|
| Rate for Payer: BCN Commercial |
$3,766.66
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: VA VA |
$4,984.46
|
|
|
COMPLEX AORTIC ARCH PROCEDURES
|
Facility
|
IP
|
$263,867.25
|
|
|
Service Code
|
MSDRG 209
|
| Min. Negotiated Rate |
$90,486.20 |
| Max. Negotiated Rate |
$263,867.25 |
| Rate for Payer: Aetna Medicare |
$99,058.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119,060.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119,060.79
|
| Rate for Payer: BCBS MAPPO |
$95,248.63
|
| Rate for Payer: BCBS Trust/PPO |
$263,867.25
|
| Rate for Payer: BCN Commercial |
$263,867.25
|
| Rate for Payer: BCN Medicare Advantage |
$95,248.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95,248.63
|
| Rate for Payer: Mclaren Medicare |
$95,248.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100,011.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109,535.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$104,773.49
|
| Rate for Payer: Nomi Health Commercial |
$146,012.52
|
| Rate for Payer: PACE Medicare |
$90,486.20
|
| Rate for Payer: PACE SWMI |
$95,248.63
|
| Rate for Payer: PHP Medicare Advantage |
$95,248.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$182,483.28
|
| Rate for Payer: Priority Health Medicare |
$95,248.63
|
| Rate for Payer: Priority Health Tiered Network |
$145,986.60
|
| Rate for Payer: Railroad Medicare Medicare |
$95,248.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184,496.44
|
| Rate for Payer: UHC Core |
$154,354.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95,248.63
|
| Rate for Payer: UHC Exchange |
$126,057.48
|
| Rate for Payer: VA VA |
$95,248.63
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$20,132.56
|
|
|
Service Code
|
MSDRG 381
|
| Min. Negotiated Rate |
$9,171.23 |
| Max. Negotiated Rate |
$20,132.56 |
| Rate for Payer: Aetna Medicare |
$10,040.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,067.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,067.41
|
| Rate for Payer: BCBS MAPPO |
$9,653.93
|
| Rate for Payer: BCBS Trust/PPO |
$20,132.56
|
| Rate for Payer: BCN Commercial |
$20,132.56
|
| Rate for Payer: BCN Medicare Advantage |
$9,653.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,653.93
|
| Rate for Payer: Mclaren Medicare |
$9,653.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,136.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,102.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,619.32
|
| Rate for Payer: Nomi Health Commercial |
$13,977.15
|
| Rate for Payer: PACE Medicare |
$9,171.23
|
| Rate for Payer: PACE SWMI |
$9,653.93
|
| Rate for Payer: PHP Medicare Advantage |
$9,653.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,468.34
|
| Rate for Payer: Priority Health Medicare |
$9,653.93
|
| Rate for Payer: Priority Health Tiered Network |
$13,974.67
|
| Rate for Payer: Railroad Medicare Medicare |
$9,653.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,661.05
|
| Rate for Payer: UHC Core |
$14,775.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,653.93
|
| Rate for Payer: UHC Exchange |
$12,066.94
|
| Rate for Payer: VA VA |
$9,653.93
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$43,817.29
|
|
|
Service Code
|
MSDRG 380
|
| Min. Negotiated Rate |
$16,152.13 |
| Max. Negotiated Rate |
$43,817.29 |
| Rate for Payer: Aetna Medicare |
$17,682.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,252.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,252.80
|
| Rate for Payer: BCBS MAPPO |
$17,002.24
|
| Rate for Payer: BCBS Trust/PPO |
$43,817.29
|
| Rate for Payer: BCN Commercial |
$43,817.29
|
| Rate for Payer: BCN Medicare Advantage |
$17,002.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,002.24
|
| Rate for Payer: Mclaren Medicare |
$17,002.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17,852.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,552.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$18,702.46
|
| Rate for Payer: Nomi Health Commercial |
$25,312.38
|
| Rate for Payer: PACE Medicare |
$16,152.13
|
| Rate for Payer: PACE SWMI |
$17,002.24
|
| Rate for Payer: PHP Medicare Advantage |
$17,002.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31,634.86
|
| Rate for Payer: Priority Health Medicare |
$17,002.24
|
| Rate for Payer: Priority Health Tiered Network |
$25,307.89
|
| Rate for Payer: Railroad Medicare Medicare |
$17,002.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,983.86
|
| Rate for Payer: UHC Core |
$26,758.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,002.24
|
| Rate for Payer: UHC Exchange |
$21,853.02
|
| Rate for Payer: VA VA |
$17,002.24
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$16,440.40
|
|
|
Service Code
|
MSDRG 382
|
| Min. Negotiated Rate |
$6,923.73 |
| Max. Negotiated Rate |
$16,440.40 |
| Rate for Payer: Aetna Medicare |
$7,579.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,110.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,110.17
|
| Rate for Payer: BCBS MAPPO |
$7,288.14
|
| Rate for Payer: BCBS Trust/PPO |
$16,440.40
|
| Rate for Payer: BCN Commercial |
$16,440.40
|
| Rate for Payer: BCN Medicare Advantage |
$7,288.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,288.14
|
| Rate for Payer: Mclaren Medicare |
$7,288.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,652.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,381.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,016.95
|
| Rate for Payer: Nomi Health Commercial |
$10,327.74
|
| Rate for Payer: PACE Medicare |
$6,923.73
|
| Rate for Payer: PACE SWMI |
$7,288.14
|
| Rate for Payer: PHP Medicare Advantage |
$7,288.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,907.39
|
| Rate for Payer: Priority Health Medicare |
$7,288.14
|
| Rate for Payer: Priority Health Tiered Network |
$10,325.91
|
| Rate for Payer: Railroad Medicare Medicare |
$7,288.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,049.78
|
| Rate for Payer: UHC Core |
$10,917.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,288.14
|
| Rate for Payer: UHC Exchange |
$8,916.28
|
| Rate for Payer: VA VA |
$7,288.14
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$22,268.25
|
|
|
Service Code
|
MSDRG 920
|
| Min. Negotiated Rate |
$8,526.16 |
| Max. Negotiated Rate |
$22,268.25 |
| Rate for Payer: Aetna Medicare |
$9,333.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,218.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,218.62
|
| Rate for Payer: BCBS MAPPO |
$8,974.90
|
| Rate for Payer: BCBS Trust/PPO |
$22,268.25
|
| Rate for Payer: BCN Commercial |
$22,268.25
|
| Rate for Payer: BCN Medicare Advantage |
$8,974.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,974.90
|
| Rate for Payer: Mclaren Medicare |
$8,974.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,423.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,321.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,872.39
|
| Rate for Payer: Nomi Health Commercial |
$12,929.67
|
| Rate for Payer: PACE Medicare |
$8,526.16
|
| Rate for Payer: PACE SWMI |
$8,974.90
|
| Rate for Payer: PHP Medicare Advantage |
$8,974.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,159.22
|
| Rate for Payer: Priority Health Medicare |
$8,974.90
|
| Rate for Payer: Priority Health Tiered Network |
$12,927.37
|
| Rate for Payer: Railroad Medicare Medicare |
$8,974.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,337.49
|
| Rate for Payer: UHC Core |
$13,668.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,974.90
|
| Rate for Payer: UHC Exchange |
$11,162.62
|
| Rate for Payer: VA VA |
$8,974.90
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$39,386.69
|
|
|
Service Code
|
MSDRG 919
|
| Min. Negotiated Rate |
$15,108.22 |
| Max. Negotiated Rate |
$39,386.69 |
| Rate for Payer: Aetna Medicare |
$16,539.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,879.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,879.24
|
| Rate for Payer: BCBS MAPPO |
$15,903.39
|
| Rate for Payer: BCBS Trust/PPO |
$39,386.69
|
| Rate for Payer: BCN Commercial |
$39,386.69
|
| Rate for Payer: BCN Medicare Advantage |
$15,903.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,903.39
|
| Rate for Payer: Mclaren Medicare |
$15,903.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,698.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,288.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,493.73
|
| Rate for Payer: Nomi Health Commercial |
$23,617.32
|
| Rate for Payer: PACE Medicare |
$15,108.22
|
| Rate for Payer: PACE SWMI |
$15,903.39
|
| Rate for Payer: PHP Medicare Advantage |
$15,903.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,516.41
|
| Rate for Payer: Priority Health Medicare |
$15,903.39
|
| Rate for Payer: Priority Health Tiered Network |
$23,613.13
|
| Rate for Payer: Railroad Medicare Medicare |
$15,903.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,842.04
|
| Rate for Payer: UHC Core |
$24,966.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,903.39
|
| Rate for Payer: UHC Exchange |
$20,389.62
|
| Rate for Payer: VA VA |
$15,903.39
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$16,478.84
|
|
|
Service Code
|
MSDRG 921
|
| Min. Negotiated Rate |
$6,032.36 |
| Max. Negotiated Rate |
$16,478.84 |
| Rate for Payer: Aetna Medicare |
$6,603.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.31
|
| Rate for Payer: BCBS MAPPO |
$6,349.85
|
| Rate for Payer: BCBS Trust/PPO |
$16,478.84
|
| Rate for Payer: BCN Commercial |
$16,478.84
|
| Rate for Payer: BCN Medicare Advantage |
$6,349.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,349.85
|
| Rate for Payer: Mclaren Medicare |
$6,349.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,984.84
|
| Rate for Payer: Nomi Health Commercial |
$8,880.36
|
| Rate for Payer: PACE Medicare |
$6,032.36
|
| Rate for Payer: PACE SWMI |
$6,349.85
|
| Rate for Payer: PHP Medicare Advantage |
$6,349.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,098.48
|
| Rate for Payer: Priority Health Medicare |
$6,349.85
|
| Rate for Payer: Priority Health Tiered Network |
$8,878.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6,349.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,220.92
|
| Rate for Payer: UHC Core |
$9,387.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,349.85
|
| Rate for Payer: UHC Exchange |
$7,666.71
|
| Rate for Payer: VA VA |
$6,349.85
|
|
|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
IP
|
$187.31
|
|
|
Service Code
|
NDC 00395009016
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.42 |
| Max. Negotiated Rate |
$168.58 |
| Rate for Payer: Aetna American Axle |
$121.75
|
| Rate for Payer: Aetna Commercial |
$159.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.75
|
| Rate for Payer: Cash Price |
$149.85
|
| Rate for Payer: Cofinity Advantage |
$131.12
|
| Rate for Payer: Cofinity Commercial |
$161.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.85
|
| Rate for Payer: Healthscope Commercial |
$168.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.48
|
| Rate for Payer: PHP Commercial |
$159.21
|
| Rate for Payer: Priority Health SBD |
$118.01
|
| Rate for Payer: UMR Bronson Commercial |
$82.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.48
|
|
