|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 24208058564
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: BCBS Trust/PPO |
$80.19
|
| Rate for Payer: BCN Commercial |
$80.19
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$94.72
|
| Rate for Payer: Healthscope Whirlpool |
$97.65
|
| Rate for Payer: Mclaren Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
TROPICAMIDE 1 % EYE DROPS
|
Facility
|
IP
|
$26.20
|
|
|
Service Code
|
NDC 17478010212
|
| Hospital Charge Code |
8250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$26.20 |
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: ASR ASR |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: Cash Price |
$20.96
|
| Rate for Payer: Cofinity Commercial |
$24.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.96
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Whirlpool |
$26.20
|
| Rate for Payer: Mclaren Commercial |
$23.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.27
|
| Rate for Payer: Nomi Health Commercial |
$21.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.05
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$76,472.91
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$39,746.12 |
| Max. Negotiated Rate |
$76,472.91 |
| Rate for Payer: Aetna Medicare |
$41,838.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52,297.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52,297.53
|
| Rate for Payer: BCBS MAPPO |
$41,838.02
|
| Rate for Payer: BCN Medicare Advantage |
$41,838.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41,838.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$41,838.02
|
| Rate for Payer: Mclaren Medicare |
$41,838.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43,929.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48,113.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$46,021.82
|
| Rate for Payer: PACE Medicare |
$39,746.12
|
| Rate for Payer: PACE SWMI |
$41,838.02
|
| Rate for Payer: PHP Commercial |
$46,021.82
|
| Rate for Payer: PHP Medicare Advantage |
$41,838.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76,472.91
|
| Rate for Payer: Priority Health Medicare |
$41,838.02
|
| Rate for Payer: Priority Health Narrow Network |
$61,178.33
|
| Rate for Payer: Railroad Medicare Medicare |
$41,838.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41,838.02
|
| Rate for Payer: UHC Exchange |
$64,848.93
|
| Rate for Payer: UHCCP DNSP |
$41,838.02
|
| Rate for Payer: VA VA |
$41,838.02
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$49,547.61
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$26,338.78 |
| Max. Negotiated Rate |
$49,547.61 |
| Rate for Payer: Aetna Medicare |
$27,725.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,656.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,656.29
|
| Rate for Payer: BCBS MAPPO |
$27,725.03
|
| Rate for Payer: BCN Medicare Advantage |
$27,725.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,725.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,725.03
|
| Rate for Payer: Mclaren Medicare |
$27,725.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29,111.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,883.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$30,497.53
|
| Rate for Payer: PACE Medicare |
$26,338.78
|
| Rate for Payer: PACE SWMI |
$27,725.03
|
| Rate for Payer: PHP Commercial |
$30,497.53
|
| Rate for Payer: PHP Medicare Advantage |
$27,725.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$49,547.61
|
| Rate for Payer: Priority Health Medicare |
$27,725.03
|
| Rate for Payer: Priority Health Narrow Network |
$39,638.09
|
| Rate for Payer: Railroad Medicare Medicare |
$27,725.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,725.03
|
| Rate for Payer: UHC Exchange |
$42,973.80
|
| Rate for Payer: UHCCP DNSP |
$27,725.03
|
| Rate for Payer: VA VA |
$27,725.03
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$40,892.16
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$22,028.83 |
| Max. Negotiated Rate |
$40,892.16 |
| Rate for Payer: Aetna Medicare |
$23,188.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,985.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,985.30
|
| Rate for Payer: BCBS MAPPO |
$23,188.24
|
| Rate for Payer: BCN Medicare Advantage |
$23,188.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,188.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$23,188.24
|
| Rate for Payer: Mclaren Medicare |
$23,188.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,347.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,666.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,507.06
|
| Rate for Payer: PACE Medicare |
$22,028.83
|
| Rate for Payer: PACE SWMI |
$23,188.24
|
| Rate for Payer: PHP Commercial |
$25,507.06
|
| Rate for Payer: PHP Medicare Advantage |
$23,188.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$40,892.16
|
| Rate for Payer: Priority Health Medicare |
$23,188.24
|
| Rate for Payer: Priority Health Narrow Network |
$32,713.73
|
| Rate for Payer: Railroad Medicare Medicare |
$23,188.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,188.24
|
| Rate for Payer: UHC Exchange |
$35,941.77
|
| Rate for Payer: UHCCP DNSP |
$23,188.24
|
| Rate for Payer: VA VA |
$23,188.24
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$134.68
|
|
|
Service Code
|
NDC 173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.83 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$121.21
|
| Rate for Payer: Aetna Medicare |
$49.83
|
| Rate for Payer: ASR ASR |
$130.64
|
| Rate for Payer: BCBS Complete |
$53.87
|
| Rate for Payer: BCBS Trust/PPO |
$111.04
|
| Rate for Payer: BCN Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$107.74
|
| Rate for Payer: Cofinity Commercial |
$126.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.74
|
| Rate for Payer: Healthscope Commercial |
$130.64
|
| Rate for Payer: Healthscope Whirlpool |
$134.68
|
| Rate for Payer: Mclaren Commercial |
$121.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.48
|
| Rate for Payer: Nomi Health Commercial |
$110.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.00
|
| Rate for Payer: Priority Health Narrow Network |
$94.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.52
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$134.68
|
|
|
Service Code
|
NDC 173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.01 |
| Max. Negotiated Rate |
$134.68 |
| Rate for Payer: Aetna Commercial |
$121.21
|
| Rate for Payer: ASR ASR |
$130.64
|
| Rate for Payer: BCBS Trust/PPO |
$110.60
|
| Rate for Payer: BCN Commercial |
$110.60
|
| Rate for Payer: Cash Price |
$107.74
|
| Rate for Payer: Cofinity Commercial |
$126.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.74
|
| Rate for Payer: Healthscope Commercial |
$130.64
|
| Rate for Payer: Healthscope Whirlpool |
$134.68
|
| Rate for Payer: Mclaren Commercial |
$121.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.48
|
| Rate for Payer: Nomi Health Commercial |
$110.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.52
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$18,969.16
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,112.36 |
| Max. Negotiated Rate |
$18,969.16 |
| Rate for Payer: Aetna Medicare |
$11,697.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,621.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,621.52
|
| Rate for Payer: BCBS MAPPO |
$11,697.22
|
| Rate for Payer: BCN Medicare Advantage |
$11,697.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,697.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,697.22
|
| Rate for Payer: Mclaren Medicare |
$11,697.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,282.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,451.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,866.94
|
| Rate for Payer: PACE Medicare |
$11,112.36
|
| Rate for Payer: PACE SWMI |
$11,697.22
|
| Rate for Payer: PHP Commercial |
$12,866.94
|
| Rate for Payer: PHP Medicare Advantage |
$11,697.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,969.16
|
| Rate for Payer: Priority Health Medicare |
$11,697.22
|
| Rate for Payer: Priority Health Narrow Network |
$15,175.33
|
| Rate for Payer: Railroad Medicare Medicare |
$11,697.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,697.22
|
| Rate for Payer: UHC Exchange |
$18,130.69
|
| Rate for Payer: UHCCP DNSP |
$11,697.22
|
| Rate for Payer: VA VA |
$11,697.22
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$12,260.64
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,514.59 |
| Max. Negotiated Rate |
$12,260.64 |
| Rate for Payer: Aetna Medicare |
$7,910.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,887.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,887.61
|
| Rate for Payer: BCBS MAPPO |
$7,910.09
|
| Rate for Payer: BCN Medicare Advantage |
$7,910.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,910.09
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,910.09
|
| Rate for Payer: Mclaren Medicare |
$7,910.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,305.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,096.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,701.10
|
| Rate for Payer: PACE Medicare |
$7,514.59
|
| Rate for Payer: PACE SWMI |
$7,910.09
|
| Rate for Payer: PHP Commercial |
$8,701.10
|
| Rate for Payer: PHP Medicare Advantage |
$7,910.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11,743.93
|
| Rate for Payer: Priority Health Medicare |
$7,910.09
|
| Rate for Payer: Priority Health Narrow Network |
$9,395.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7,910.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,910.09
|
| Rate for Payer: UHC Exchange |
$12,260.64
|
| Rate for Payer: UHCCP DNSP |
$7,910.09
|
| Rate for Payer: VA VA |
$7,910.09
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
|
IP
|
$23,327.11
|
|
|
Service Code
|
MSDRG 256
|
| Min. Negotiated Rate |
$13,282.38 |
| Max. Negotiated Rate |
$23,327.11 |
| Rate for Payer: Aetna Medicare |
$13,981.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,476.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,476.81
|
| Rate for Payer: BCBS MAPPO |
$13,981.45
|
| Rate for Payer: BCN Medicare Advantage |
$13,981.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,981.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,981.45
|
| Rate for Payer: Mclaren Medicare |
$13,981.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14,680.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,078.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$15,379.59
|
| Rate for Payer: PACE Medicare |
$13,282.38
|
| Rate for Payer: PACE SWMI |
$13,981.45
|
| Rate for Payer: PHP Commercial |
$15,379.59
|
| Rate for Payer: PHP Medicare Advantage |
$13,981.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23,327.11
|
| Rate for Payer: Priority Health Medicare |
$13,981.45
|
| Rate for Payer: Priority Health Narrow Network |
$18,661.69
|
| Rate for Payer: Railroad Medicare Medicare |
$13,981.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13,981.45
|
| Rate for Payer: UHC Exchange |
$21,671.25
|
| Rate for Payer: UHCCP DNSP |
$13,981.45
|
| Rate for Payer: VA VA |
$13,981.45
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$37,059.04
|
|
|
Service Code
|
MSDRG 255
|
| Min. Negotiated Rate |
$20,120.15 |
| Max. Negotiated Rate |
$37,059.04 |
| Rate for Payer: Aetna Medicare |
$21,179.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,473.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,473.88
|
| Rate for Payer: BCBS MAPPO |
$21,179.10
|
| Rate for Payer: BCN Medicare Advantage |
$21,179.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,179.10
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,179.10
|
| Rate for Payer: Mclaren Medicare |
$21,179.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,238.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,355.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$23,297.01
|
| Rate for Payer: PACE Medicare |
$20,120.15
|
| Rate for Payer: PACE SWMI |
$21,179.10
|
| Rate for Payer: PHP Commercial |
$23,297.01
|
| Rate for Payer: PHP Medicare Advantage |
$21,179.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37,059.04
|
| Rate for Payer: Priority Health Medicare |
$21,179.10
|
| Rate for Payer: Priority Health Narrow Network |
$29,647.23
|
| Rate for Payer: Railroad Medicare Medicare |
$21,179.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21,179.10
|
| Rate for Payer: UHC Exchange |
$32,827.61
|
| Rate for Payer: UHCCP DNSP |
$21,179.10
|
| Rate for Payer: VA VA |
$21,179.10
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,005.52
|
|
|
Service Code
|
MSDRG 257
|
| Min. Negotiated Rate |
$9,138.68 |
| Max. Negotiated Rate |
$15,005.52 |
| Rate for Payer: Aetna Medicare |
$9,619.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,024.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,024.58
|
| Rate for Payer: BCBS MAPPO |
$9,619.66
|
| Rate for Payer: BCN Medicare Advantage |
$9,619.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,619.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,619.66
|
| Rate for Payer: Mclaren Medicare |
$9,619.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,100.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,062.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,581.63
|
| Rate for Payer: PACE Medicare |
$9,138.68
|
| Rate for Payer: PACE SWMI |
$9,619.66
|
| Rate for Payer: PHP Commercial |
$10,581.63
|
| Rate for Payer: PHP Medicare Advantage |
$9,619.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$15,005.52
|
| Rate for Payer: Priority Health Medicare |
$9,619.66
|
| Rate for Payer: Priority Health Narrow Network |
$12,004.41
|
| Rate for Payer: Railroad Medicare Medicare |
$9,619.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,619.66
|
| Rate for Payer: UHC Exchange |
$14,910.47
|
| Rate for Payer: UHCCP DNSP |
$9,619.66
|
| Rate for Payer: VA VA |
$9,619.66
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$16,332.70
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$14,766.71 |
| Max. Negotiated Rate |
$16,332.70 |
| Rate for Payer: BCBS Complete |
$16,332.70
|
| Rate for Payer: Mclaren Medicaid |
$15,554.95
|
| Rate for Payer: Meridian Medicaid |
$16,332.70
|
| Rate for Payer: PHP Medicaid |
$14,766.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,554.95
|
| Rate for Payer: UHC Medicaid |
$15,554.95
|
| Rate for Payer: UHCCP Medicaid |
$15,554.95
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$6,414.61
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$5,799.57 |
| Max. Negotiated Rate |
$6,414.61 |
| Rate for Payer: BCBS Complete |
$6,414.61
|
| Rate for Payer: Mclaren Medicaid |
$6,109.15
|
| Rate for Payer: Meridian Medicaid |
$6,414.61
|
| Rate for Payer: PHP Medicaid |
$5,799.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,109.15
|
| Rate for Payer: UHC Medicaid |
$6,109.15
|
| Rate for Payer: UHCCP Medicaid |
$6,109.15
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$10,592.74
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$9,577.10 |
| Max. Negotiated Rate |
$10,592.74 |
| Rate for Payer: BCBS Complete |
$10,592.74
|
| Rate for Payer: Mclaren Medicaid |
$10,088.32
|
| Rate for Payer: Meridian Medicaid |
$10,592.74
|
| Rate for Payer: PHP Medicaid |
$9,577.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,088.32
|
| Rate for Payer: UHC Medicaid |
$10,088.32
|
| Rate for Payer: UHCCP Medicaid |
$10,088.32
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$7,206.96
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$6,515.96 |
| Max. Negotiated Rate |
$7,206.96 |
| Rate for Payer: BCBS Complete |
$7,206.96
|
| Rate for Payer: Mclaren Medicaid |
$6,863.77
|
| Rate for Payer: Meridian Medicaid |
$7,206.96
|
| Rate for Payer: PHP Medicaid |
$6,515.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,863.77
|
| Rate for Payer: UHC Medicaid |
$6,863.77
|
| Rate for Payer: UHCCP Medicaid |
$6,863.77
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$24,661.15
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$13,946.66 |
| Max. Negotiated Rate |
$24,661.15 |
| Rate for Payer: Aetna Medicare |
$14,680.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,350.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,350.86
|
| Rate for Payer: BCBS MAPPO |
$14,680.69
|
| Rate for Payer: BCN Medicare Advantage |
$14,680.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,680.69
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,680.69
|
| Rate for Payer: Mclaren Medicare |
$14,680.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,414.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,882.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,148.76
|
| Rate for Payer: PACE Medicare |
$13,946.66
|
| Rate for Payer: PACE SWMI |
$14,680.69
|
| Rate for Payer: PHP Commercial |
$16,148.76
|
| Rate for Payer: PHP Medicare Advantage |
$14,680.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24,661.15
|
| Rate for Payer: Priority Health Medicare |
$14,680.69
|
| Rate for Payer: Priority Health Narrow Network |
$19,728.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14,680.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,680.69
|
| Rate for Payer: UHC Exchange |
$22,755.07
|
| Rate for Payer: UHCCP DNSP |
$14,680.69
|
| Rate for Payer: VA VA |
$14,680.69
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,831.03
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$9,051.80 |
| Max. Negotiated Rate |
$14,831.03 |
| Rate for Payer: Aetna Medicare |
$9,528.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,910.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,910.26
|
| Rate for Payer: BCBS MAPPO |
$9,528.21
|
| Rate for Payer: BCN Medicare Advantage |
$9,528.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,528.21
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,528.21
|
| Rate for Payer: Mclaren Medicare |
$9,528.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,004.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,957.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,481.03
|
| Rate for Payer: PACE Medicare |
$9,051.80
|
| Rate for Payer: PACE SWMI |
$9,528.21
|
| Rate for Payer: PHP Commercial |
$10,481.03
|
| Rate for Payer: PHP Medicare Advantage |
$9,528.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,831.03
|
| Rate for Payer: Priority Health Medicare |
$9,528.21
|
| Rate for Payer: Priority Health Narrow Network |
$11,864.83
|
| Rate for Payer: Railroad Medicare Medicare |
$9,528.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,528.21
|
| Rate for Payer: UHC Exchange |
$14,768.73
|
| Rate for Payer: UHCCP DNSP |
$9,528.21
|
| Rate for Payer: VA VA |
$9,528.21
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$14,807.68
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$9,040.15 |
| Max. Negotiated Rate |
$14,807.68 |
| Rate for Payer: Aetna Medicare |
$9,515.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,894.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,894.94
|
| Rate for Payer: BCBS MAPPO |
$9,515.95
|
| Rate for Payer: BCN Medicare Advantage |
$9,515.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,515.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,515.95
|
| Rate for Payer: Mclaren Medicare |
$9,515.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,991.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,943.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,467.55
|
| Rate for Payer: PACE Medicare |
$9,040.15
|
| Rate for Payer: PACE SWMI |
$9,515.95
|
| Rate for Payer: PHP Commercial |
$10,467.55
|
| Rate for Payer: PHP Medicare Advantage |
$9,515.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14,807.68
|
| Rate for Payer: Priority Health Medicare |
$9,515.95
|
| Rate for Payer: Priority Health Narrow Network |
$11,846.14
|
| Rate for Payer: Railroad Medicare Medicare |
$9,515.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,515.95
|
| Rate for Payer: UHC Exchange |
$14,749.72
|
| Rate for Payer: UHCCP DNSP |
$9,515.95
|
| Rate for Payer: VA VA |
$9,515.95
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$6,380.82
|
|
|
Service Code
|
APR-DRG 4653
|
| Min. Negotiated Rate |
$5,769.02 |
| Max. Negotiated Rate |
$6,380.82 |
| Rate for Payer: BCBS Complete |
$6,380.82
|
| Rate for Payer: Mclaren Medicaid |
$6,076.97
|
| Rate for Payer: Meridian Medicaid |
$6,380.82
|
| Rate for Payer: PHP Medicaid |
$5,769.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,076.97
|
| Rate for Payer: UHC Medicaid |
$6,076.97
|
| Rate for Payer: UHCCP Medicaid |
$6,076.97
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$4,930.16
|
|
|
Service Code
|
APR-DRG 4652
|
| Min. Negotiated Rate |
$4,457.46 |
| Max. Negotiated Rate |
$4,930.16 |
| Rate for Payer: BCBS Complete |
$4,930.16
|
| Rate for Payer: Mclaren Medicaid |
$4,695.39
|
| Rate for Payer: Meridian Medicaid |
$4,930.16
|
| Rate for Payer: PHP Medicaid |
$4,457.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,695.39
|
| Rate for Payer: UHC Medicaid |
$4,695.39
|
| Rate for Payer: UHCCP Medicaid |
$4,695.39
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$3,222.29
|
|
|
Service Code
|
APR-DRG 4651
|
| Min. Negotiated Rate |
$2,913.34 |
| Max. Negotiated Rate |
$3,222.29 |
| Rate for Payer: BCBS Complete |
$3,222.29
|
| Rate for Payer: Mclaren Medicaid |
$3,068.85
|
| Rate for Payer: Meridian Medicaid |
$3,222.29
|
| Rate for Payer: PHP Medicaid |
$2,913.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,068.85
|
| Rate for Payer: UHC Medicaid |
$3,068.85
|
| Rate for Payer: UHCCP Medicaid |
$3,068.85
|
|
|
URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION
|
Facility
|
IP
|
$11,885.90
|
|
|
Service Code
|
APR-DRG 4654
|
| Min. Negotiated Rate |
$10,746.28 |
| Max. Negotiated Rate |
$11,885.90 |
| Rate for Payer: BCBS Complete |
$11,885.90
|
| Rate for Payer: Mclaren Medicaid |
$11,319.91
|
| Rate for Payer: Meridian Medicaid |
$11,885.90
|
| Rate for Payer: PHP Medicaid |
$10,746.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,319.91
|
| Rate for Payer: UHC Medicaid |
$11,319.91
|
| Rate for Payer: UHCCP Medicaid |
$11,319.91
|
|
|
URINARY STONES WITH MCC
|
Facility
|
IP
|
$18,471.82
|
|
|
Service Code
|
MSDRG 693
|
| Min. Negotiated Rate |
$10,864.70 |
| Max. Negotiated Rate |
$18,471.82 |
| Rate for Payer: Aetna Medicare |
$11,436.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,295.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,295.66
|
| Rate for Payer: BCBS MAPPO |
$11,436.53
|
| Rate for Payer: BCN Medicare Advantage |
$11,436.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,436.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,436.53
|
| Rate for Payer: Mclaren Medicare |
$11,436.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,008.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,152.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,580.18
|
| Rate for Payer: PACE Medicare |
$10,864.70
|
| Rate for Payer: PACE SWMI |
$11,436.53
|
| Rate for Payer: PHP Commercial |
$12,580.18
|
| Rate for Payer: PHP Medicare Advantage |
$11,436.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$18,471.82
|
| Rate for Payer: Priority Health Medicare |
$11,436.53
|
| Rate for Payer: Priority Health Narrow Network |
$14,777.45
|
| Rate for Payer: Railroad Medicare Medicare |
$11,436.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,436.53
|
| Rate for Payer: UHC Exchange |
$17,726.62
|
| Rate for Payer: UHCCP DNSP |
$11,436.53
|
| Rate for Payer: VA VA |
$11,436.53
|
|
|
URINARY STONES WITHOUT MCC
|
Facility
|
IP
|
$11,444.69
|
|
|
Service Code
|
MSDRG 694
|
| Min. Negotiated Rate |
$7,014.49 |
| Max. Negotiated Rate |
$11,444.69 |
| Rate for Payer: Aetna Medicare |
$7,383.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,229.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,229.59
|
| Rate for Payer: BCBS MAPPO |
$7,383.67
|
| Rate for Payer: BCN Medicare Advantage |
$7,383.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,383.67
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,383.67
|
| Rate for Payer: Mclaren Medicare |
$7,383.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,752.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,491.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,122.04
|
| Rate for Payer: PACE Medicare |
$7,014.49
|
| Rate for Payer: PACE SWMI |
$7,383.67
|
| Rate for Payer: PHP Commercial |
$8,122.04
|
| Rate for Payer: PHP Medicare Advantage |
$7,383.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$10,739.62
|
| Rate for Payer: Priority Health Medicare |
$7,383.67
|
| Rate for Payer: Priority Health Narrow Network |
$8,591.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7,383.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,383.67
|
| Rate for Payer: UHC Exchange |
$11,444.69
|
| Rate for Payer: UHCCP DNSP |
$7,383.67
|
| Rate for Payer: VA VA |
$7,383.67
|
|
