|
COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL)
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$390.31 |
| 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) |
$429.34
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$390.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
COLPOPEXY, VAGINAL; EXTRA-PERITONEAL APPROACH (SACROSPINOUS, ILIOCOCCYGEUS)
|
Facility
|
OP
|
$21,144.90
|
|
|
Service Code
|
CPT 57282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$685.01 |
| Max. Negotiated Rate |
$21,144.90 |
| Rate for Payer: Aetna Medicare |
$6,985.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,396.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,396.05
|
| Rate for Payer: BCBS Complete |
$3,858.15
|
| Rate for Payer: BCBS MAPPO |
$6,716.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,422.21
|
| Rate for Payer: BCN Medicare Advantage |
$6,716.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,716.84
|
| Rate for Payer: Mclaren Medicaid |
$3,674.11
|
| Rate for Payer: Mclaren Medicare |
$6,716.84
|
| Rate for Payer: Meridian Medicaid |
$3,858.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,052.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,724.37
|
| Rate for Payer: PACE Medicare |
$6,381.00
|
| Rate for Payer: PACE SWMI |
$6,716.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,716.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,674.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,144.90
|
| Rate for Payer: Priority Health Medicare |
$6,716.84
|
| Rate for Payer: Priority Health Narrow Network |
$16,915.92
|
| Rate for Payer: Railroad Medicare Medicare |
$6,716.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$753.51
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,716.84
|
| Rate for Payer: UHC Exchange |
$685.01
|
| Rate for Payer: UHC Medicare Advantage |
$6,918.35
|
| Rate for Payer: VA VA |
$6,716.84
|
|
|
COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY)
|
Facility
|
OP
|
$21,144.90
|
|
|
Service Code
|
CPT 57283
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$21,144.90 |
| Rate for Payer: Aetna Medicare |
$6,985.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,396.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,396.05
|
| Rate for Payer: BCBS Complete |
$3,858.15
|
| Rate for Payer: BCBS MAPPO |
$6,716.84
|
| Rate for Payer: BCBS Trust/PPO |
$6,896.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,716.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,716.84
|
| Rate for Payer: Mclaren Medicaid |
$3,674.11
|
| Rate for Payer: Mclaren Medicare |
$6,716.84
|
| Rate for Payer: Meridian Medicaid |
$3,858.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,052.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,724.37
|
| Rate for Payer: PACE Medicare |
$6,381.00
|
| Rate for Payer: PACE SWMI |
$6,716.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,716.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,674.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,144.90
|
| Rate for Payer: Priority Health Medicare |
$6,716.84
|
| Rate for Payer: Priority Health Narrow Network |
$16,915.92
|
| Rate for Payer: Railroad Medicare Medicare |
$6,716.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.91
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,716.84
|
| Rate for Payer: UHC Exchange |
$689.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,918.35
|
| Rate for Payer: VA VA |
$6,716.84
|
|
|
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.39 |
| 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 |
$1,415.94
|
| 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) |
$363.43
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$330.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA;
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 57452
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$89.39 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$156.22
|
| Rate for Payer: BCCCP Commercial |
$134.56
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.61
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$446.09
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.33
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Exchange |
$89.39
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH BIOPSY(S) OF THE CERVIX AND ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$897.69
|
|
|
Service Code
|
CPT 57454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.30 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$224.31
|
| Rate for Payer: BCCCP Commercial |
$179.90
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.43
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$131.30
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE
|
Facility
|
OP
|
$897.69
|
|
|
Service Code
|
CPT 57456
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$200.42
|
| Rate for Payer: BCCCP Commercial |
$161.36
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.13
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$99.21
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE BIOPSY(S) OF THE CERVIX
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$156.52 |
| 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 |
$3,023.66
|
| Rate for Payer: BCCCP Commercial |
$331.36
|
| 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) |
$172.17
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$156.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH LOOP ELECTRODE CONIZATION OF THE CERVIX
|
Facility
|
OP
|
$8,748.29
|
|
|
Service Code
|
CPT 57461
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.11 |
| 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 |
$3,023.66
|
| Rate for Payer: BCCCP Commercial |
$370.46
|
| 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) |
$197.02
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,778.95
|
| Rate for Payer: UHC Exchange |
$179.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT;
|
Facility
|
OP
|
$897.69
|
|
|
Service Code
|
CPT 57420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$897.69 |
| Rate for Payer: Aetna Medicare |
$296.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.45
|
| Rate for Payer: BCBS Complete |
$163.80
|
| Rate for Payer: BCBS MAPPO |
$285.16
|
| Rate for Payer: BCBS Trust/PPO |
$68.36
|
| Rate for Payer: BCN Medicare Advantage |
$285.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.16
|
| Rate for Payer: Mclaren Medicaid |
$155.98
|
| Rate for Payer: Mclaren Medicare |
$285.16
|
| Rate for Payer: Meridian Medicaid |
$163.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.93
|
| Rate for Payer: PACE Medicare |
$270.90
|
| Rate for Payer: PACE SWMI |
$285.16
|
| Rate for Payer: PHP Medicare Advantage |
$285.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.69
|
| Rate for Payer: Priority Health Medicare |
$285.16
|
| Rate for Payer: Priority Health Narrow Network |
$718.15
|
| Rate for Payer: Railroad Medicare Medicare |
$285.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.89
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.16
|
| Rate for Payer: UHC Exchange |
$88.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.71
|
| Rate for Payer: VA VA |
$285.16
|
|
|
COLPOSCOPY OF THE ENTIRE VAGINA, WITH CERVIX IF PRESENT; WITH BIOPSY(S) OF VAGINA/CERVIX
|
Facility
|
OP
|
$2,249.54
|
|
|
Service Code
|
CPT 57421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$119.52 |
| Max. Negotiated Rate |
$2,249.54 |
| Rate for Payer: Aetna Medicare |
$743.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$893.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$893.22
|
| Rate for Payer: BCBS Complete |
$410.45
|
| Rate for Payer: BCBS MAPPO |
$714.58
|
| Rate for Payer: BCBS Trust/PPO |
$752.29
|
| Rate for Payer: BCN Medicare Advantage |
$714.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.58
|
| Rate for Payer: Mclaren Medicaid |
$390.88
|
| Rate for Payer: Mclaren Medicare |
$714.58
|
| Rate for Payer: Meridian Medicaid |
$410.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$750.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$821.77
|
| Rate for Payer: PACE Medicare |
$678.85
|
| Rate for Payer: PACE SWMI |
$714.58
|
| Rate for Payer: PHP Medicare Advantage |
$714.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,249.54
|
| Rate for Payer: Priority Health Medicare |
$714.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,799.63
|
| Rate for Payer: Railroad Medicare Medicare |
$714.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.47
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.58
|
| Rate for Payer: UHC Exchange |
$119.52
|
| Rate for Payer: UHC Medicare Advantage |
$736.02
|
| Rate for Payer: VA VA |
$714.58
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC
|
Facility
|
IP
|
$93,298.04
|
|
|
Service Code
|
MS-DRG 454
|
| Min. Negotiated Rate |
$45,262.52 |
| Max. Negotiated Rate |
$93,298.04 |
| Rate for Payer: Aetna Medicare |
$49,550.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59,555.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59,555.95
|
| Rate for Payer: BCBS MAPPO |
$47,644.76
|
| Rate for Payer: BCBS Trust/PPO |
$86,458.84
|
| Rate for Payer: BCN Medicare Advantage |
$47,644.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,644.76
|
| Rate for Payer: Mclaren Medicare |
$47,644.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50,027.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,791.47
|
| Rate for Payer: PACE Medicare |
$45,262.52
|
| Rate for Payer: PACE SWMI |
$47,644.76
|
| Rate for Payer: PHP Medicare Advantage |
$47,644.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87,768.42
|
| Rate for Payer: Priority Health Medicare |
$47,644.76
|
| Rate for Payer: Priority Health Narrow Network |
$70,214.74
|
| Rate for Payer: Railroad Medicare Medicare |
$47,644.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93,298.04
|
| Rate for Payer: UHC Core |
$76,502.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$47,644.76
|
| Rate for Payer: UHC Exchange |
$60,820.49
|
| Rate for Payer: UHC Medicare Advantage |
$49,074.10
|
| Rate for Payer: VA VA |
$47,644.76
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$135,171.80
|
|
|
Service Code
|
MS-DRG 453
|
| Min. Negotiated Rate |
$65,358.68 |
| Max. Negotiated Rate |
$135,171.80 |
| Rate for Payer: Aetna Medicare |
$71,550.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85,998.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85,998.26
|
| Rate for Payer: BCBS MAPPO |
$68,798.61
|
| Rate for Payer: BCBS Trust/PPO |
$126,416.46
|
| Rate for Payer: BCN Medicare Advantage |
$68,798.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68,798.61
|
| Rate for Payer: Mclaren Medicare |
$68,798.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$72,238.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79,118.40
|
| Rate for Payer: PACE Medicare |
$65,358.68
|
| Rate for Payer: PACE SWMI |
$68,798.61
|
| Rate for Payer: PHP Medicare Advantage |
$68,798.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127,160.38
|
| Rate for Payer: Priority Health Medicare |
$68,798.61
|
| Rate for Payer: Priority Health Narrow Network |
$101,728.30
|
| Rate for Payer: Railroad Medicare Medicare |
$68,798.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135,171.80
|
| Rate for Payer: UHC Core |
$110,838.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$68,798.61
|
| Rate for Payer: UHC Exchange |
$88,117.76
|
| Rate for Payer: UHC Medicare Advantage |
$70,862.57
|
| Rate for Payer: VA VA |
$68,798.61
|
|
|
COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$71,135.17
|
|
|
Service Code
|
MS-DRG 455
|
| Min. Negotiated Rate |
$34,203.09 |
| Max. Negotiated Rate |
$71,135.17 |
| Rate for Payer: Aetna Medicare |
$37,443.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45,004.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45,004.06
|
| Rate for Payer: BCBS MAPPO |
$36,003.25
|
| Rate for Payer: BCBS Trust/PPO |
$71,135.17
|
| Rate for Payer: BCN Medicare Advantage |
$36,003.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36,003.25
|
| Rate for Payer: Mclaren Medicare |
$36,003.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37,803.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41,403.74
|
| Rate for Payer: PACE Medicare |
$34,203.09
|
| Rate for Payer: PACE SWMI |
$36,003.25
|
| Rate for Payer: PHP Medicare Advantage |
$36,003.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,089.99
|
| Rate for Payer: Priority Health Medicare |
$36,003.25
|
| Rate for Payer: Priority Health Narrow Network |
$52,871.99
|
| Rate for Payer: Railroad Medicare Medicare |
$36,003.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70,253.82
|
| Rate for Payer: UHC Core |
$57,606.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$36,003.25
|
| Rate for Payer: UHC Exchange |
$45,798.09
|
| Rate for Payer: UHC Medicare Advantage |
$37,083.35
|
| Rate for Payer: VA VA |
$36,003.25
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED;
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 57260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$768.51 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,807.27
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.36
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$768.51
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
COMBINED ANTEROPOSTERIOR COLPORRHAPHY, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED; WITH ENTEROCELE REPAIR
|
Facility
|
OP
|
$13,918.15
|
|
|
Service Code
|
CPT 57265
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$859.21 |
| Max. Negotiated Rate |
$13,918.15 |
| Rate for Payer: Aetna Medicare |
$4,598.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,526.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,526.50
|
| Rate for Payer: BCBS Complete |
$2,539.54
|
| Rate for Payer: BCBS MAPPO |
$4,421.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,972.74
|
| Rate for Payer: BCN Medicare Advantage |
$4,421.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,421.20
|
| Rate for Payer: Mclaren Medicaid |
$2,418.40
|
| Rate for Payer: Mclaren Medicare |
$4,421.20
|
| Rate for Payer: Meridian Medicaid |
$2,539.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,642.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,084.38
|
| Rate for Payer: PACE Medicare |
$4,200.14
|
| Rate for Payer: PACE SWMI |
$4,421.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,421.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,418.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,918.15
|
| Rate for Payer: Priority Health Medicare |
$4,421.20
|
| Rate for Payer: Priority Health Narrow Network |
$11,134.52
|
| Rate for Payer: Railroad Medicare Medicare |
$4,421.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.13
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,421.20
|
| Rate for Payer: UHC Exchange |
$859.21
|
| Rate for Payer: UHC Medicare Advantage |
$4,553.84
|
| Rate for Payer: VA VA |
$4,421.20
|
|
|
COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE
|
Facility
|
OP
|
$1,911.48
|
|
|
Service Code
|
CPT 51728
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.57 |
| Max. Negotiated Rate |
$1,911.48 |
| Rate for Payer: Aetna Medicare |
$631.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$759.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$759.00
|
| Rate for Payer: BCBS Complete |
$348.78
|
| Rate for Payer: BCBS MAPPO |
$607.20
|
| Rate for Payer: BCBS Trust/PPO |
$267.57
|
| Rate for Payer: BCN Medicare Advantage |
$607.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.20
|
| Rate for Payer: Mclaren Medicaid |
$332.14
|
| Rate for Payer: Mclaren Medicare |
$607.20
|
| Rate for Payer: Meridian Medicaid |
$348.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$698.28
|
| Rate for Payer: PACE Medicare |
$576.84
|
| Rate for Payer: PACE SWMI |
$607.20
|
| Rate for Payer: PHP Medicare Advantage |
$607.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.48
|
| Rate for Payer: Priority Health Medicare |
$607.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,529.18
|
| Rate for Payer: Railroad Medicare Medicare |
$607.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.96
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.20
|
| Rate for Payer: UHC Exchange |
$357.24
|
| Rate for Payer: UHC Medicare Advantage |
$625.42
|
| Rate for Payer: VA VA |
$607.20
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
|
IP
|
$18,429.61
|
|
|
Service Code
|
MS-DRG 381
|
| Min. Negotiated Rate |
$8,341.86 |
| Max. Negotiated Rate |
$18,429.61 |
| Rate for Payer: Aetna Medicare |
$9,132.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,976.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,976.14
|
| Rate for Payer: BCBS MAPPO |
$8,780.91
|
| Rate for Payer: BCBS Trust/PPO |
$18,429.61
|
| Rate for Payer: BCN Medicare Advantage |
$8,780.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,780.91
|
| Rate for Payer: Mclaren Medicare |
$8,780.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,219.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,098.05
|
| Rate for Payer: PACE Medicare |
$8,341.86
|
| Rate for Payer: PACE SWMI |
$8,780.91
|
| Rate for Payer: PHP Medicare Advantage |
$8,780.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,397.46
|
| Rate for Payer: Priority Health Medicare |
$8,780.91
|
| Rate for Payer: Priority Health Narrow Network |
$12,317.97
|
| Rate for Payer: Railroad Medicare Medicare |
$8,780.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,367.54
|
| Rate for Payer: UHC Core |
$13,421.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,780.91
|
| Rate for Payer: UHC Exchange |
$10,669.91
|
| Rate for Payer: UHC Medicare Advantage |
$9,044.34
|
| Rate for Payer: VA VA |
$8,780.91
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$40,110.91
|
|
|
Service Code
|
MS-DRG 380
|
| Min. Negotiated Rate |
$14,751.18 |
| Max. Negotiated Rate |
$40,110.91 |
| Rate for Payer: Aetna Medicare |
$16,148.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,409.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,409.45
|
| Rate for Payer: BCBS MAPPO |
$15,527.56
|
| Rate for Payer: BCBS Trust/PPO |
$40,110.91
|
| Rate for Payer: BCN Medicare Advantage |
$15,527.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,527.56
|
| Rate for Payer: Mclaren Medicare |
$15,527.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,303.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,856.69
|
| Rate for Payer: PACE Medicare |
$14,751.18
|
| Rate for Payer: PACE SWMI |
$15,527.56
|
| Rate for Payer: PHP Medicare Advantage |
$15,527.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,960.82
|
| Rate for Payer: Priority Health Medicare |
$15,527.56
|
| Rate for Payer: Priority Health Narrow Network |
$22,368.66
|
| Rate for Payer: Railroad Medicare Medicare |
$15,527.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,722.42
|
| Rate for Payer: UHC Core |
$24,371.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,527.56
|
| Rate for Payer: UHC Exchange |
$19,375.88
|
| Rate for Payer: UHC Medicare Advantage |
$15,993.39
|
| Rate for Payer: VA VA |
$15,527.56
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
|
IP
|
$15,049.76
|
|
|
Service Code
|
MS-DRG 382
|
| Min. Negotiated Rate |
$6,029.24 |
| Max. Negotiated Rate |
$15,049.76 |
| Rate for Payer: Aetna Medicare |
$6,600.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,933.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,933.21
|
| Rate for Payer: BCBS MAPPO |
$6,346.57
|
| Rate for Payer: BCBS Trust/PPO |
$15,049.76
|
| Rate for Payer: BCN Medicare Advantage |
$6,346.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,346.57
|
| Rate for Payer: Mclaren Medicare |
$6,346.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,663.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,298.56
|
| Rate for Payer: PACE Medicare |
$6,029.24
|
| Rate for Payer: PACE SWMI |
$6,346.57
|
| Rate for Payer: PHP Medicare Advantage |
$6,346.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,864.32
|
| Rate for Payer: Priority Health Medicare |
$6,346.57
|
| Rate for Payer: Priority Health Narrow Network |
$8,691.46
|
| Rate for Payer: Railroad Medicare Medicare |
$6,346.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,548.80
|
| Rate for Payer: UHC Core |
$9,469.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,346.57
|
| Rate for Payer: UHC Exchange |
$7,528.60
|
| Rate for Payer: UHC Medicare Advantage |
$6,536.97
|
| Rate for Payer: VA VA |
$6,346.57
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
|
IP
|
$20,384.64
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$8,054.91 |
| Max. Negotiated Rate |
$20,384.64 |
| Rate for Payer: Aetna Medicare |
$8,818.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,598.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,598.56
|
| Rate for Payer: BCBS MAPPO |
$8,478.85
|
| Rate for Payer: BCBS Trust/PPO |
$20,384.64
|
| Rate for Payer: BCN Medicare Advantage |
$8,478.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,478.85
|
| Rate for Payer: Mclaren Medicare |
$8,478.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,902.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,750.68
|
| Rate for Payer: PACE Medicare |
$8,054.91
|
| Rate for Payer: PACE SWMI |
$8,478.85
|
| Rate for Payer: PHP Medicare Advantage |
$8,478.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,834.95
|
| Rate for Payer: Priority Health Medicare |
$8,478.85
|
| Rate for Payer: Priority Health Narrow Network |
$11,867.96
|
| Rate for Payer: Railroad Medicare Medicare |
$8,478.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,769.59
|
| Rate for Payer: UHC Core |
$12,930.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,478.85
|
| Rate for Payer: UHC Exchange |
$10,280.11
|
| Rate for Payer: UHC Medicare Advantage |
$8,733.22
|
| Rate for Payer: VA VA |
$8,478.85
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
|
IP
|
$36,055.09
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$13,844.87 |
| Max. Negotiated Rate |
$36,055.09 |
| Rate for Payer: Aetna Medicare |
$15,156.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,216.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,216.94
|
| Rate for Payer: BCBS MAPPO |
$14,573.55
|
| Rate for Payer: BCBS Trust/PPO |
$36,055.09
|
| Rate for Payer: BCN Medicare Advantage |
$14,573.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,573.55
|
| Rate for Payer: Mclaren Medicare |
$14,573.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,302.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,759.58
|
| Rate for Payer: PACE Medicare |
$13,844.87
|
| Rate for Payer: PACE SWMI |
$14,573.55
|
| Rate for Payer: PHP Medicare Advantage |
$14,573.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,184.30
|
| Rate for Payer: Priority Health Medicare |
$14,573.55
|
| Rate for Payer: Priority Health Narrow Network |
$20,947.44
|
| Rate for Payer: Railroad Medicare Medicare |
$14,573.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,833.97
|
| Rate for Payer: UHC Core |
$22,823.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,573.55
|
| Rate for Payer: UHC Exchange |
$18,144.82
|
| Rate for Payer: UHC Medicare Advantage |
$15,010.76
|
| Rate for Payer: VA VA |
$14,573.55
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$15,084.94
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$5,595.14 |
| Max. Negotiated Rate |
$15,084.94 |
| Rate for Payer: Aetna Medicare |
$6,125.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,362.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,362.02
|
| Rate for Payer: BCBS MAPPO |
$5,889.62
|
| Rate for Payer: BCBS Trust/PPO |
$15,084.94
|
| Rate for Payer: BCN Medicare Advantage |
$5,889.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,889.62
|
| Rate for Payer: Mclaren Medicare |
$5,889.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,184.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,773.06
|
| Rate for Payer: PACE Medicare |
$5,595.14
|
| Rate for Payer: PACE SWMI |
$5,889.62
|
| Rate for Payer: PHP Medicare Advantage |
$5,889.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,013.37
|
| Rate for Payer: Priority Health Medicare |
$5,889.62
|
| Rate for Payer: Priority Health Narrow Network |
$8,010.70
|
| Rate for Payer: Railroad Medicare Medicare |
$5,889.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,644.24
|
| Rate for Payer: UHC Core |
$8,728.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,889.62
|
| Rate for Payer: UHC Exchange |
$6,938.92
|
| Rate for Payer: UHC Medicare Advantage |
$6,066.31
|
| Rate for Payer: VA VA |
$5,889.62
|
|
|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 574030416
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.41 |
| Max. Negotiated Rate |
$178.79 |
| Rate for Payer: Aetna American Axle |
$129.13
|
| Rate for Payer: Aetna Commercial |
$168.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.13
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$139.06
|
| Rate for Payer: Cofinity Commercial |
$170.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$178.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$139.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$149.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.86
|
| Rate for Payer: PHP Commercial |
$168.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.06
|
| Rate for Payer: Priority Health SBD |
$125.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$149.00
|
|
|
COMPOUNDING VEHICLE NO.8 ORAL LIQUID
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 395009016
|
| Hospital Charge Code |
119063
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.36
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
