|
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTURE PATTERNS WHICH DISRUPT THE PELVIC RING, UNILATERAL OR BILATERAL, (INCLUDES ILIUM, SACROILIAC JOINT AND/OR SACRUM)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT G0413
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,051.74 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,084.15
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,156.91
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$1,051.74
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR OR TRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTERCONDYLAR EXTENSION
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 24538
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$787.50 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,391.26
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$866.25
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$787.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$392.93 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.22
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$392.93
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE) (EG, PINS OR SCREWS)
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$577.94 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.73
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$577.94
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.76 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$544.24
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$494.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$479.05 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,785.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$526.96
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$479.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS TRANSCATHETER CLOSURE OF THE LEFT ATRIAL APPENDAGE WITH ENDOCARDIAL IMPLANT, INCLUDING FLUOROSCOPY, TRANSSEPTAL PUNCTURE, CATHETER PLACEMENT(S), LEFT ATRIAL ANGIOGRAPHY, LEFT ATRIAL APPENDAGE ANGIOGRAPHY, WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$2,797.25
|
|
|
Service Code
|
CPT 33340
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$2,797.25 |
| Rate for Payer: BCBS Trust/PPO |
$2,797.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.67
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$747.88
|
|
|
PERCUTANEOUS TRANSCATHETER CLOSURE OF THE LEFT ATRIAL APPENDAGE WITH ENDOCARDIAL IMPLANT, INCLUDING FLUOROSCOPY, TRANSSEPTAL PUNCTURE, CATHETER PLACEMENT(S), LEFT ATRIAL ANGIOGRAPHY, LEFT ATRIAL APPENDAGE ANGIOGRAPHY, WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$2,797.25
|
|
|
Service Code
|
CPT 33340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$747.88 |
| Max. Negotiated Rate |
$2,797.25 |
| Rate for Payer: BCBS Trust/PPO |
$2,797.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.67
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$747.88
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S);
|
Facility
|
OP
|
$15,993.75
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$351.02 |
| Max. Negotiated Rate |
$15,993.75 |
| Rate for Payer: Aetna Medicare |
$5,283.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,350.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,350.66
|
| Rate for Payer: BCBS Complete |
$2,918.26
|
| Rate for Payer: BCBS MAPPO |
$5,080.53
|
| Rate for Payer: BCBS Trust/PPO |
$5,165.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,080.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,080.53
|
| Rate for Payer: Mclaren Medicaid |
$2,779.05
|
| Rate for Payer: Mclaren Medicare |
$5,080.53
|
| Rate for Payer: Meridian Medicaid |
$2,918.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,334.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,842.61
|
| Rate for Payer: PACE Medicare |
$4,826.50
|
| Rate for Payer: PACE SWMI |
$5,080.53
|
| Rate for Payer: PHP Medicare Advantage |
$5,080.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,779.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,993.75
|
| Rate for Payer: Priority Health Medicare |
$5,080.53
|
| Rate for Payer: Priority Health Narrow Network |
$12,795.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,080.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.12
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,080.53
|
| Rate for Payer: UHC Exchange |
$351.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,232.95
|
| Rate for Payer: VA VA |
$5,080.53
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENTING, AND ALL ANGIOPLASTY WITHIN THE PERIPHERAL DIALYSIS CIRCUIT
|
Facility
|
OP
|
$49,067.27
|
|
|
Service Code
|
CPT 36906
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$486.58 |
| Max. Negotiated Rate |
$49,067.27 |
| Rate for Payer: Aetna Medicare |
$16,210.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,483.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,483.22
|
| Rate for Payer: BCBS Complete |
$8,952.93
|
| Rate for Payer: BCBS MAPPO |
$15,586.58
|
| Rate for Payer: BCBS Trust/PPO |
$15,324.76
|
| Rate for Payer: BCN Medicare Advantage |
$15,586.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,586.58
|
| Rate for Payer: Mclaren Medicaid |
$8,525.86
|
| Rate for Payer: Mclaren Medicare |
$15,586.58
|
| Rate for Payer: Meridian Medicaid |
$8,952.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,365.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,924.57
|
| Rate for Payer: PACE Medicare |
$14,807.25
|
| Rate for Payer: PACE SWMI |
$15,586.58
|
| Rate for Payer: PHP Medicare Advantage |
$15,586.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,525.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49,067.27
|
| Rate for Payer: Priority Health Medicare |
$15,586.58
|
| Rate for Payer: Priority Health Narrow Network |
$39,253.82
|
| Rate for Payer: Railroad Medicare Medicare |
$15,586.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.24
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,586.58
|
| Rate for Payer: UHC Exchange |
$486.58
|
| Rate for Payer: UHC Medicare Advantage |
$16,054.18
|
| Rate for Payer: VA VA |
$15,586.58
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$421.42 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$9,788.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.56
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$421.42
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, VEIN(S), INCLUDING INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTIONS AND FLUOROSCOPIC GUIDANCE
|
Facility
|
OP
|
$30,783.77
|
|
|
Service Code
|
CPT 37187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.92 |
| Max. Negotiated Rate |
$30,783.77 |
| Rate for Payer: Aetna Medicare |
$10,169.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,223.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,223.36
|
| Rate for Payer: BCBS Complete |
$5,616.88
|
| Rate for Payer: BCBS MAPPO |
$9,778.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,674.03
|
| Rate for Payer: BCN Medicare Advantage |
$9,778.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,778.69
|
| Rate for Payer: Mclaren Medicaid |
$5,348.94
|
| Rate for Payer: Mclaren Medicare |
$9,778.69
|
| Rate for Payer: Meridian Medicaid |
$5,616.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,267.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,245.49
|
| Rate for Payer: PACE Medicare |
$9,289.76
|
| Rate for Payer: PACE SWMI |
$9,778.69
|
| Rate for Payer: PHP Medicare Advantage |
$9,778.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,348.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,783.77
|
| Rate for Payer: Priority Health Medicare |
$9,778.69
|
| Rate for Payer: Priority Health Narrow Network |
$24,627.02
|
| Rate for Payer: Railroad Medicare Medicare |
$9,778.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.41
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,778.69
|
| Rate for Payer: UHC Exchange |
$374.92
|
| Rate for Payer: UHC Medicare Advantage |
$10,072.05
|
| Rate for Payer: VA VA |
$9,778.69
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$12,699.49
|
|
|
Service Code
|
CPT 22515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$12,699.49 |
| Rate for Payer: BCBS Trust/PPO |
$12,699.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.32
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$211.20
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 22514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$464.31 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$6,194.45
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.74
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$464.31
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; THORACIC
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 22513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$498.04 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$6,115.77
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.84
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$498.04
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$10,666.11
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$701.71 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$5,105.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.88
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$701.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
PERINDOPRIL ERBUMINE 4 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
|
Service Code
|
NDC 0054-0111-25
|
| Hospital Charge Code |
13160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna American Axle |
$192.50
|
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.74
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.31
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| Rate for Payer: UMR Bronson Commercial |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.12
|
|
|
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.47 |
| Max. Negotiated Rate |
$8,748.29 |
| Rate for Payer: Aetna Medicare |
$2,890.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,583.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,748.29
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$6,998.63
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.52
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$270.47
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$45,636.78
|
|
|
Service Code
|
MS-DRG 041
|
| Min. Negotiated Rate |
$16,817.08 |
| Max. Negotiated Rate |
$45,636.78 |
| Rate for Payer: Aetna Medicare |
$18,410.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,127.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,127.74
|
| Rate for Payer: BCBS MAPPO |
$17,702.19
|
| Rate for Payer: BCBS Trust/PPO |
$45,636.78
|
| Rate for Payer: BCN Medicare Advantage |
$17,702.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,702.19
|
| Rate for Payer: Mclaren Medicare |
$17,702.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,587.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,357.52
|
| Rate for Payer: PACE Medicare |
$16,817.08
|
| Rate for Payer: PACE SWMI |
$17,702.19
|
| Rate for Payer: PHP Medicare Advantage |
$17,702.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,010.37
|
| Rate for Payer: Priority Health Medicare |
$17,702.19
|
| Rate for Payer: Priority Health Narrow Network |
$25,608.30
|
| Rate for Payer: Railroad Medicare Medicare |
$17,702.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,027.10
|
| Rate for Payer: UHC Core |
$27,901.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,702.19
|
| Rate for Payer: UHC Exchange |
$22,182.08
|
| Rate for Payer: UHC Medicare Advantage |
$18,233.26
|
| Rate for Payer: VA VA |
$17,702.19
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$65,305.25
|
|
|
Service Code
|
MS-DRG 040
|
| Min. Negotiated Rate |
$28,675.22 |
| Max. Negotiated Rate |
$65,305.25 |
| Rate for Payer: Aetna Medicare |
$31,391.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,730.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,730.55
|
| Rate for Payer: BCBS MAPPO |
$30,184.44
|
| Rate for Payer: BCBS Trust/PPO |
$65,305.25
|
| Rate for Payer: BCN Medicare Advantage |
$30,184.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,184.44
|
| Rate for Payer: Mclaren Medicare |
$30,184.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31,693.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,712.11
|
| Rate for Payer: PACE Medicare |
$28,675.22
|
| Rate for Payer: PACE SWMI |
$30,184.44
|
| Rate for Payer: PHP Medicare Advantage |
$30,184.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,254.37
|
| Rate for Payer: Priority Health Medicare |
$30,184.44
|
| Rate for Payer: Priority Health Narrow Network |
$44,203.50
|
| Rate for Payer: Railroad Medicare Medicare |
$30,184.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,735.53
|
| Rate for Payer: UHC Core |
$48,162.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,184.44
|
| Rate for Payer: UHC Exchange |
$38,289.37
|
| Rate for Payer: UHC Medicare Advantage |
$31,089.97
|
| Rate for Payer: VA VA |
$30,184.44
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,578.18
|
|
|
Service Code
|
MS-DRG 042
|
| Min. Negotiated Rate |
$13,223.34 |
| Max. Negotiated Rate |
$39,578.18 |
| Rate for Payer: Aetna Medicare |
$14,476.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,399.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,399.12
|
| Rate for Payer: BCBS MAPPO |
$13,919.30
|
| Rate for Payer: BCBS Trust/PPO |
$39,578.18
|
| Rate for Payer: BCN Medicare Advantage |
$13,919.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,919.30
|
| Rate for Payer: Mclaren Medicare |
$13,919.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,615.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,007.20
|
| Rate for Payer: PACE Medicare |
$13,223.34
|
| Rate for Payer: PACE SWMI |
$13,919.30
|
| Rate for Payer: PHP Medicare Advantage |
$13,919.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,965.99
|
| Rate for Payer: Priority Health Medicare |
$13,919.30
|
| Rate for Payer: Priority Health Narrow Network |
$19,972.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,919.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,538.91
|
| Rate for Payer: UHC Core |
$21,761.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,919.30
|
| Rate for Payer: UHC Exchange |
$17,300.57
|
| Rate for Payer: UHC Medicare Advantage |
$14,336.88
|
| Rate for Payer: VA VA |
$13,919.30
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$19,306.61
|
|
|
Service Code
|
MS-DRG 300
|
| Min. Negotiated Rate |
$8,297.96 |
| Max. Negotiated Rate |
$19,306.61 |
| Rate for Payer: Aetna Medicare |
$9,084.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,918.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,918.36
|
| Rate for Payer: BCBS MAPPO |
$8,734.69
|
| Rate for Payer: BCBS Trust/PPO |
$19,306.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,734.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,734.69
|
| Rate for Payer: Mclaren Medicare |
$8,734.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,171.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,044.89
|
| Rate for Payer: PACE Medicare |
$8,297.96
|
| Rate for Payer: PACE SWMI |
$8,734.69
|
| Rate for Payer: PHP Medicare Advantage |
$8,734.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,311.36
|
| Rate for Payer: Priority Health Medicare |
$8,734.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,249.09
|
| Rate for Payer: Railroad Medicare Medicare |
$8,734.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,276.02
|
| Rate for Payer: UHC Core |
$13,346.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,734.69
|
| Rate for Payer: UHC Exchange |
$10,610.25
|
| Rate for Payer: UHC Medicare Advantage |
$8,996.73
|
| Rate for Payer: VA VA |
$8,734.69
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$27,619.28
|
|
|
Service Code
|
MS-DRG 299
|
| Min. Negotiated Rate |
$12,025.67 |
| Max. Negotiated Rate |
$27,619.28 |
| Rate for Payer: Aetna Medicare |
$13,164.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,823.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,823.25
|
| Rate for Payer: BCBS MAPPO |
$12,658.60
|
| Rate for Payer: BCBS Trust/PPO |
$27,619.28
|
| Rate for Payer: BCN Medicare Advantage |
$12,658.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,658.60
|
| Rate for Payer: Mclaren Medicare |
$12,658.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,291.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,557.39
|
| Rate for Payer: PACE Medicare |
$12,025.67
|
| Rate for Payer: PACE SWMI |
$12,658.60
|
| Rate for Payer: PHP Medicare Advantage |
$12,658.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,618.34
|
| Rate for Payer: Priority Health Medicare |
$12,658.60
|
| Rate for Payer: Priority Health Narrow Network |
$18,094.67
|
| Rate for Payer: Railroad Medicare Medicare |
$12,658.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,043.35
|
| Rate for Payer: UHC Core |
$19,715.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,658.60
|
| Rate for Payer: UHC Exchange |
$15,673.73
|
| Rate for Payer: UHC Medicare Advantage |
$13,038.36
|
| Rate for Payer: VA VA |
$12,658.60
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$16,059.94
|
|
|
Service Code
|
MS-DRG 301
|
| Min. Negotiated Rate |
$5,682.99 |
| Max. Negotiated Rate |
$16,059.94 |
| Rate for Payer: Aetna Medicare |
$6,221.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,477.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,477.61
|
| Rate for Payer: BCBS MAPPO |
$5,982.09
|
| Rate for Payer: BCBS Trust/PPO |
$16,059.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,982.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,982.09
|
| Rate for Payer: Mclaren Medicare |
$5,982.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,281.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,879.40
|
| Rate for Payer: PACE Medicare |
$5,682.99
|
| Rate for Payer: PACE SWMI |
$5,982.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,982.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,185.57
|
| Rate for Payer: Priority Health Medicare |
$5,982.09
|
| Rate for Payer: Priority Health Narrow Network |
$8,148.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5,982.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,827.29
|
| Rate for Payer: UHC Core |
$8,878.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,982.09
|
| Rate for Payer: UHC Exchange |
$7,058.25
|
| Rate for Payer: UHC Medicare Advantage |
$6,161.55
|
| Rate for Payer: VA VA |
$5,982.09
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$118.65
|
|
|
Service Code
|
NDC 49230-206-94
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna American Axle |
$77.12
|
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| Rate for Payer: Cofinity Commercial |
$83.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$94.92
|
| Rate for Payer: Healthscope Commercial |
$106.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$88.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$100.85
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.06
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.99
|
|
