|
PERAMPANEL 4 MG TABLET
|
Facility
|
IP
|
$4,222.11
|
|
|
Service Code
|
NDC 69616027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,857.73 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Advantage |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.58
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,857.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
OP
|
$4,222.11
|
|
|
Service Code
|
NDC 69616027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,562.18 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna Medicare |
$2,111.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: BCBS Complete |
$1,688.84
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Advantage |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,377.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.58
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,744.37
|
| Rate for Payer: UHC Core |
$2,199.72
|
| Rate for Payer: UHC Exchange |
$1,659.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
IP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,857.73 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Advantage |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.58
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,857.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
OP
|
$4,222.11
|
|
|
Service Code
|
NDC 62856027430
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,562.18 |
| Max. Negotiated Rate |
$3,799.90 |
| Rate for Payer: Aetna American Axle |
$2,744.37
|
| Rate for Payer: Aetna Commercial |
$3,588.79
|
| Rate for Payer: Aetna Medicare |
$2,111.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,744.37
|
| Rate for Payer: BCBS Complete |
$1,688.84
|
| Rate for Payer: Cash Price |
$3,377.69
|
| Rate for Payer: Cofinity Advantage |
$2,955.48
|
| Rate for Payer: Cofinity Commercial |
$3,631.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,377.69
|
| Rate for Payer: Healthscope Commercial |
$3,799.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,955.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,166.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,377.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,588.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,166.58
|
| Rate for Payer: PHP Commercial |
$3,588.79
|
| Rate for Payer: Priority Health SBD |
$2,659.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,744.37
|
| Rate for Payer: UHC Core |
$2,199.72
|
| Rate for Payer: UHC Exchange |
$1,659.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,166.58
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$80,876.14
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$33,338.60 |
| Max. Negotiated Rate |
$80,876.14 |
| Rate for Payer: Aetna Medicare |
$36,496.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43,866.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43,866.57
|
| Rate for Payer: BCBS MAPPO |
$35,093.26
|
| Rate for Payer: BCBS Trust/PPO |
$80,876.14
|
| Rate for Payer: BCN Commercial |
$80,876.14
|
| Rate for Payer: BCN Medicare Advantage |
$35,093.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35,093.26
|
| Rate for Payer: Mclaren Medicare |
$35,093.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36,847.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40,357.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$38,602.59
|
| Rate for Payer: Nomi Health Commercial |
$53,218.95
|
| Rate for Payer: PACE Medicare |
$33,338.60
|
| Rate for Payer: PACE SWMI |
$35,093.26
|
| Rate for Payer: PHP Medicare Advantage |
$35,093.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$66,511.89
|
| Rate for Payer: Priority Health Medicare |
$35,093.26
|
| Rate for Payer: Priority Health Tiered Network |
$53,209.50
|
| Rate for Payer: Railroad Medicare Medicare |
$35,093.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,245.65
|
| Rate for Payer: UHC Core |
$56,259.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35,093.26
|
| Rate for Payer: UHC Exchange |
$45,945.69
|
| Rate for Payer: VA VA |
$35,093.26
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$67,900.05
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$26,714.42 |
| Max. Negotiated Rate |
$67,900.05 |
| Rate for Payer: Aetna Medicare |
$29,245.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,150.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,150.55
|
| Rate for Payer: BCBS MAPPO |
$28,120.44
|
| Rate for Payer: BCBS Trust/PPO |
$67,900.05
|
| Rate for Payer: BCN Commercial |
$67,900.05
|
| Rate for Payer: BCN Medicare Advantage |
$28,120.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,120.44
|
| Rate for Payer: Mclaren Medicare |
$28,120.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,526.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,338.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,932.48
|
| Rate for Payer: Nomi Health Commercial |
$42,462.93
|
| Rate for Payer: PACE Medicare |
$26,714.42
|
| Rate for Payer: PACE SWMI |
$28,120.44
|
| Rate for Payer: PHP Medicare Advantage |
$28,120.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53,069.25
|
| Rate for Payer: Priority Health Medicare |
$28,120.44
|
| Rate for Payer: Priority Health Tiered Network |
$42,455.39
|
| Rate for Payer: Railroad Medicare Medicare |
$28,120.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,654.71
|
| Rate for Payer: UHC Core |
$44,888.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28,120.44
|
| Rate for Payer: UHC Exchange |
$36,659.66
|
| Rate for Payer: VA VA |
$28,120.44
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$23,620.99
|
|
|
Service Code
|
APR-DRG 1744
|
| Min. Negotiated Rate |
$22,496.18 |
| Max. Negotiated Rate |
$23,620.99 |
| Rate for Payer: BCBS Complete |
$23,620.99
|
| Rate for Payer: Mclaren Medicaid |
$22,496.18
|
| Rate for Payer: Meridian Medicaid |
$23,620.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$22,496.18
|
| Rate for Payer: UHC Medicaid |
$22,496.18
|
| Rate for Payer: UHCCP Medicaid |
$22,496.18
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$14,532.64
|
|
|
Service Code
|
APR-DRG 1742
|
| Min. Negotiated Rate |
$13,840.61 |
| Max. Negotiated Rate |
$14,532.64 |
| Rate for Payer: BCBS Complete |
$14,532.64
|
| Rate for Payer: Mclaren Medicaid |
$13,840.61
|
| Rate for Payer: Meridian Medicaid |
$14,532.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,840.61
|
| Rate for Payer: UHC Medicaid |
$13,840.61
|
| Rate for Payer: UHCCP Medicaid |
$13,840.61
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$16,342.56
|
|
|
Service Code
|
APR-DRG 1743
|
| Min. Negotiated Rate |
$15,564.35 |
| Max. Negotiated Rate |
$16,342.56 |
| Rate for Payer: BCBS Complete |
$16,342.56
|
| Rate for Payer: Mclaren Medicaid |
$15,564.35
|
| Rate for Payer: Meridian Medicaid |
$16,342.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,564.35
|
| Rate for Payer: UHC Medicaid |
$15,564.35
|
| Rate for Payer: UHCCP Medicaid |
$15,564.35
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITH AMI
|
Facility
|
IP
|
$11,598.03
|
|
|
Service Code
|
APR-DRG 1741
|
| Min. Negotiated Rate |
$11,045.74 |
| Max. Negotiated Rate |
$11,598.03 |
| Rate for Payer: BCBS Complete |
$11,598.03
|
| Rate for Payer: Mclaren Medicaid |
$11,045.74
|
| Rate for Payer: Meridian Medicaid |
$11,598.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,045.74
|
| Rate for Payer: UHC Medicaid |
$11,045.74
|
| Rate for Payer: UHCCP Medicaid |
$11,045.74
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$26,511.42
|
|
|
Service Code
|
APR-DRG 1754
|
| Min. Negotiated Rate |
$25,248.97 |
| Max. Negotiated Rate |
$26,511.42 |
| Rate for Payer: BCBS Complete |
$26,511.42
|
| Rate for Payer: Mclaren Medicaid |
$25,248.97
|
| Rate for Payer: Meridian Medicaid |
$26,511.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,248.97
|
| Rate for Payer: UHC Medicaid |
$25,248.97
|
| Rate for Payer: UHCCP Medicaid |
$25,248.97
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$12,691.24
|
|
|
Service Code
|
APR-DRG 1752
|
| Min. Negotiated Rate |
$12,086.90 |
| Max. Negotiated Rate |
$12,691.24 |
| Rate for Payer: BCBS Complete |
$12,691.24
|
| Rate for Payer: Mclaren Medicaid |
$12,086.90
|
| Rate for Payer: Meridian Medicaid |
$12,691.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,086.90
|
| Rate for Payer: UHC Medicaid |
$12,086.90
|
| Rate for Payer: UHCCP Medicaid |
$12,086.90
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$16,366.78
|
|
|
Service Code
|
APR-DRG 1753
|
| Min. Negotiated Rate |
$15,587.41 |
| Max. Negotiated Rate |
$16,366.78 |
| Rate for Payer: BCBS Complete |
$16,366.78
|
| Rate for Payer: Mclaren Medicaid |
$15,587.41
|
| Rate for Payer: Meridian Medicaid |
$16,366.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,587.41
|
| Rate for Payer: UHC Medicaid |
$15,587.41
|
| Rate for Payer: UHCCP Medicaid |
$15,587.41
|
|
|
PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI
|
Facility
|
IP
|
$9,547.19
|
|
|
Service Code
|
APR-DRG 1751
|
| Min. Negotiated Rate |
$9,092.56 |
| Max. Negotiated Rate |
$9,547.19 |
| Rate for Payer: BCBS Complete |
$9,547.19
|
| Rate for Payer: Mclaren Medicaid |
$9,092.56
|
| Rate for Payer: Meridian Medicaid |
$9,547.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,092.56
|
| Rate for Payer: UHC Medicaid |
$9,092.56
|
| Rate for Payer: UHCCP Medicaid |
$9,092.56
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$66,738.87
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$22,178.86 |
| Max. Negotiated Rate |
$66,738.87 |
| Rate for Payer: Aetna Medicare |
$24,280.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,182.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,182.71
|
| Rate for Payer: BCBS MAPPO |
$23,346.17
|
| Rate for Payer: BCBS Trust/PPO |
$66,738.87
|
| Rate for Payer: BCN Commercial |
$66,738.87
|
| Rate for Payer: BCN Medicare Advantage |
$23,346.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,346.17
|
| Rate for Payer: Mclaren Medicare |
$23,346.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,513.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,848.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,680.79
|
| Rate for Payer: Nomi Health Commercial |
$35,098.32
|
| Rate for Payer: PACE Medicare |
$22,178.86
|
| Rate for Payer: PACE SWMI |
$23,346.17
|
| Rate for Payer: PHP Medicare Advantage |
$23,346.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43,865.12
|
| Rate for Payer: Priority Health Medicare |
$23,346.17
|
| Rate for Payer: Priority Health Tiered Network |
$35,092.09
|
| Rate for Payer: Railroad Medicare Medicare |
$23,346.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,349.04
|
| Rate for Payer: UHC Core |
$37,103.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,346.17
|
| Rate for Payer: UHC Exchange |
$30,301.55
|
| Rate for Payer: VA VA |
$23,346.17
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$46,463.56
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$14,569.58 |
| Max. Negotiated Rate |
$46,463.56 |
| Rate for Payer: Aetna Medicare |
$15,949.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,170.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,170.50
|
| Rate for Payer: BCBS MAPPO |
$15,336.40
|
| Rate for Payer: BCBS Trust/PPO |
$46,463.56
|
| Rate for Payer: BCN Commercial |
$46,463.56
|
| Rate for Payer: BCN Medicare Advantage |
$15,336.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,336.40
|
| Rate for Payer: Mclaren Medicare |
$15,336.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,103.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,636.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,870.04
|
| Rate for Payer: Nomi Health Commercial |
$22,742.70
|
| Rate for Payer: PACE Medicare |
$14,569.58
|
| Rate for Payer: PACE SWMI |
$15,336.40
|
| Rate for Payer: PHP Medicare Advantage |
$15,336.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28,423.33
|
| Rate for Payer: Priority Health Medicare |
$15,336.40
|
| Rate for Payer: Priority Health Tiered Network |
$22,738.66
|
| Rate for Payer: Railroad Medicare Medicare |
$15,336.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,736.90
|
| Rate for Payer: UHC Core |
$24,042.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,336.40
|
| Rate for Payer: UHC Exchange |
$19,634.53
|
| Rate for Payer: VA VA |
$15,336.40
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$56,175.73
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$17,902.31 |
| Max. Negotiated Rate |
$56,175.73 |
| Rate for Payer: Aetna Medicare |
$19,598.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,555.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,555.67
|
| Rate for Payer: BCBS MAPPO |
$18,844.54
|
| Rate for Payer: BCBS Trust/PPO |
$56,175.73
|
| Rate for Payer: BCN Commercial |
$56,175.73
|
| Rate for Payer: BCN Medicare Advantage |
$18,844.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,844.54
|
| Rate for Payer: Mclaren Medicare |
$18,844.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,786.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,671.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,728.99
|
| Rate for Payer: Nomi Health Commercial |
$28,154.25
|
| Rate for Payer: PACE Medicare |
$17,902.31
|
| Rate for Payer: PACE SWMI |
$18,844.54
|
| Rate for Payer: PHP Medicare Advantage |
$18,844.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,186.57
|
| Rate for Payer: Priority Health Medicare |
$18,844.54
|
| Rate for Payer: Priority Health Tiered Network |
$28,149.25
|
| Rate for Payer: Railroad Medicare Medicare |
$18,844.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,574.75
|
| Rate for Payer: UHC Core |
$29,762.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,844.54
|
| Rate for Payer: UHC Exchange |
$24,306.50
|
| Rate for Payer: VA VA |
$18,844.54
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$35,236.10
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$12,436.46 |
| Max. Negotiated Rate |
$35,236.10 |
| Rate for Payer: Aetna Medicare |
$13,614.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,363.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,363.76
|
| Rate for Payer: BCBS MAPPO |
$13,091.01
|
| Rate for Payer: BCBS Trust/PPO |
$35,236.10
|
| Rate for Payer: BCN Commercial |
$35,236.10
|
| Rate for Payer: BCN Medicare Advantage |
$13,091.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,091.01
|
| Rate for Payer: Mclaren Medicare |
$13,091.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,745.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,054.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,400.11
|
| Rate for Payer: Nomi Health Commercial |
$19,279.05
|
| Rate for Payer: PACE Medicare |
$12,436.46
|
| Rate for Payer: PACE SWMI |
$13,091.01
|
| Rate for Payer: PHP Medicare Advantage |
$13,091.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24,094.54
|
| Rate for Payer: Priority Health Medicare |
$13,091.01
|
| Rate for Payer: Priority Health Tiered Network |
$19,275.63
|
| Rate for Payer: Railroad Medicare Medicare |
$13,091.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,360.35
|
| Rate for Payer: UHC Core |
$20,380.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,091.01
|
| Rate for Payer: UHC Exchange |
$16,644.25
|
| Rate for Payer: VA VA |
$13,091.01
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$74,850.64
|
|
|
Service Code
|
MSDRG 359
|
| Min. Negotiated Rate |
$27,881.46 |
| Max. Negotiated Rate |
$74,850.64 |
| Rate for Payer: Aetna Medicare |
$30,522.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$36,686.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$36,686.14
|
| Rate for Payer: BCBS MAPPO |
$29,348.91
|
| Rate for Payer: BCBS Trust/PPO |
$74,850.64
|
| Rate for Payer: BCN Commercial |
$74,850.64
|
| Rate for Payer: BCN Medicare Advantage |
$29,348.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,348.91
|
| Rate for Payer: Mclaren Medicare |
$29,348.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30,816.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33,751.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$32,283.80
|
| Rate for Payer: Nomi Health Commercial |
$44,357.94
|
| Rate for Payer: PACE Medicare |
$27,881.46
|
| Rate for Payer: PACE SWMI |
$29,348.91
|
| Rate for Payer: PHP Medicare Advantage |
$29,348.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$55,437.59
|
| Rate for Payer: Priority Health Medicare |
$29,348.91
|
| Rate for Payer: Priority Health Tiered Network |
$44,350.07
|
| Rate for Payer: Railroad Medicare Medicare |
$29,348.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56,049.18
|
| Rate for Payer: UHC Core |
$46,892.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29,348.91
|
| Rate for Payer: UHC Exchange |
$38,295.69
|
| Rate for Payer: VA VA |
$29,348.91
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$58,012.20
|
|
|
Service Code
|
MSDRG 360
|
| Min. Negotiated Rate |
$19,743.88 |
| Max. Negotiated Rate |
$58,012.20 |
| Rate for Payer: Aetna Medicare |
$21,614.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,978.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,978.79
|
| Rate for Payer: BCBS MAPPO |
$20,783.03
|
| Rate for Payer: BCBS Trust/PPO |
$58,012.20
|
| Rate for Payer: BCN Commercial |
$58,012.20
|
| Rate for Payer: BCN Medicare Advantage |
$20,783.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,783.03
|
| Rate for Payer: Mclaren Medicare |
$20,783.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,822.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,900.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,861.33
|
| Rate for Payer: Nomi Health Commercial |
$31,144.47
|
| Rate for Payer: PACE Medicare |
$19,743.88
|
| Rate for Payer: PACE SWMI |
$20,783.03
|
| Rate for Payer: PHP Medicare Advantage |
$20,783.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38,923.68
|
| Rate for Payer: Priority Health Medicare |
$20,783.03
|
| Rate for Payer: Priority Health Tiered Network |
$31,138.94
|
| Rate for Payer: Railroad Medicare Medicare |
$20,783.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,353.09
|
| Rate for Payer: UHC Core |
$32,923.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,783.03
|
| Rate for Payer: UHC Exchange |
$26,888.06
|
| Rate for Payer: VA VA |
$20,783.03
|
|
|
PERCUTANEOUS CORONARY ATHERECTOMY WITHOUT INTRALUMINAL DEVICE
|
Facility
|
IP
|
$46,943.96
|
|
|
Service Code
|
MSDRG 318
|
| Min. Negotiated Rate |
$19,806.63 |
| Max. Negotiated Rate |
$46,943.96 |
| Rate for Payer: Aetna Medicare |
$21,683.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,061.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,061.35
|
| Rate for Payer: BCBS MAPPO |
$20,849.08
|
| Rate for Payer: BCBS Trust/PPO |
$46,943.96
|
| Rate for Payer: BCN Commercial |
$46,943.96
|
| Rate for Payer: BCN Medicare Advantage |
$20,849.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,849.08
|
| Rate for Payer: Mclaren Medicare |
$20,849.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,891.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,976.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,933.99
|
| Rate for Payer: Nomi Health Commercial |
$31,246.38
|
| Rate for Payer: PACE Medicare |
$19,806.63
|
| Rate for Payer: PACE SWMI |
$20,849.08
|
| Rate for Payer: PHP Medicare Advantage |
$20,849.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39,051.05
|
| Rate for Payer: Priority Health Medicare |
$20,849.08
|
| Rate for Payer: Priority Health Tiered Network |
$31,240.83
|
| Rate for Payer: Railroad Medicare Medicare |
$20,849.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,481.86
|
| Rate for Payer: UHC Core |
$33,031.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,849.08
|
| Rate for Payer: UHC Exchange |
$26,976.04
|
| Rate for Payer: VA VA |
$20,849.08
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$20,535.59
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,321.09 |
| Max. Negotiated Rate |
$20,535.59 |
| Rate for Payer: Aetna Medicare |
$6,604.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,937.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,937.60
|
| Rate for Payer: BCBS Complete |
$3,487.46
|
| Rate for Payer: BCBS MAPPO |
$6,350.08
|
| Rate for Payer: BCBS Trust/PPO |
$9,765.57
|
| Rate for Payer: BCN Commercial |
$9,765.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,350.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,350.08
|
| Rate for Payer: Mclaren Medicaid |
$6,350.08
|
| Rate for Payer: Mclaren Medicare |
$6,350.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,667.58
|
| Rate for Payer: Meridian Medicaid |
$6,667.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,302.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,985.09
|
| Rate for Payer: Nomi Health Commercial |
$19,050.24
|
| Rate for Payer: PACE Medicare |
$6,032.58
|
| Rate for Payer: PACE SWMI |
$6,350.08
|
| Rate for Payer: PHP Medicare Advantage |
$6,350.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,321.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,535.59
|
| Rate for Payer: Priority Health Medicare |
$6,350.08
|
| Rate for Payer: Priority Health Tiered Network |
$16,428.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6,350.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,350.08
|
| Rate for Payer: UHC Medicaid |
$3,321.09
|
| Rate for Payer: UHCCP Medicaid |
$3,321.09
|
| Rate for Payer: VA VA |
$6,350.08
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$14,351.65
|
|
|
Service Code
|
APR-DRG 0302
|
| Min. Negotiated Rate |
$13,668.24 |
| Max. Negotiated Rate |
$14,351.65 |
| Rate for Payer: BCBS Complete |
$14,351.65
|
| Rate for Payer: Mclaren Medicaid |
$13,668.24
|
| Rate for Payer: Meridian Medicaid |
$14,351.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,668.24
|
| Rate for Payer: UHC Medicaid |
$13,668.24
|
| Rate for Payer: UHCCP Medicaid |
$13,668.24
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$8,413.41
|
|
|
Service Code
|
APR-DRG 0301
|
| Min. Negotiated Rate |
$8,012.77 |
| Max. Negotiated Rate |
$8,413.41 |
| Rate for Payer: BCBS Complete |
$8,413.41
|
| Rate for Payer: Mclaren Medicaid |
$8,012.77
|
| Rate for Payer: Meridian Medicaid |
$8,413.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,012.77
|
| Rate for Payer: UHC Medicaid |
$8,012.77
|
| Rate for Payer: UHCCP Medicaid |
$8,012.77
|
|
|
PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$18,446.67
|
|
|
Service Code
|
APR-DRG 0303
|
| Min. Negotiated Rate |
$17,568.26 |
| Max. Negotiated Rate |
$18,446.67 |
| Rate for Payer: BCBS Complete |
$18,446.67
|
| Rate for Payer: Mclaren Medicaid |
$17,568.26
|
| Rate for Payer: Meridian Medicaid |
$18,446.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17,568.26
|
| Rate for Payer: UHC Medicaid |
$17,568.26
|
| Rate for Payer: UHCCP Medicaid |
$17,568.26
|
|
