|
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
|
$14,350.60
|
|
|
Service Code
|
CPT 22515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,350.60 |
| Max. Negotiated Rate |
$14,350.60 |
| Rate for Payer: BCBS Trust/PPO |
$14,350.60
|
| Rate for Payer: BCN Commercial |
$14,350.60
|
|
|
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
|
$23,381.57
|
|
|
Service Code
|
CPT 22514
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$6,999.82
|
| Rate for Payer: BCN Commercial |
$6,999.82
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
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
|
$23,381.57
|
|
|
Service Code
|
CPT 22513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$6,910.91
|
| Rate for Payer: BCN Commercial |
$6,910.91
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 22511
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,962.37
|
| Rate for Payer: BCN Commercial |
$2,962.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PERI-IMPLANT CAPSULECTOMY, BREAST, COMPLETE, INCLUDING REMOVAL OF ALL INTRACAPSULAR CONTENTS
|
Facility
|
OP
|
$12,616.62
|
|
|
Service Code
|
CPT 19371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,040.41 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$6,469.61
|
| Rate for Payer: BCN Commercial |
$6,469.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Mclaren Medicaid |
$3,901.35
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PERINDOPRIL ERBUMINE 4 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
|
Service Code
|
NDC 00054011125
|
| 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 Advantage |
$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 Commercial |
$251.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.12
|
| Rate for Payer: PHP Commercial |
$251.74
|
| 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
|
|
|
PERINDOPRIL ERBUMINE 4 MG TABLET
|
Facility
|
OP
|
$296.16
|
|
|
Service Code
|
NDC 00054011125
|
| Hospital Charge Code |
13160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.58 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna American Axle |
$192.50
|
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna Medicare |
$148.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: BCBS Complete |
$118.46
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$236.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.12
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.50
|
| Rate for Payer: UHC Core |
$154.30
|
| Rate for Payer: UHC Exchange |
$116.39
|
| Rate for Payer: UMR Bronson Commercial |
$109.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.12
|
|
|
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 56810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,006.33
|
| Rate for Payer: BCN Commercial |
$2,006.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$8,288.11
|
|
|
Service Code
|
APR-DRG 1973
|
| Min. Negotiated Rate |
$7,893.44 |
| Max. Negotiated Rate |
$8,288.11 |
| Rate for Payer: BCBS Complete |
$8,288.11
|
| Rate for Payer: Mclaren Medicaid |
$7,893.44
|
| Rate for Payer: Meridian Medicaid |
$8,288.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,893.44
|
| Rate for Payer: UHC Medicaid |
$7,893.44
|
| Rate for Payer: UHCCP Medicaid |
$7,893.44
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$12,087.73
|
|
|
Service Code
|
APR-DRG 1974
|
| Min. Negotiated Rate |
$11,512.13 |
| Max. Negotiated Rate |
$12,087.73 |
| Rate for Payer: BCBS Complete |
$12,087.73
|
| Rate for Payer: Mclaren Medicaid |
$11,512.13
|
| Rate for Payer: Meridian Medicaid |
$12,087.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,512.13
|
| Rate for Payer: UHC Medicaid |
$11,512.13
|
| Rate for Payer: UHCCP Medicaid |
$11,512.13
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$4,006.04
|
|
|
Service Code
|
APR-DRG 1971
|
| Min. Negotiated Rate |
$3,815.28 |
| Max. Negotiated Rate |
$4,006.04 |
| Rate for Payer: BCBS Complete |
$4,006.04
|
| Rate for Payer: Mclaren Medicaid |
$3,815.28
|
| Rate for Payer: Meridian Medicaid |
$4,006.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,815.28
|
| Rate for Payer: UHC Medicaid |
$3,815.28
|
| Rate for Payer: UHCCP Medicaid |
$3,815.28
|
|
|
PERIPHERAL AND OTHER VASCULAR DISORDERS
|
Facility
|
IP
|
$5,271.78
|
|
|
Service Code
|
APR-DRG 1972
|
| Min. Negotiated Rate |
$5,020.74 |
| Max. Negotiated Rate |
$5,271.78 |
| Rate for Payer: BCBS Complete |
$5,271.78
|
| Rate for Payer: Mclaren Medicaid |
$5,020.74
|
| Rate for Payer: Meridian Medicaid |
$5,271.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,020.74
|
| Rate for Payer: UHC Medicaid |
$5,020.74
|
| Rate for Payer: UHCCP Medicaid |
$5,020.74
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$5,683.40
|
|
|
Service Code
|
APR-DRG 0482
|
| Min. Negotiated Rate |
$5,412.76 |
| Max. Negotiated Rate |
$5,683.40 |
| Rate for Payer: BCBS Complete |
$5,683.40
|
| Rate for Payer: Mclaren Medicaid |
$5,412.76
|
| Rate for Payer: Meridian Medicaid |
$5,683.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,412.76
|
| Rate for Payer: UHC Medicaid |
$5,412.76
|
| Rate for Payer: UHCCP Medicaid |
$5,412.76
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$4,417.06
|
|
|
Service Code
|
APR-DRG 0481
|
| Min. Negotiated Rate |
$4,206.72 |
| Max. Negotiated Rate |
$4,417.06 |
| Rate for Payer: BCBS Complete |
$4,417.06
|
| Rate for Payer: Mclaren Medicaid |
$4,206.72
|
| Rate for Payer: Meridian Medicaid |
$4,417.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,206.72
|
| Rate for Payer: UHC Medicaid |
$4,206.72
|
| Rate for Payer: UHCCP Medicaid |
$4,206.72
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$13,767.51
|
|
|
Service Code
|
APR-DRG 0484
|
| Min. Negotiated Rate |
$13,111.92 |
| Max. Negotiated Rate |
$13,767.51 |
| Rate for Payer: BCBS Complete |
$13,767.51
|
| Rate for Payer: Mclaren Medicaid |
$13,111.92
|
| Rate for Payer: Meridian Medicaid |
$13,767.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,111.92
|
| Rate for Payer: UHC Medicaid |
$13,111.92
|
| Rate for Payer: UHCCP Medicaid |
$13,111.92
|
|
|
PERIPHERAL, CRANIAL AND AUTONOMIC NERVE DISORDERS
|
Facility
|
IP
|
$8,656.15
|
|
|
Service Code
|
APR-DRG 0483
|
| Min. Negotiated Rate |
$8,243.95 |
| Max. Negotiated Rate |
$8,656.15 |
| Rate for Payer: BCBS Complete |
$8,656.15
|
| Rate for Payer: Mclaren Medicaid |
$8,243.95
|
| Rate for Payer: Meridian Medicaid |
$8,656.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,243.95
|
| Rate for Payer: UHC Medicaid |
$8,243.95
|
| Rate for Payer: UHCCP Medicaid |
$8,243.95
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR
|
Facility
|
IP
|
$49,853.76
|
|
|
Service Code
|
MSDRG 041
|
| Min. Negotiated Rate |
$18,031.01 |
| Max. Negotiated Rate |
$49,853.76 |
| Rate for Payer: Aetna Medicare |
$19,739.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,725.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,725.01
|
| Rate for Payer: BCBS MAPPO |
$18,980.01
|
| Rate for Payer: BCBS Trust/PPO |
$49,853.76
|
| Rate for Payer: BCN Commercial |
$49,853.76
|
| Rate for Payer: BCN Medicare Advantage |
$18,980.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,980.01
|
| Rate for Payer: Mclaren Medicare |
$18,980.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19,929.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,827.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$20,878.01
|
| Rate for Payer: Nomi Health Commercial |
$28,363.23
|
| Rate for Payer: PACE Medicare |
$18,031.01
|
| Rate for Payer: PACE SWMI |
$18,980.01
|
| Rate for Payer: PHP Medicare Advantage |
$18,980.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,447.75
|
| Rate for Payer: Priority Health Medicare |
$18,980.01
|
| Rate for Payer: Priority Health Tiered Network |
$28,358.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18,980.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,838.81
|
| Rate for Payer: UHC Core |
$29,983.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$18,980.01
|
| Rate for Payer: UHC Exchange |
$24,486.92
|
| Rate for Payer: VA VA |
$18,980.01
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC
|
Facility
|
IP
|
$71,339.66
|
|
|
Service Code
|
MSDRG 040
|
| Min. Negotiated Rate |
$31,238.84 |
| Max. Negotiated Rate |
$71,339.66 |
| Rate for Payer: Aetna Medicare |
$34,198.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,103.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,103.74
|
| Rate for Payer: BCBS MAPPO |
$32,882.99
|
| Rate for Payer: BCBS Trust/PPO |
$71,339.66
|
| Rate for Payer: BCN Commercial |
$71,339.66
|
| Rate for Payer: BCN Medicare Advantage |
$32,882.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,882.99
|
| Rate for Payer: Mclaren Medicare |
$32,882.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,527.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,815.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,171.29
|
| Rate for Payer: Nomi Health Commercial |
$49,809.48
|
| Rate for Payer: PACE Medicare |
$31,238.84
|
| Rate for Payer: PACE SWMI |
$32,882.99
|
| Rate for Payer: PHP Medicare Advantage |
$32,882.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62,250.81
|
| Rate for Payer: Priority Health Medicare |
$32,882.99
|
| Rate for Payer: Priority Health Tiered Network |
$49,800.64
|
| Rate for Payer: Railroad Medicare Medicare |
$32,882.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62,937.56
|
| Rate for Payer: UHC Core |
$52,655.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,882.99
|
| Rate for Payer: UHC Exchange |
$43,002.18
|
| Rate for Payer: VA VA |
$32,882.99
|
|
|
PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$43,235.32
|
|
|
Service Code
|
MSDRG 042
|
| Min. Negotiated Rate |
$14,289.14 |
| Max. Negotiated Rate |
$43,235.32 |
| Rate for Payer: Aetna Medicare |
$15,642.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,801.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,801.50
|
| Rate for Payer: BCBS MAPPO |
$15,041.20
|
| Rate for Payer: BCBS Trust/PPO |
$43,235.32
|
| Rate for Payer: BCN Commercial |
$43,235.32
|
| Rate for Payer: BCN Medicare Advantage |
$15,041.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,041.20
|
| Rate for Payer: Mclaren Medicare |
$15,041.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,793.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,297.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,545.32
|
| Rate for Payer: Nomi Health Commercial |
$22,287.33
|
| Rate for Payer: PACE Medicare |
$14,289.14
|
| Rate for Payer: PACE SWMI |
$15,041.20
|
| Rate for Payer: PHP Medicare Advantage |
$15,041.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27,854.22
|
| Rate for Payer: Priority Health Medicare |
$15,041.20
|
| Rate for Payer: Priority Health Tiered Network |
$22,283.37
|
| Rate for Payer: Railroad Medicare Medicare |
$15,041.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,161.51
|
| Rate for Payer: UHC Core |
$23,560.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,041.20
|
| Rate for Payer: UHC Exchange |
$19,241.39
|
| Rate for Payer: VA VA |
$15,041.20
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH CC
|
Facility
|
IP
|
$21,090.60
|
|
|
Service Code
|
MSDRG 300
|
| Min. Negotiated Rate |
$9,044.14 |
| Max. Negotiated Rate |
$21,090.60 |
| Rate for Payer: Aetna Medicare |
$9,900.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,900.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,900.19
|
| Rate for Payer: BCBS MAPPO |
$9,520.15
|
| Rate for Payer: BCBS Trust/PPO |
$21,090.60
|
| Rate for Payer: BCN Commercial |
$21,090.60
|
| Rate for Payer: BCN Medicare Advantage |
$9,520.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,520.15
|
| Rate for Payer: Mclaren Medicare |
$9,520.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,996.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,948.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,472.17
|
| Rate for Payer: Nomi Health Commercial |
$13,770.75
|
| Rate for Payer: PACE Medicare |
$9,044.14
|
| Rate for Payer: PACE SWMI |
$9,520.15
|
| Rate for Payer: PHP Medicare Advantage |
$9,520.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,210.38
|
| Rate for Payer: Priority Health Medicare |
$9,520.15
|
| Rate for Payer: Priority Health Tiered Network |
$13,768.31
|
| Rate for Payer: Railroad Medicare Medicare |
$9,520.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,400.25
|
| Rate for Payer: UHC Core |
$14,557.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,520.15
|
| Rate for Payer: UHC Exchange |
$11,888.75
|
| Rate for Payer: VA VA |
$9,520.15
|
|
|
PERIPHERAL VASCULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$30,171.39
|
|
|
Service Code
|
MSDRG 299
|
| Min. Negotiated Rate |
$13,534.40 |
| Max. Negotiated Rate |
$30,171.39 |
| Rate for Payer: Aetna Medicare |
$14,816.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,808.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,808.42
|
| Rate for Payer: BCBS MAPPO |
$14,246.74
|
| Rate for Payer: BCBS Trust/PPO |
$30,171.39
|
| Rate for Payer: BCN Commercial |
$30,171.39
|
| Rate for Payer: BCN Medicare Advantage |
$14,246.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,246.74
|
| Rate for Payer: Mclaren Medicare |
$14,246.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,959.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,383.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,671.41
|
| Rate for Payer: Nomi Health Commercial |
$21,061.83
|
| Rate for Payer: PACE Medicare |
$13,534.40
|
| Rate for Payer: PACE SWMI |
$14,246.74
|
| Rate for Payer: PHP Medicare Advantage |
$14,246.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,322.62
|
| Rate for Payer: Priority Health Medicare |
$14,246.74
|
| Rate for Payer: Priority Health Tiered Network |
$21,058.09
|
| Rate for Payer: Railroad Medicare Medicare |
$14,246.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,613.01
|
| Rate for Payer: UHC Core |
$22,265.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,246.74
|
| Rate for Payer: UHC Exchange |
$18,183.38
|
| Rate for Payer: VA VA |
$14,246.74
|
|
|
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,543.93
|
|
|
Service Code
|
MSDRG 301
|
| Min. Negotiated Rate |
$6,281.01 |
| Max. Negotiated Rate |
$17,543.93 |
| Rate for Payer: Aetna Medicare |
$6,876.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,264.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,264.49
|
| Rate for Payer: BCBS MAPPO |
$6,611.59
|
| Rate for Payer: BCBS Trust/PPO |
$17,543.93
|
| Rate for Payer: BCN Commercial |
$17,543.93
|
| Rate for Payer: BCN Medicare Advantage |
$6,611.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,611.59
|
| Rate for Payer: Mclaren Medicare |
$6,611.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,942.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,603.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,272.75
|
| Rate for Payer: Nomi Health Commercial |
$9,284.13
|
| Rate for Payer: PACE Medicare |
$6,281.01
|
| Rate for Payer: PACE SWMI |
$6,611.59
|
| Rate for Payer: PHP Medicare Advantage |
$6,611.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,603.10
|
| Rate for Payer: Priority Health Medicare |
$6,611.59
|
| Rate for Payer: Priority Health Tiered Network |
$9,282.48
|
| Rate for Payer: Railroad Medicare Medicare |
$6,611.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,731.11
|
| Rate for Payer: UHC Core |
$9,814.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,611.59
|
| Rate for Payer: UHC Exchange |
$8,015.30
|
| Rate for Payer: VA VA |
$6,611.59
|
|
|
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 49230020694
|
| 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 Advantage |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| 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 Commercial |
$100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.99
|
| Rate for Payer: PHP Commercial |
$100.85
|
| 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
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
IP
|
$135.60
|
|
|
Service Code
|
NDC 49230020692
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.66 |
| Max. Negotiated Rate |
$122.04 |
| Rate for Payer: Aetna American Axle |
$88.14
|
| Rate for Payer: Aetna Commercial |
$115.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.14
|
| Rate for Payer: Cash Price |
$108.48
|
| Rate for Payer: Cofinity Advantage |
$94.92
|
| Rate for Payer: Cofinity Commercial |
$116.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.48
|
| Rate for Payer: Healthscope Commercial |
$122.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.70
|
| Rate for Payer: PHP Commercial |
$115.26
|
| Rate for Payer: Priority Health SBD |
$85.43
|
| Rate for Payer: UMR Bronson Commercial |
$59.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.70
|
|
|
PERITON.DIALYSIS SOLN 6-1.5 % DEXTROS LOW CALC 2.5 MEQ/L-MAG 0.5 MEQ/L
|
Facility
|
OP
|
$118.65
|
|
|
Service Code
|
NDC 49230020694
|
| Hospital Charge Code |
27796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.90 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna American Axle |
$77.12
|
| Rate for Payer: Aetna Commercial |
$100.85
|
| Rate for Payer: Aetna Medicare |
$59.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.12
|
| Rate for Payer: BCBS Complete |
$47.46
|
| Rate for Payer: Cash Price |
$94.92
|
| Rate for Payer: Cofinity Advantage |
$83.06
|
| Rate for Payer: Cofinity Commercial |
$102.04
|
| 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: MI Amish Medical Board Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.99
|
| Rate for Payer: PHP Commercial |
$100.85
|
| Rate for Payer: Priority Health SBD |
$74.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.12
|
| Rate for Payer: UHC Core |
$61.82
|
| Rate for Payer: UHC Exchange |
$46.63
|
| Rate for Payer: UMR Bronson Commercial |
$43.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$88.99
|
|
