|
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
CPT 27372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$399.15 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.06
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$399.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 28190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$130.98 |
| Max. Negotiated Rate |
$1,463.00 |
| Rate for Payer: Aetna Medicare |
$651.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$782.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$782.55
|
| Rate for Payer: BCBS Complete |
$359.60
|
| Rate for Payer: BCBS MAPPO |
$626.04
|
| Rate for Payer: BCBS Trust/PPO |
$405.67
|
| Rate for Payer: BCN Medicare Advantage |
$626.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$626.04
|
| Rate for Payer: Mclaren Medicaid |
$342.44
|
| Rate for Payer: Mclaren Medicare |
$626.04
|
| Rate for Payer: Meridian Medicaid |
$359.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$657.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.95
|
| Rate for Payer: PACE Medicare |
$594.74
|
| Rate for Payer: PACE SWMI |
$626.04
|
| Rate for Payer: PHP Medicare Advantage |
$626.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.44
|
| Rate for Payer: Priority Health Medicare |
$626.04
|
| Rate for Payer: Railroad Medicare Medicare |
$626.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.08
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$626.04
|
| Rate for Payer: UHC Exchange |
$130.98
|
| Rate for Payer: UHC Medicare Advantage |
$644.82
|
| Rate for Payer: VA VA |
$626.04
|
|
|
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$174.20 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$925.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.62
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$174.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
CPT 20680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$416.18 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,023.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.80
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$416.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
REMOVAL OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PUMP, RESERVOIR, AND CUFF
|
Facility
|
OP
|
$14,099.66
|
|
|
Service Code
|
CPT 53446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.65 |
| Max. Negotiated Rate |
$14,099.66 |
| Rate for Payer: Aetna Medicare |
$4,788.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,755.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,755.12
|
| Rate for Payer: BCBS Complete |
$2,644.60
|
| Rate for Payer: BCBS MAPPO |
$4,604.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,510.65
|
| Rate for Payer: BCN Medicare Advantage |
$4,604.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,604.10
|
| Rate for Payer: Mclaren Medicaid |
$2,518.44
|
| Rate for Payer: Mclaren Medicare |
$4,604.10
|
| Rate for Payer: Meridian Medicaid |
$2,644.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,834.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,294.72
|
| Rate for Payer: PACE Medicare |
$4,373.90
|
| Rate for Payer: PACE SWMI |
$4,604.10
|
| Rate for Payer: PHP Medicare Advantage |
$4,604.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,518.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,099.66
|
| Rate for Payer: Priority Health Medicare |
$4,604.10
|
| Rate for Payer: Priority Health Narrow Network |
$11,279.73
|
| Rate for Payer: Railroad Medicare Medicare |
$4,604.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$693.72
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,604.10
|
| Rate for Payer: UHC Exchange |
$630.65
|
| Rate for Payer: UHC Medicare Advantage |
$4,742.22
|
| Rate for Payer: VA VA |
$4,604.10
|
|
|
REMOVAL OF INTACT BREAST IMPLANT
|
Facility
|
OP
|
$10,308.37
|
|
|
Service Code
|
CPT 19328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$547.16 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,920.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.88
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$547.16
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
REMOVAL OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 58301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$296.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$356.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$356.81
|
| Rate for Payer: BCBS Complete |
$163.96
|
| Rate for Payer: BCBS MAPPO |
$285.45
|
| Rate for Payer: BCBS Trust/PPO |
$97.31
|
| Rate for Payer: BCN Medicare Advantage |
$285.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.45
|
| Rate for Payer: Mclaren Medicaid |
$156.14
|
| Rate for Payer: Mclaren Medicare |
$285.45
|
| Rate for Payer: Meridian Medicaid |
$163.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.27
|
| Rate for Payer: PACE Medicare |
$271.18
|
| Rate for Payer: PACE SWMI |
$285.45
|
| Rate for Payer: PHP Medicare Advantage |
$285.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.14
|
| Rate for Payer: Priority Health Medicare |
$285.45
|
| Rate for Payer: Railroad Medicare Medicare |
$285.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.31
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.45
|
| Rate for Payer: UHC Exchange |
$64.83
|
| Rate for Payer: UHC Medicare Advantage |
$294.01
|
| Rate for Payer: VA VA |
$285.45
|
|
|
REMOVAL OF RUPTURED BREAST IMPLANT, INCLUDING IMPLANT CONTENTS (EG, SALINE, SILICONE GEL)
|
Facility
|
OP
|
$10,308.37
|
|
|
Service Code
|
CPT 19330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.20 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,218.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.92
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$637.20
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.64 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.68
|
| Rate for Payer: BCBS Complete |
$102.32
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCBS Trust/PPO |
$81.34
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Mclaren Medicaid |
$97.44
|
| Rate for Payer: Mclaren Medicare |
$178.14
|
| Rate for Payer: Meridian Medicaid |
$102.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.86
|
| Rate for Payer: PACE Medicare |
$169.23
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.49
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: Priority Health Narrow Network |
$433.19
|
| Rate for Payer: Railroad Medicare Medicare |
$178.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.20
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$75.64
|
| Rate for Payer: UHC Medicare Advantage |
$183.48
|
| Rate for Payer: VA VA |
$178.14
|
|
|
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 63662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$851.02 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,148.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,784.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,784.44
|
| Rate for Payer: BCBS Complete |
$1,739.02
|
| Rate for Payer: BCBS MAPPO |
$3,027.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,262.04
|
| Rate for Payer: BCN Medicare Advantage |
$3,027.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,027.55
|
| Rate for Payer: Mclaren Medicaid |
$1,656.07
|
| Rate for Payer: Mclaren Medicare |
$3,027.55
|
| Rate for Payer: Meridian Medicaid |
$1,739.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,178.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,481.68
|
| Rate for Payer: PACE Medicare |
$2,876.17
|
| Rate for Payer: PACE SWMI |
$3,027.55
|
| Rate for Payer: PHP Medicare Advantage |
$3,027.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,656.07
|
| Rate for Payer: Priority Health Medicare |
$3,027.55
|
| Rate for Payer: Railroad Medicare Medicare |
$3,027.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$936.12
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,027.55
|
| Rate for Payer: UHC Exchange |
$851.02
|
| Rate for Payer: UHC Medicare Advantage |
$3,118.38
|
| Rate for Payer: VA VA |
$3,027.55
|
|
|
REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)
|
Facility
|
OP
|
$5,175.07
|
|
|
Service Code
|
CPT 15851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$5,175.07 |
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$48.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,175.07
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,140.06
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.24
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$63.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
REMOVAL OF TISSUE EXPANDER WITHOUT INSERTION OF IMPLANT
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
CPT 11971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$546.50 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$601.15
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$546.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
REMOVAL OF TOTAL OR NEAR TOTAL NON-INFECTED MESH OR OTHER PROSTHESIS AT THE TIME OF INITIAL OR RECURRENT ANTERIOR ABDOMINAL HERNIA REPAIR OR PARASTOMAL HERNIA REPAIR, ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 49623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$192.54 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$356.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.79
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$192.54
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$4,461.38
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$184.02 |
| Max. Negotiated Rate |
$4,461.38 |
| Rate for Payer: Aetna Medicare |
$1,482.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,781.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,781.30
|
| Rate for Payer: BCBS Complete |
$818.54
|
| Rate for Payer: BCBS MAPPO |
$1,425.04
|
| Rate for Payer: BCBS Trust/PPO |
$659.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,425.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,425.04
|
| Rate for Payer: Mclaren Medicaid |
$779.50
|
| Rate for Payer: Mclaren Medicare |
$1,425.04
|
| Rate for Payer: Meridian Medicaid |
$818.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,496.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,638.80
|
| Rate for Payer: PACE Medicare |
$1,353.79
|
| Rate for Payer: PACE SWMI |
$1,425.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,425.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,461.38
|
| Rate for Payer: Priority Health Medicare |
$1,425.04
|
| Rate for Payer: Priority Health Narrow Network |
$3,569.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,425.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.42
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,425.04
|
| Rate for Payer: UHC Exchange |
$184.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.79
|
| Rate for Payer: VA VA |
$1,425.04
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$1,683.01
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.96 |
| Max. Negotiated Rate |
$1,683.01 |
| Rate for Payer: Aetna Medicare |
$581.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.71
|
| Rate for Payer: BCBS Complete |
$321.07
|
| Rate for Payer: BCBS MAPPO |
$558.97
|
| Rate for Payer: BCBS Trust/PPO |
$474.99
|
| Rate for Payer: BCN Medicare Advantage |
$558.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.97
|
| Rate for Payer: Mclaren Medicaid |
$305.76
|
| Rate for Payer: Mclaren Medicare |
$558.97
|
| Rate for Payer: Meridian Medicaid |
$321.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.82
|
| Rate for Payer: PACE Medicare |
$531.02
|
| Rate for Payer: PACE SWMI |
$558.97
|
| Rate for Payer: PHP Medicare Advantage |
$558.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,683.01
|
| Rate for Payer: Priority Health Medicare |
$558.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.40
|
| Rate for Payer: Railroad Medicare Medicare |
$558.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.16
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.97
|
| Rate for Payer: UHC Exchange |
$131.96
|
| Rate for Payer: UHC Medicare Advantage |
$575.74
|
| Rate for Payer: VA VA |
$558.97
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$8,913.25
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$215.46 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,370.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.01
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$215.46
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
REMOVAL OR REVISION OF SLING FOR MALE URINARY INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$5,755.12
|
|
|
Service Code
|
CPT 53442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$770.47 |
| Max. Negotiated Rate |
$5,755.12 |
| Rate for Payer: Aetna Medicare |
$4,788.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5,755.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5,755.12
|
| Rate for Payer: BCBS Complete |
$2,644.60
|
| Rate for Payer: BCBS MAPPO |
$4,604.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,510.65
|
| Rate for Payer: BCN Medicare Advantage |
$4,604.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,604.10
|
| Rate for Payer: Mclaren Medicaid |
$2,518.44
|
| Rate for Payer: Mclaren Medicare |
$4,604.10
|
| Rate for Payer: Meridian Medicaid |
$2,644.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,834.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,294.72
|
| Rate for Payer: PACE Medicare |
$4,373.90
|
| Rate for Payer: PACE SWMI |
$4,604.10
|
| Rate for Payer: PHP Medicare Advantage |
$4,604.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,518.44
|
| Rate for Payer: Priority Health Medicare |
$4,604.10
|
| Rate for Payer: Railroad Medicare Medicare |
$4,604.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.52
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,604.10
|
| Rate for Payer: UHC Exchange |
$770.47
|
| Rate for Payer: UHC Medicare Advantage |
$4,742.22
|
| Rate for Payer: VA VA |
$4,604.10
|
|
|
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,197.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$807.18
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$733.80
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$4,336.79
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$341.19 |
| Max. Negotiated Rate |
$4,336.79 |
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,336.79
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,469.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.31
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$341.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 11983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.85 |
| 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 |
$236.02
|
| 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) |
$110.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.53
|
| Rate for Payer: UHC Exchange |
$100.85
|
| Rate for Payer: UHC Medicare Advantage |
$365.17
|
| Rate for Payer: VA VA |
$354.53
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$13,740.80
|
|
|
Service Code
|
MS-DRG 683
|
| Min. Negotiated Rate |
$6,631.10 |
| Max. Negotiated Rate |
$13,740.80 |
| Rate for Payer: Aetna Medicare |
$7,259.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,725.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,725.12
|
| Rate for Payer: BCBS MAPPO |
$6,980.10
|
| Rate for Payer: BCBS Trust/PPO |
$12,975.57
|
| Rate for Payer: BCN Medicare Advantage |
$6,980.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,980.10
|
| Rate for Payer: Mclaren Medicare |
$6,980.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,329.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,027.12
|
| Rate for Payer: PACE Medicare |
$6,631.10
|
| Rate for Payer: PACE SWMI |
$6,980.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,980.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,926.41
|
| Rate for Payer: Priority Health Medicare |
$6,980.10
|
| Rate for Payer: Priority Health Narrow Network |
$10,341.13
|
| Rate for Payer: Railroad Medicare Medicare |
$6,980.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,740.80
|
| Rate for Payer: UHC Core |
$8,431.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,980.10
|
| Rate for Payer: UHC Exchange |
$9,030.52
|
| Rate for Payer: UHC Medicare Advantage |
$7,189.50
|
| Rate for Payer: VA VA |
$6,980.10
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$23,860.65
|
|
|
Service Code
|
MS-DRG 682
|
| Min. Negotiated Rate |
$10,736.11 |
| Max. Negotiated Rate |
$23,860.65 |
| Rate for Payer: Aetna Medicare |
$11,753.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,126.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,126.46
|
| Rate for Payer: BCBS MAPPO |
$11,301.17
|
| Rate for Payer: BCBS Trust/PPO |
$23,860.65
|
| Rate for Payer: BCN Medicare Advantage |
$11,301.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,301.17
|
| Rate for Payer: Mclaren Medicare |
$11,301.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,866.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,996.35
|
| Rate for Payer: PACE Medicare |
$10,736.11
|
| Rate for Payer: PACE SWMI |
$11,301.17
|
| Rate for Payer: PHP Medicare Advantage |
$11,301.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,536.36
|
| Rate for Payer: Priority Health Medicare |
$11,301.17
|
| Rate for Payer: Priority Health Narrow Network |
$17,229.09
|
| Rate for Payer: Railroad Medicare Medicare |
$11,301.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,893.20
|
| Rate for Payer: UHC Core |
$14,047.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,301.17
|
| Rate for Payer: UHC Exchange |
$15,045.52
|
| Rate for Payer: UHC Medicare Advantage |
$11,640.21
|
| Rate for Payer: VA VA |
$11,301.17
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$9,787.13
|
|
|
Service Code
|
MS-DRG 684
|
| Min. Negotiated Rate |
$4,631.28 |
| Max. Negotiated Rate |
$9,787.13 |
| Rate for Payer: Aetna Medicare |
$5,070.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,093.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,093.79
|
| Rate for Payer: BCBS MAPPO |
$4,875.03
|
| Rate for Payer: BCBS Trust/PPO |
$9,787.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,875.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,875.03
|
| Rate for Payer: Mclaren Medicare |
$4,875.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,118.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,606.28
|
| Rate for Payer: PACE Medicare |
$4,631.28
|
| Rate for Payer: PACE SWMI |
$4,875.03
|
| Rate for Payer: PHP Medicare Advantage |
$4,875.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,731.93
|
| Rate for Payer: Priority Health Medicare |
$4,875.03
|
| Rate for Payer: Priority Health Narrow Network |
$6,985.54
|
| Rate for Payer: Railroad Medicare Medicare |
$4,875.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,282.06
|
| Rate for Payer: UHC Core |
$5,695.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,875.03
|
| Rate for Payer: UHC Exchange |
$6,100.21
|
| Rate for Payer: UHC Medicare Advantage |
$5,021.28
|
| Rate for Payer: VA VA |
$4,875.03
|
|
|
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
|
Facility
|
OP
|
$8,913.25
|
|
|
Service Code
|
CPT 35206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$765.56 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$842.12
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$765.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 35236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$963.99 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$2,042.73
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,060.39
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$963.99
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
