|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$22,020.49
|
|
|
Service Code
|
MS-DRG 811
|
| Min. Negotiated Rate |
$10,071.11 |
| Max. Negotiated Rate |
$22,020.49 |
| Rate for Payer: Aetna Medicare |
$11,025.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,251.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,251.46
|
| Rate for Payer: BCBS MAPPO |
$10,601.17
|
| Rate for Payer: BCBS Trust/PPO |
$22,020.49
|
| Rate for Payer: BCN Medicare Advantage |
$10,601.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,601.17
|
| Rate for Payer: Mclaren Medicare |
$10,601.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,131.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,191.35
|
| Rate for Payer: PACE Medicare |
$10,071.11
|
| Rate for Payer: PACE SWMI |
$10,601.17
|
| Rate for Payer: PHP Medicare Advantage |
$10,601.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,141.55
|
| Rate for Payer: Priority Health Medicare |
$10,601.17
|
| Rate for Payer: Priority Health Narrow Network |
$16,113.24
|
| Rate for Payer: Railroad Medicare Medicare |
$10,601.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,410.51
|
| Rate for Payer: UHC Core |
$13,137.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,601.17
|
| Rate for Payer: UHC Exchange |
$14,071.09
|
| Rate for Payer: UHC Medicare Advantage |
$10,919.21
|
| Rate for Payer: VA VA |
$10,601.17
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$15,167.08
|
|
|
Service Code
|
MS-DRG 812
|
| Min. Negotiated Rate |
$6,630.41 |
| Max. Negotiated Rate |
$15,167.08 |
| Rate for Payer: Aetna Medicare |
$7,258.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,724.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,724.22
|
| Rate for Payer: BCBS MAPPO |
$6,979.38
|
| Rate for Payer: BCBS Trust/PPO |
$15,167.08
|
| Rate for Payer: BCN Medicare Advantage |
$6,979.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,979.38
|
| Rate for Payer: Mclaren Medicare |
$6,979.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,328.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,026.29
|
| Rate for Payer: PACE Medicare |
$6,630.41
|
| Rate for Payer: PACE SWMI |
$6,979.38
|
| Rate for Payer: PHP Medicare Advantage |
$6,979.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,924.97
|
| Rate for Payer: Priority Health Medicare |
$6,979.38
|
| Rate for Payer: Priority Health Narrow Network |
$10,339.98
|
| Rate for Payer: Railroad Medicare Medicare |
$6,979.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,739.28
|
| Rate for Payer: UHC Core |
$8,430.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,979.38
|
| Rate for Payer: UHC Exchange |
$9,029.52
|
| Rate for Payer: UHC Medicare Advantage |
$7,188.76
|
| Rate for Payer: VA VA |
$6,979.38
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$445.98 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.58
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$445.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$48.91
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.81 |
| Max. Negotiated Rate |
$44.02 |
| Rate for Payer: Aetna Commercial |
$41.57
|
| Rate for Payer: Aetna Commercial |
$58.86
|
| Rate for Payer: Aetna Commercial |
$405.10
|
| Rate for Payer: Aetna Commercial |
$44.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.93
|
| Rate for Payer: Cash Price |
$41.76
|
| Rate for Payer: Cash Price |
$381.27
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cash Price |
$55.40
|
| Rate for Payer: Cofinity Commercial |
$409.87
|
| Rate for Payer: Cofinity Commercial |
$333.61
|
| Rate for Payer: Cofinity Commercial |
$34.24
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$36.54
|
| Rate for Payer: Cofinity Commercial |
$44.89
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$59.56
|
| Rate for Payer: Healthscope Commercial |
$428.93
|
| Rate for Payer: Healthscope Commercial |
$46.98
|
| Rate for Payer: Healthscope Commercial |
$62.32
|
| Rate for Payer: Healthscope Commercial |
$44.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.10
|
| Rate for Payer: PHP Commercial |
$405.10
|
| Rate for Payer: PHP Commercial |
$44.37
|
| Rate for Payer: PHP Commercial |
$41.57
|
| Rate for Payer: PHP Commercial |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.54
|
| Rate for Payer: Priority Health SBD |
$300.25
|
| Rate for Payer: Priority Health SBD |
$43.63
|
| Rate for Payer: Priority Health SBD |
$30.81
|
| Rate for Payer: Priority Health SBD |
$32.89
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$476.59
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna Commercial |
$405.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.78
|
| Rate for Payer: BCBS Complete |
$190.64
|
| Rate for Payer: BCBS Trust/PPO |
$42.25
|
| Rate for Payer: Cash Price |
$381.27
|
| Rate for Payer: Cash Price |
$381.27
|
| Rate for Payer: Cofinity Commercial |
$333.61
|
| Rate for Payer: Cofinity Commercial |
$409.87
|
| Rate for Payer: Healthscope Commercial |
$428.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.10
|
| Rate for Payer: PHP Commercial |
$405.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.61
|
| Rate for Payer: Priority Health SBD |
$300.25
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$31,445.29
|
|
|
Service Code
|
MS-DRG 945
|
| Min. Negotiated Rate |
$10,795.64 |
| Max. Negotiated Rate |
$31,445.29 |
| Rate for Payer: Aetna Medicare |
$11,818.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,204.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,204.79
|
| Rate for Payer: BCBS MAPPO |
$11,363.83
|
| Rate for Payer: BCBS Trust/PPO |
$31,445.29
|
| Rate for Payer: BCN Medicare Advantage |
$11,363.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,363.83
|
| Rate for Payer: Mclaren Medicare |
$11,363.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,932.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,068.40
|
| Rate for Payer: PACE Medicare |
$10,795.64
|
| Rate for Payer: PACE SWMI |
$11,363.83
|
| Rate for Payer: PHP Medicare Advantage |
$11,363.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,661.20
|
| Rate for Payer: Priority Health Medicare |
$11,363.83
|
| Rate for Payer: Priority Health Narrow Network |
$17,328.96
|
| Rate for Payer: Railroad Medicare Medicare |
$11,363.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,025.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,363.83
|
| Rate for Payer: UHC Exchange |
$15,132.74
|
| Rate for Payer: UHC Medicare Advantage |
$11,704.74
|
| Rate for Payer: VA VA |
$11,363.83
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$18,017.36
|
|
|
Service Code
|
MS-DRG 946
|
| Min. Negotiated Rate |
$7,396.69 |
| Max. Negotiated Rate |
$18,017.36 |
| Rate for Payer: Aetna Medicare |
$8,097.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,732.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,732.49
|
| Rate for Payer: BCBS MAPPO |
$7,785.99
|
| Rate for Payer: BCBS Trust/PPO |
$18,017.36
|
| Rate for Payer: BCN Medicare Advantage |
$7,785.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,785.99
|
| Rate for Payer: Mclaren Medicare |
$7,785.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,175.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,953.89
|
| Rate for Payer: PACE Medicare |
$7,396.69
|
| Rate for Payer: PACE SWMI |
$7,785.99
|
| Rate for Payer: PHP Medicare Advantage |
$7,785.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,532.16
|
| Rate for Payer: Priority Health Medicare |
$7,785.99
|
| Rate for Payer: Priority Health Narrow Network |
$11,625.73
|
| Rate for Payer: Railroad Medicare Medicare |
$7,785.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,447.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,785.99
|
| Rate for Payer: UHC Exchange |
$10,152.32
|
| Rate for Payer: UHC Medicare Advantage |
$8,019.57
|
| Rate for Payer: VA VA |
$7,785.99
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.82 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,601.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$846.80
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$5,402.75
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$355.93 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna Medicare |
$1,786.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,147.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,147.49
|
| Rate for Payer: BCBS Complete |
$986.81
|
| Rate for Payer: BCBS MAPPO |
$1,717.99
|
| Rate for Payer: BCBS Trust/PPO |
$827.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,717.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,717.99
|
| Rate for Payer: Mclaren Medicaid |
$939.74
|
| Rate for Payer: Mclaren Medicare |
$1,717.99
|
| Rate for Payer: Meridian Medicaid |
$986.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,803.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,975.69
|
| Rate for Payer: PACE Medicare |
$1,632.09
|
| Rate for Payer: PACE SWMI |
$1,717.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,717.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$939.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,717.99
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,717.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.52
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,717.99
|
| Rate for Payer: UHC Exchange |
$355.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.53
|
| Rate for Payer: VA VA |
$1,717.99
|
|
|
REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION
|
Facility
|
IP
|
$1,918.34
|
|
|
Service Code
|
HCPCS J0248
|
| Hospital Charge Code |
300469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,208.55 |
| Max. Negotiated Rate |
$1,726.51 |
| Rate for Payer: Aetna Commercial |
$1,630.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.92
|
| Rate for Payer: Cash Price |
$1,534.67
|
| Rate for Payer: Cofinity Commercial |
$1,342.84
|
| Rate for Payer: Cofinity Commercial |
$1,649.77
|
| Rate for Payer: Healthscope Commercial |
$1,726.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,630.59
|
| Rate for Payer: PHP Commercial |
$1,630.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,342.84
|
| Rate for Payer: Priority Health SBD |
$1,208.55
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$185.54
|
|
|
Service Code
|
NDC 0143-9391-10
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.89 |
| Max. Negotiated Rate |
$166.99 |
| Rate for Payer: Aetna Commercial |
$157.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.60
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cofinity Commercial |
$129.88
|
| Rate for Payer: Cofinity Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$166.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.71
|
| Rate for Payer: PHP Commercial |
$157.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.88
|
| Rate for Payer: Priority Health SBD |
$116.89
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457-198-00
|
| 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: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.62
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$185.54
|
|
|
Service Code
|
NDC 0143-9391-01
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.89 |
| Max. Negotiated Rate |
$166.99 |
| Rate for Payer: Aetna Commercial |
$157.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.60
|
| Rate for Payer: Cash Price |
$148.43
|
| Rate for Payer: Cofinity Commercial |
$129.88
|
| Rate for Payer: Cofinity Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$166.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.71
|
| Rate for Payer: PHP Commercial |
$157.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.88
|
| Rate for Payer: Priority Health SBD |
$116.89
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
NDC 63323-723-01
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health SBD |
$188.37
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
NDC 63323-723-03
|
| Hospital Charge Code |
18398
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health SBD |
$188.37
|
|
|
REMIFENTANIL 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$229.46
|
|
|
Service Code
|
NDC 67457-198-03
|
| 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: Healthscope Commercial |
$206.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.04
|
| Rate for Payer: PHP Commercial |
$195.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.62
|
| Rate for Payer: Priority Health SBD |
$144.56
|
|
|
REMOVAL AND REPLACEMENT OF ALL COMPONENT(S) OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$57,816.97
|
|
|
Service Code
|
CPT 54410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$845.13 |
| Max. Negotiated Rate |
$57,816.97 |
| Rate for Payer: Aetna Medicare |
$18,666.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,435.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,435.89
|
| Rate for Payer: BCBS Complete |
$10,309.74
|
| Rate for Payer: BCBS MAPPO |
$17,948.71
|
| Rate for Payer: BCBS Trust/PPO |
$9,413.32
|
| Rate for Payer: BCN Medicare Advantage |
$17,948.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,948.71
|
| Rate for Payer: Mclaren Medicaid |
$9,817.94
|
| Rate for Payer: Mclaren Medicare |
$17,948.71
|
| Rate for Payer: Meridian Medicaid |
$10,309.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,846.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,641.02
|
| Rate for Payer: PACE Medicare |
$17,051.27
|
| Rate for Payer: PACE SWMI |
$17,948.71
|
| Rate for Payer: PHP Medicare Advantage |
$17,948.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,817.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,816.97
|
| Rate for Payer: Priority Health Medicare |
$17,948.71
|
| Rate for Payer: Priority Health Narrow Network |
$46,253.58
|
| Rate for Payer: Railroad Medicare Medicare |
$17,948.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.64
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,948.71
|
| Rate for Payer: UHC Exchange |
$845.13
|
| Rate for Payer: UHC Medicare Advantage |
$18,487.17
|
| Rate for Payer: VA VA |
$17,948.71
|
|
|
REMOVAL AND REPLACEMENT OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING PUMP, RESERVOIR, AND CUFF AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$57,816.97
|
|
|
Service Code
|
CPT 53447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$788.48 |
| Max. Negotiated Rate |
$57,816.97 |
| Rate for Payer: Aetna Medicare |
$18,666.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,435.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,435.89
|
| Rate for Payer: BCBS Complete |
$10,309.74
|
| Rate for Payer: BCBS MAPPO |
$17,948.71
|
| Rate for Payer: BCBS Trust/PPO |
$9,413.32
|
| Rate for Payer: BCN Medicare Advantage |
$17,948.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,948.71
|
| Rate for Payer: Mclaren Medicaid |
$9,817.94
|
| Rate for Payer: Mclaren Medicare |
$17,948.71
|
| Rate for Payer: Meridian Medicaid |
$10,309.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,846.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,641.02
|
| Rate for Payer: PACE Medicare |
$17,051.27
|
| Rate for Payer: PACE SWMI |
$17,948.71
|
| Rate for Payer: PHP Medicare Advantage |
$17,948.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,817.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57,816.97
|
| Rate for Payer: Priority Health Medicare |
$17,948.71
|
| Rate for Payer: Priority Health Narrow Network |
$46,253.58
|
| Rate for Payer: Railroad Medicare Medicare |
$17,948.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.33
|
| Rate for Payer: UHC Core |
$10,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,948.71
|
| Rate for Payer: UHC Exchange |
$788.48
|
| Rate for Payer: UHC Medicare Advantage |
$18,487.17
|
| Rate for Payer: VA VA |
$17,948.71
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.30 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Medicare |
$1,500.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,803.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,803.26
|
| Rate for Payer: BCBS Complete |
$828.64
|
| Rate for Payer: BCBS MAPPO |
$1,442.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,442.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,442.61
|
| Rate for Payer: Mclaren Medicaid |
$789.11
|
| Rate for Payer: Mclaren Medicare |
$1,442.61
|
| Rate for Payer: Meridian Medicaid |
$828.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,514.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,659.00
|
| Rate for Payer: PACE Medicare |
$1,370.48
|
| Rate for Payer: PACE SWMI |
$1,442.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.11
|
| Rate for Payer: Priority Health Medicare |
$1,442.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,442.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.73
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,442.61
|
| Rate for Payer: UHC Exchange |
$94.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,485.89
|
| Rate for Payer: VA VA |
$1,442.61
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$60.08
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$60.08
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.04
|
| Rate for Payer: BCBS Complete |
$31.26
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS Trust/PPO |
$39.36
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Mclaren Medicaid |
$29.77
|
| Rate for Payer: Mclaren Medicare |
$54.43
|
| Rate for Payer: Meridian Medicaid |
$31.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.59
|
| Rate for Payer: PACE Medicare |
$51.71
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.33
|
| Rate for Payer: Priority Health Medicare |
$54.43
|
| Rate for Payer: Priority Health Narrow Network |
$138.66
|
| Rate for Payer: Railroad Medicare Medicare |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$15.72
|
| Rate for Payer: UHC Medicare Advantage |
$56.06
|
| Rate for Payer: VA VA |
$54.43
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$71.38 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.16
|
| Rate for Payer: BCBS Complete |
$203.64
|
| Rate for Payer: BCBS MAPPO |
$354.53
|
| Rate for Payer: BCBS Trust/PPO |
$290.77
|
| Rate for Payer: BCN Medicare Advantage |
$354.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.53
|
| Rate for Payer: Mclaren Medicaid |
$193.93
|
| Rate for Payer: Mclaren Medicare |
$354.53
|
| Rate for Payer: Meridian Medicaid |
$203.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.71
|
| Rate for Payer: PACE Medicare |
$336.80
|
| Rate for Payer: PACE SWMI |
$354.53
|
| Rate for Payer: PHP Medicare Advantage |
$354.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.03
|
| Rate for Payer: Priority Health Medicare |
$354.53
|
| Rate for Payer: Priority Health Narrow Network |
$676.02
|
| Rate for Payer: Railroad Medicare Medicare |
$354.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.52
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$71.38
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS WITHOUT REPLACEMENT OF PROSTHESIS
|
Facility
|
OP
|
$9,610.69
|
|
|
Service Code
|
CPT 54406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$716.44 |
| Max. Negotiated Rate |
$9,610.69 |
| Rate for Payer: Aetna Medicare |
$3,226.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,877.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,877.45
|
| Rate for Payer: BCBS Complete |
$1,781.77
|
| Rate for Payer: BCBS MAPPO |
$3,101.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,281.32
|
| Rate for Payer: BCN Medicare Advantage |
$3,101.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,101.96
|
| Rate for Payer: Mclaren Medicaid |
$1,696.77
|
| Rate for Payer: Mclaren Medicare |
$3,101.96
|
| Rate for Payer: Meridian Medicaid |
$1,781.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,257.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,567.25
|
| Rate for Payer: PACE Medicare |
$2,946.86
|
| Rate for Payer: PACE SWMI |
$3,101.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,101.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,610.69
|
| Rate for Payer: Priority Health Medicare |
$3,101.96
|
| Rate for Payer: Priority Health Narrow Network |
$7,688.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,101.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.08
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,101.96
|
| Rate for Payer: UHC Exchange |
$716.44
|
| Rate for Payer: UHC Medicare Advantage |
$3,195.02
|
| Rate for Payer: VA VA |
$3,101.96
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.61 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Medicare |
$1,092.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,312.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,312.52
|
| Rate for Payer: BCBS Complete |
$603.13
|
| Rate for Payer: BCBS MAPPO |
$1,050.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,196.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,050.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,050.02
|
| Rate for Payer: Mclaren Medicaid |
$574.36
|
| Rate for Payer: Mclaren Medicare |
$1,050.02
|
| Rate for Payer: Meridian Medicaid |
$603.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,102.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,207.52
|
| Rate for Payer: PACE Medicare |
$997.52
|
| Rate for Payer: PACE SWMI |
$1,050.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,050.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$574.36
|
| Rate for Payer: Priority Health Medicare |
$1,050.02
|
| Rate for Payer: Railroad Medicare Medicare |
$1,050.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.17
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,050.02
|
| Rate for Payer: UHC Exchange |
$225.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.52
|
| Rate for Payer: VA VA |
$1,050.02
|
|
