|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072301
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$281.33
|
|
|
Service Code
|
NDC 00143939101
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$177.24 |
| Max. Negotiated Rate |
$253.20 |
| Rate for Payer: Aetna Commercial |
$239.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.86
|
| Rate for Payer: Cash Price |
$225.06
|
| Rate for Payer: Cofinity Commercial |
$196.93
|
| Rate for Payer: Cofinity Commercial |
$241.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$225.06
|
| Rate for Payer: Healthscope Commercial |
$253.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.13
|
| Rate for Payer: PHP Commercial |
$239.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.86
|
| Rate for Payer: Priority Health SBD |
$177.24
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.32 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019800
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.78 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna Medicare |
$114.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: BCBS Complete |
$91.78
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457019803
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$144.56 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna Commercial |
$195.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.15
|
| Rate for Payer: Cash Price |
$183.57
|
| Rate for Payer: Cofinity Commercial |
$160.62
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$160.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.15
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$238.60
|
|
|
Service Code
|
NDC 63323072303
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.44 |
| Max. Negotiated Rate |
$214.74 |
| Rate for Payer: Aetna Commercial |
$202.81
|
| Rate for Payer: Aetna Medicare |
$119.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.09
|
| Rate for Payer: BCBS Complete |
$95.44
|
| Rate for Payer: Cash Price |
$190.88
|
| Rate for Payer: Cofinity Commercial |
$167.02
|
| Rate for Payer: Cofinity Commercial |
$205.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$190.88
|
| Rate for Payer: Healthscope Commercial |
$214.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.81
|
| Rate for Payer: PHP Commercial |
$202.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.09
|
| Rate for Payer: Priority Health SBD |
$150.32
|
|
|
REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$55,259.25
|
|
|
Service Code
|
CPT 54410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,522.21 |
| Max. Negotiated Rate |
$55,259.25 |
| Rate for Payer: Aetna Medicare |
$20,416.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,538.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,538.72
|
| Rate for Payer: BCBS Complete |
$11,048.32
|
| Rate for Payer: BCBS MAPPO |
$19,630.98
|
| Rate for Payer: BCN Medicare Advantage |
$19,630.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,630.98
|
| Rate for Payer: Mclaren Medicaid |
$10,522.21
|
| Rate for Payer: Mclaren Medicare |
$19,630.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,612.53
|
| Rate for Payer: Meridian Medicaid |
$11,048.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,575.63
|
| Rate for Payer: PACE Medicare |
$18,649.43
|
| Rate for Payer: PACE SWMI |
$19,630.98
|
| Rate for Payer: PHP Medicare Advantage |
$19,630.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,522.21
|
| Rate for Payer: Priority Health Medicare |
$19,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,630.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,259.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,630.98
|
| Rate for Payer: UHC Medicare Advantage |
$19,630.98
|
| Rate for Payer: UHCCP Medicaid |
$11,052.24
|
| Rate for Payer: VA VA |
$19,630.98
|
|
|
REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING PUMP, RESERVOIR, AND CUFF AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$55,259.25
|
|
|
Service Code
|
CPT 53447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,522.21 |
| Max. Negotiated Rate |
$55,259.25 |
| Rate for Payer: Aetna Medicare |
$20,416.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,538.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,538.72
|
| Rate for Payer: BCBS Complete |
$11,048.32
|
| Rate for Payer: BCBS MAPPO |
$19,630.98
|
| Rate for Payer: BCN Medicare Advantage |
$19,630.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,630.98
|
| Rate for Payer: Mclaren Medicaid |
$10,522.21
|
| Rate for Payer: Mclaren Medicare |
$19,630.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,612.53
|
| Rate for Payer: Meridian Medicaid |
$11,048.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,575.63
|
| Rate for Payer: PACE Medicare |
$18,649.43
|
| Rate for Payer: PACE SWMI |
$19,630.98
|
| Rate for Payer: PHP Medicare Advantage |
$19,630.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,522.21
|
| Rate for Payer: Priority Health Medicare |
$19,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,630.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,259.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,630.98
|
| Rate for Payer: UHC Medicare Advantage |
$19,630.98
|
| Rate for Payer: UHCCP Medicaid |
$11,052.24
|
| Rate for Payer: VA VA |
$19,630.98
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$163.07
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$163.07 |
| Rate for Payer: Aetna Medicare |
$60.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.41
|
| Rate for Payer: BCBS Complete |
$32.60
|
| Rate for Payer: BCBS MAPPO |
$57.93
|
| Rate for Payer: BCN Medicare Advantage |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.93
|
| Rate for Payer: Mclaren Medicaid |
$31.05
|
| Rate for Payer: Mclaren Medicare |
$57.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.83
|
| Rate for Payer: Meridian Medicaid |
$32.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.62
|
| Rate for Payer: PACE Medicare |
$55.03
|
| Rate for Payer: PACE SWMI |
$57.93
|
| Rate for Payer: PHP Medicare Advantage |
$57.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.05
|
| Rate for Payer: Priority Health Medicare |
$57.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.93
|
| Rate for Payer: UHC Medicare Advantage |
$57.93
|
| Rate for Payer: UHCCP Medicaid |
$32.61
|
| Rate for Payer: VA VA |
$57.93
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$1,095.50
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$1,095.50 |
| Rate for Payer: Aetna Medicare |
$404.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.18
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| Rate for Payer: Priority Health Medicare |
$389.18
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,095.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$219.11
|
| Rate for Payer: VA VA |
$389.18
|
|
|
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS WITHOUT REPLACEMENT OF PROSTHESIS
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 54406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,893.77
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$647.41
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 27372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 28190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP, RESERVOIR, AND CUFF
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 53446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,791.33
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
REMOVAL OF INTACT BREAST IMPLANT
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 19328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$835.10
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$167.03
|
| Rate for Payer: VA VA |
$296.67
|
|
