|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$72,016.23
|
|
|
Service Code
|
APR-DRG 1611
|
| Min. Negotiated Rate |
$68,586.88 |
| Max. Negotiated Rate |
$72,016.23 |
| Rate for Payer: BCBS Complete |
$72,016.23
|
| Rate for Payer: Mclaren Medicaid |
$68,586.88
|
| Rate for Payer: Meridian Medicaid |
$72,016.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$68,586.88
|
| Rate for Payer: UHC Medicaid |
$68,586.88
|
| Rate for Payer: UHCCP Medicaid |
$68,586.88
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$85,449.22
|
|
|
Service Code
|
APR-DRG 1612
|
| Min. Negotiated Rate |
$81,380.21 |
| Max. Negotiated Rate |
$85,449.22 |
| Rate for Payer: BCBS Complete |
$85,449.22
|
| Rate for Payer: Mclaren Medicaid |
$81,380.21
|
| Rate for Payer: Meridian Medicaid |
$85,449.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$81,380.21
|
| Rate for Payer: UHC Medicaid |
$81,380.21
|
| Rate for Payer: UHCCP Medicaid |
$81,380.21
|
|
|
IMPLANTABLE HEART ASSIST SYSTEMS
|
Facility
|
IP
|
$173,742.00
|
|
|
Service Code
|
APR-DRG 1614
|
| Min. Negotiated Rate |
$165,468.58 |
| Max. Negotiated Rate |
$173,742.00 |
| Rate for Payer: BCBS Complete |
$173,742.00
|
| Rate for Payer: Mclaren Medicaid |
$165,468.58
|
| Rate for Payer: Meridian Medicaid |
$173,742.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$165,468.58
|
| Rate for Payer: UHC Medicaid |
$165,468.58
|
| Rate for Payer: UHCCP Medicaid |
$165,468.58
|
|
|
IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (IE, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,542.67
|
|
|
Service Code
|
CPT 15777
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,542.67 |
| Max. Negotiated Rate |
$4,542.67 |
| Rate for Payer: BCBS Trust/PPO |
$4,542.67
|
| Rate for Payer: BCN Commercial |
$4,542.67
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$40,376.46
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$10,990.84 |
| Max. Negotiated Rate |
$40,376.46 |
| Rate for Payer: Aetna Medicare |
$12,032.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,461.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,461.64
|
| Rate for Payer: BCBS MAPPO |
$11,569.31
|
| Rate for Payer: BCBS Trust/PPO |
$40,376.46
|
| Rate for Payer: BCN Commercial |
$40,376.46
|
| Rate for Payer: BCN Medicare Advantage |
$11,569.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,569.31
|
| Rate for Payer: Mclaren Medicare |
$11,569.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,147.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,304.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,726.24
|
| Rate for Payer: Nomi Health Commercial |
$18,345.09
|
| Rate for Payer: PACE Medicare |
$10,990.84
|
| Rate for Payer: PACE SWMI |
$11,569.31
|
| Rate for Payer: PHP Medicare Advantage |
$11,569.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,927.30
|
| Rate for Payer: Priority Health Medicare |
$11,569.31
|
| Rate for Payer: Priority Health Tiered Network |
$18,341.83
|
| Rate for Payer: Railroad Medicare Medicare |
$11,569.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,180.23
|
| Rate for Payer: UHC Core |
$19,393.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,569.31
|
| Rate for Payer: UHC Exchange |
$15,837.93
|
| Rate for Payer: VA VA |
$11,569.31
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$28,588.18
|
|
|
Service Code
|
APR-DRG 4234
|
| Min. Negotiated Rate |
$27,226.84 |
| Max. Negotiated Rate |
$28,588.18 |
| Rate for Payer: BCBS Complete |
$28,588.18
|
| Rate for Payer: Mclaren Medicaid |
$27,226.84
|
| Rate for Payer: Meridian Medicaid |
$28,588.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$27,226.84
|
| Rate for Payer: UHC Medicaid |
$27,226.84
|
| Rate for Payer: UHCCP Medicaid |
$27,226.84
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$10,936.84
|
|
|
Service Code
|
APR-DRG 4233
|
| Min. Negotiated Rate |
$10,416.04 |
| Max. Negotiated Rate |
$10,936.84 |
| Rate for Payer: BCBS Complete |
$10,936.84
|
| Rate for Payer: Mclaren Medicaid |
$10,416.04
|
| Rate for Payer: Meridian Medicaid |
$10,936.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,416.04
|
| Rate for Payer: UHC Medicaid |
$10,416.04
|
| Rate for Payer: UHCCP Medicaid |
$10,416.04
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$3,358.39
|
|
|
Service Code
|
APR-DRG 4231
|
| Min. Negotiated Rate |
$3,198.47 |
| Max. Negotiated Rate |
$3,358.39 |
| Rate for Payer: BCBS Complete |
$3,358.39
|
| Rate for Payer: Mclaren Medicaid |
$3,198.47
|
| Rate for Payer: Meridian Medicaid |
$3,358.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,198.47
|
| Rate for Payer: UHC Medicaid |
$3,198.47
|
| Rate for Payer: UHCCP Medicaid |
$3,198.47
|
|
|
INBORN ERRORS OF METABOLISM
|
Facility
|
IP
|
$7,761.91
|
|
|
Service Code
|
APR-DRG 4232
|
| Min. Negotiated Rate |
$7,392.29 |
| Max. Negotiated Rate |
$7,761.91 |
| Rate for Payer: BCBS Complete |
$7,761.91
|
| Rate for Payer: Mclaren Medicaid |
$7,392.29
|
| Rate for Payer: Meridian Medicaid |
$7,761.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,392.29
|
| Rate for Payer: UHC Medicaid |
$7,392.29
|
| Rate for Payer: UHCCP Medicaid |
$7,392.29
|
|
|
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA, THIGH OR KNEE REGION
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 27301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,180.96 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.96
|
| Rate for Payer: BCN Commercial |
$1,180.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS OR HEMATOMA
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 27603
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,180.96 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,180.96
|
| Rate for Payer: BCN Commercial |
$1,180.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 10061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 10060
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$193.02
|
| Rate for Payer: BCN Commercial |
$193.02
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE
|
Facility
|
OP
|
$646.50
|
|
|
Service Code
|
CPT 10060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$193.02
|
| Rate for Payer: BCN Commercial |
$193.02
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Mclaren Medicaid |
$104.55
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: VA VA |
$199.91
|
|
|
INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUID COLLECTION
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 10140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,236.38
|
| Rate for Payer: BCN Commercial |
$1,236.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 10081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$535.08
|
| Rate for Payer: BCN Commercial |
$535.08
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
|
Facility
|
OP
|
$2,996.60
|
|
|
Service Code
|
CPT 46050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.62 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$733.96
|
| Rate for Payer: BCN Commercial |
$733.96
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; COMPLICATED
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 10121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,149.30
|
| Rate for Payer: BCN Commercial |
$1,149.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$860.68
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES; SIMPLE
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 10120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
INCISION OF LINGUAL FRENUM (FRENOTOMY)
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 41010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$726.30 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$726.30
|
| Rate for Payer: BCN Commercial |
$726.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$808.56
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 46083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$152.76
|
| Rate for Payer: BCN Commercial |
$152.76
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$9,070.65
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
198874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,714.51 |
| Max. Negotiated Rate |
$8,163.59 |
| Rate for Payer: Aetna Commercial |
$7,710.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,895.92
|
| Rate for Payer: Cash Price |
$7,256.52
|
| Rate for Payer: Cofinity Advantage |
$6,349.45
|
| Rate for Payer: Cofinity Commercial |
$7,800.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,256.52
|
| Rate for Payer: Healthscope Commercial |
$8,163.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,710.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,802.99
|
| Rate for Payer: PHP Commercial |
$7,710.05
|
| Rate for Payer: Priority Health SBD |
$5,714.51
|
|
|
INCLISIRAN 284 MG/1.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$9,070.65
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
198874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$8,163.59 |
| Rate for Payer: Aetna Commercial |
$7,710.05
|
| Rate for Payer: Aetna Medicare |
$13.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,895.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.76
|
| Rate for Payer: BCBS Complete |
$6.93
|
| Rate for Payer: BCBS MAPPO |
$12.61
|
| Rate for Payer: BCBS Trust/PPO |
$31.81
|
| Rate for Payer: BCN Commercial |
$31.81
|
| Rate for Payer: BCN Medicare Advantage |
$12.61
|
| Rate for Payer: Cash Price |
$7,256.52
|
| Rate for Payer: Cash Price |
$7,256.52
|
| Rate for Payer: Cofinity Advantage |
$6,349.45
|
| Rate for Payer: Cofinity Commercial |
$7,800.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,256.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.61
|
| Rate for Payer: Healthscope Commercial |
$8,163.59
|
| Rate for Payer: Mclaren Medicaid |
$6.60
|
| Rate for Payer: Mclaren Medicare |
$12.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.24
|
| Rate for Payer: Meridian Medicaid |
$13.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,710.05
|
| Rate for Payer: Nomi Health Commercial |
$37.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,802.99
|
| Rate for Payer: PACE Medicare |
$11.98
|
| Rate for Payer: PACE SWMI |
$12.61
|
| Rate for Payer: PHP Commercial |
$7,710.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.84
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health SBD |
$5,714.51
|
| Rate for Payer: Priority Health Tiered Network |
$31.07
|
| Rate for Payer: Railroad Medicare Medicare |
$12.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.94
|
| Rate for Payer: UHC Core |
$20.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.61
|
| Rate for Payer: UHC Exchange |
$20.94
|
| Rate for Payer: UHC Medicaid |
$6.60
|
| Rate for Payer: UHCCP Medicaid |
$6.60
|
| Rate for Payer: VA VA |
$12.61
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 62559051101
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.06 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Advantage |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.31
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health SBD |
$185.06
|
|
|
INDAPAMIDE 2.5 MG TABLET
|
Facility
|
OP
|
$293.75
|
|
|
Service Code
|
NDC 62559051101
|
| Hospital Charge Code |
3879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.44 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna Medicare |
$146.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: BCBS Complete |
$117.50
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Advantage |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.31
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.94
|
| Rate for Payer: UHC Core |
$153.04
|
| Rate for Payer: UHC Exchange |
$115.44
|
|
