|
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; UP TO TWO-THIRDS OF EYELID, 1 STAGE OR FIRST STAGE
|
Facility
|
OP
|
$6,538.91
|
|
|
Service Code
|
CPT 67971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$697.78 |
| Max. Negotiated Rate |
$6,538.91 |
| Rate for Payer: Aetna Medicare |
$2,160.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,596.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,596.41
|
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: BCBS MAPPO |
$2,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,567.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,077.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,077.13
|
| Rate for Payer: Mclaren Medicaid |
$1,136.19
|
| Rate for Payer: Mclaren Medicare |
$2,077.13
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,180.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,388.70
|
| Rate for Payer: PACE Medicare |
$1,973.27
|
| Rate for Payer: PACE SWMI |
$2,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,077.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.91
|
| Rate for Payer: Priority Health Medicare |
$2,077.13
|
| Rate for Payer: Priority Health Narrow Network |
$5,231.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2,077.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.56
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,077.13
|
| Rate for Payer: UHC Exchange |
$697.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,139.44
|
| Rate for Payer: VA VA |
$2,077.13
|
|
|
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 21196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,396.87 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,171.65
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,536.56
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,396.87
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
RECONSTRUCTION OF NAIL BED WITH GRAFT
|
Facility
|
OP
|
$5,102.91
|
|
|
Service Code
|
CPT 11762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$183.69 |
| Max. Negotiated Rate |
$5,102.91 |
| Rate for Payer: Aetna Medicare |
$1,685.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$212.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,102.91
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$4,082.33
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.06
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,620.98
|
| Rate for Payer: UHC Exchange |
$183.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26587
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,036.03 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,139.63
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$1,036.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECONSTRUCTION, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$277.02 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.72
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$277.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE APPROACH (NUSS PROCEDURE), WITH THORACOSCOPY
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 21743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,573.80 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,171.38
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$48,167.27
|
|
|
Service Code
|
MS-DRG 333
|
| Min. Negotiated Rate |
$15,710.19 |
| Max. Negotiated Rate |
$48,167.27 |
| Rate for Payer: Aetna Medicare |
$17,198.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,671.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,671.30
|
| Rate for Payer: BCBS MAPPO |
$16,537.04
|
| Rate for Payer: BCBS Trust/PPO |
$48,167.27
|
| Rate for Payer: BCN Medicare Advantage |
$16,537.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,537.04
|
| Rate for Payer: Mclaren Medicare |
$16,537.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,363.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,017.60
|
| Rate for Payer: PACE Medicare |
$15,710.19
|
| Rate for Payer: PACE SWMI |
$16,537.04
|
| Rate for Payer: PHP Medicare Advantage |
$16,537.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,840.66
|
| Rate for Payer: Priority Health Medicare |
$16,537.04
|
| Rate for Payer: Priority Health Narrow Network |
$23,872.53
|
| Rate for Payer: Railroad Medicare Medicare |
$16,537.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,720.69
|
| Rate for Payer: UHC Core |
$26,010.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,537.04
|
| Rate for Payer: UHC Exchange |
$20,678.55
|
| Rate for Payer: UHC Medicare Advantage |
$17,033.15
|
| Rate for Payer: VA VA |
$16,537.04
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$68,556.94
|
|
|
Service Code
|
MS-DRG 332
|
| Min. Negotiated Rate |
$27,238.88 |
| Max. Negotiated Rate |
$68,556.94 |
| Rate for Payer: Aetna Medicare |
$29,819.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35,840.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35,840.64
|
| Rate for Payer: BCBS MAPPO |
$28,672.51
|
| Rate for Payer: BCBS Trust/PPO |
$68,556.94
|
| Rate for Payer: BCN Medicare Advantage |
$28,672.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28,672.51
|
| Rate for Payer: Mclaren Medicare |
$28,672.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$30,106.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32,973.39
|
| Rate for Payer: PACE Medicare |
$27,238.88
|
| Rate for Payer: PACE SWMI |
$28,672.51
|
| Rate for Payer: PHP Medicare Advantage |
$28,672.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,055.77
|
| Rate for Payer: Priority Health Medicare |
$28,672.51
|
| Rate for Payer: Priority Health Narrow Network |
$41,644.62
|
| Rate for Payer: Railroad Medicare Medicare |
$28,672.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,335.41
|
| Rate for Payer: UHC Core |
$45,374.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$28,672.51
|
| Rate for Payer: UHC Exchange |
$36,072.85
|
| Rate for Payer: UHC Medicare Advantage |
$29,532.69
|
| Rate for Payer: VA VA |
$28,672.51
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$38,095.56
|
|
|
Service Code
|
MS-DRG 334
|
| Min. Negotiated Rate |
$12,237.24 |
| Max. Negotiated Rate |
$38,095.56 |
| Rate for Payer: Aetna Medicare |
$13,396.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,101.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,101.64
|
| Rate for Payer: BCBS MAPPO |
$12,881.31
|
| Rate for Payer: BCBS Trust/PPO |
$38,095.56
|
| Rate for Payer: BCN Medicare Advantage |
$12,881.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,881.31
|
| Rate for Payer: Mclaren Medicare |
$12,881.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,525.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,813.51
|
| Rate for Payer: PACE Medicare |
$12,237.24
|
| Rate for Payer: PACE SWMI |
$12,881.31
|
| Rate for Payer: PHP Medicare Advantage |
$12,881.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,033.06
|
| Rate for Payer: Priority Health Medicare |
$12,881.31
|
| Rate for Payer: Priority Health Narrow Network |
$18,426.45
|
| Rate for Payer: Railroad Medicare Medicare |
$12,881.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,484.20
|
| Rate for Payer: UHC Core |
$20,076.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,881.31
|
| Rate for Payer: UHC Exchange |
$15,961.11
|
| Rate for Payer: UHC Medicare Advantage |
$13,267.75
|
| Rate for Payer: VA VA |
$12,881.31
|
|
|
RECTAL SENSATION, TONE, AND COMPLIANCE TEST (IE, RESPONSE TO GRADED BALLOON DISTENTION)
|
Facility
|
OP
|
$2,330.79
|
|
|
Service Code
|
CPT 91120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$152.61 |
| Max. Negotiated Rate |
$2,330.79 |
| Rate for Payer: Aetna Medicare |
$290.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$348.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$348.75
|
| Rate for Payer: BCBS Complete |
$160.26
|
| Rate for Payer: BCBS MAPPO |
$279.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,330.79
|
| Rate for Payer: BCN Medicare Advantage |
$279.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.00
|
| Rate for Payer: Mclaren Medicaid |
$152.61
|
| Rate for Payer: Mclaren Medicare |
$279.00
|
| Rate for Payer: Meridian Medicaid |
$160.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$292.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.85
|
| Rate for Payer: PACE Medicare |
$265.05
|
| Rate for Payer: PACE SWMI |
$279.00
|
| Rate for Payer: PHP Medicare Advantage |
$279.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.32
|
| Rate for Payer: Priority Health Medicare |
$279.00
|
| Rate for Payer: Priority Health Narrow Network |
$702.66
|
| Rate for Payer: Railroad Medicare Medicare |
$279.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.28
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.00
|
| Rate for Payer: UHC Exchange |
$491.16
|
| Rate for Payer: UHC Medicare Advantage |
$287.37
|
| Rate for Payer: VA VA |
$279.00
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$25,199.36
|
|
|
Service Code
|
MS-DRG 811
|
| Min. Negotiated Rate |
$10,762.12 |
| Max. Negotiated Rate |
$25,199.36 |
| Rate for Payer: Aetna Medicare |
$11,781.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,160.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,160.69
|
| Rate for Payer: BCBS MAPPO |
$11,328.55
|
| Rate for Payer: BCBS Trust/PPO |
$25,199.36
|
| Rate for Payer: BCN Medicare Advantage |
$11,328.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,328.55
|
| Rate for Payer: Mclaren Medicare |
$11,328.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,894.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,027.83
|
| Rate for Payer: PACE Medicare |
$10,762.12
|
| Rate for Payer: PACE SWMI |
$11,328.55
|
| Rate for Payer: PHP Medicare Advantage |
$11,328.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,141.55
|
| Rate for Payer: Priority Health Medicare |
$11,328.55
|
| Rate for Payer: Priority Health Narrow Network |
$16,113.24
|
| Rate for Payer: Railroad Medicare Medicare |
$11,328.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,410.51
|
| Rate for Payer: UHC Core |
$17,556.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,328.55
|
| Rate for Payer: UHC Exchange |
$13,957.40
|
| Rate for Payer: UHC Medicare Advantage |
$11,668.41
|
| Rate for Payer: VA VA |
$11,328.55
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$17,356.60
|
|
|
Service Code
|
MS-DRG 812
|
| Min. Negotiated Rate |
$7,080.51 |
| Max. Negotiated Rate |
$17,356.60 |
| Rate for Payer: Aetna Medicare |
$7,751.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,316.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,316.46
|
| Rate for Payer: BCBS MAPPO |
$7,453.17
|
| Rate for Payer: BCBS Trust/PPO |
$17,356.60
|
| Rate for Payer: BCN Medicare Advantage |
$7,453.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,453.17
|
| Rate for Payer: Mclaren Medicare |
$7,453.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,825.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,571.15
|
| Rate for Payer: PACE Medicare |
$7,080.51
|
| Rate for Payer: PACE SWMI |
$7,453.17
|
| Rate for Payer: PHP Medicare Advantage |
$7,453.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,924.97
|
| Rate for Payer: Priority Health Medicare |
$7,453.17
|
| Rate for Payer: Priority Health Narrow Network |
$10,339.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,453.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,739.28
|
| Rate for Payer: UHC Core |
$11,265.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,453.17
|
| Rate for Payer: UHC Exchange |
$8,956.56
|
| Rate for Payer: UHC Medicare Advantage |
$7,676.77
|
| Rate for Payer: VA VA |
$7,453.17
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$9,755.07
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$445.98 |
| Max. Negotiated Rate |
$9,755.07 |
| Rate for Payer: Aetna Medicare |
$3,222.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,873.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,873.46
|
| Rate for Payer: BCBS Complete |
$1,779.93
|
| Rate for Payer: BCBS MAPPO |
$3,098.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,445.49
|
| Rate for Payer: BCN Medicare Advantage |
$3,098.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,098.77
|
| Rate for Payer: Mclaren Medicaid |
$1,695.03
|
| Rate for Payer: Mclaren Medicare |
$3,098.77
|
| Rate for Payer: Meridian Medicaid |
$1,779.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,253.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,563.59
|
| Rate for Payer: PACE Medicare |
$2,943.83
|
| Rate for Payer: PACE SWMI |
$3,098.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,098.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,755.07
|
| Rate for Payer: Priority Health Medicare |
$3,098.77
|
| Rate for Payer: Priority Health Narrow Network |
$7,804.06
|
| Rate for Payer: Railroad Medicare Medicare |
$3,098.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.58
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,098.77
|
| Rate for Payer: UHC Exchange |
$445.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,191.73
|
| Rate for Payer: VA VA |
$3,098.77
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$62.08
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.32 |
| Max. Negotiated Rate |
$55.87 |
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$67.57
|
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna American Axle |
$83.74
|
| Rate for Payer: Aetna American Axle |
$309.78
|
| Rate for Payer: Aetna Commercial |
$405.10
|
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Commercial |
$88.37
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$109.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.74
|
| Rate for Payer: Cash Price |
$103.06
|
| Rate for Payer: Cash Price |
$83.17
|
| Rate for Payer: Cash Price |
$381.27
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cofinity Commercial |
$333.61
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$89.41
|
| Rate for Payer: Cofinity Commercial |
$72.77
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Commercial |
$110.79
|
| Rate for Payer: Cofinity Commercial |
$90.18
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$409.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$93.56
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$115.95
|
| Rate for Payer: Healthscope Commercial |
$428.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$88.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$405.10
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$88.37
|
| Rate for Payer: PHP Commercial |
$109.51
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$405.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.46
|
| Rate for Payer: Priority Health SBD |
$65.49
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Priority Health SBD |
$81.16
|
| Rate for Payer: Priority Health SBD |
$300.25
|
| Rate for Payer: UMR Bronson Commercial |
$45.74
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$209.70
|
| Rate for Payer: UMR Bronson Commercial |
$14.77
|
| Rate for Payer: UMR Bronson Commercial |
$56.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.44
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$35,984.73
|
|
|
Service Code
|
MS-DRG 945
|
| Min. Negotiated Rate |
$11,537.36 |
| Max. Negotiated Rate |
$35,984.73 |
| Rate for Payer: Aetna Medicare |
$12,630.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,180.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,180.74
|
| Rate for Payer: BCBS MAPPO |
$12,144.59
|
| Rate for Payer: BCBS Trust/PPO |
$35,984.73
|
| Rate for Payer: BCN Medicare Advantage |
$12,144.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,144.59
|
| Rate for Payer: Mclaren Medicare |
$12,144.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,751.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,966.28
|
| Rate for Payer: PACE Medicare |
$11,537.36
|
| Rate for Payer: PACE SWMI |
$12,144.59
|
| Rate for Payer: PHP Medicare Advantage |
$12,144.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,661.20
|
| Rate for Payer: Priority Health Medicare |
$12,144.59
|
| Rate for Payer: Priority Health Narrow Network |
$17,328.96
|
| Rate for Payer: Railroad Medicare Medicare |
$12,144.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23,025.91
|
| Rate for Payer: UHC Core |
$18,880.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,144.59
|
| Rate for Payer: UHC Exchange |
$15,010.47
|
| Rate for Payer: UHC Medicare Advantage |
$12,508.93
|
| Rate for Payer: VA VA |
$12,144.59
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,618.34
|
|
|
Service Code
|
MS-DRG 946
|
| Min. Negotiated Rate |
$7,900.43 |
| Max. Negotiated Rate |
$20,618.34 |
| Rate for Payer: Aetna Medicare |
$8,648.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,395.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,395.30
|
| Rate for Payer: BCBS MAPPO |
$8,316.24
|
| Rate for Payer: BCBS Trust/PPO |
$20,618.34
|
| Rate for Payer: BCN Medicare Advantage |
$8,316.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,316.24
|
| Rate for Payer: Mclaren Medicare |
$8,316.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,732.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,563.68
|
| Rate for Payer: PACE Medicare |
$7,900.43
|
| Rate for Payer: PACE SWMI |
$8,316.24
|
| Rate for Payer: PHP Medicare Advantage |
$8,316.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,532.16
|
| Rate for Payer: Priority Health Medicare |
$8,316.24
|
| Rate for Payer: Priority Health Narrow Network |
$11,625.73
|
| Rate for Payer: Railroad Medicare Medicare |
$8,316.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,447.73
|
| Rate for Payer: UHC Core |
$12,666.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,316.24
|
| Rate for Payer: UHC Exchange |
$10,070.29
|
| Rate for Payer: UHC Medicare Advantage |
$8,565.73
|
| Rate for Payer: VA VA |
$8,316.24
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.82 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$4,450.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$846.80
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$769.82
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
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 |
$1,784.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,415.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.52
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$355.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: VA VA |
$1,716.23
|
|
|
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 |
$844.07 |
| Max. Negotiated Rate |
$1,726.51 |
| Rate for Payer: Aetna American Axle |
$1,246.92
|
| 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: Encore Health Key Benefits Commercial |
$1,534.67
|
| Rate for Payer: Healthscope Commercial |
$1,726.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,342.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,438.76
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$844.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,438.76
|
|
|
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 |
$131.56 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| 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: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
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 |
$100.96 |
| Max. Negotiated Rate |
$206.51 |
| Rate for Payer: Aetna American Axle |
$149.15
|
| 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: Encore Health Key Benefits Commercial |
$183.57
|
| Rate for Payer: Healthscope Commercial |
$206.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.10
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$100.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.10
|
|
|
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 |
$131.56 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna American Axle |
$194.35
|
| 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: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.25
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.25
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457-198-05
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.89 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.37
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$137.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457-198-99
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$137.89 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.71
|
| Rate for Payer: Healthscope Commercial |
$282.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.38
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.37
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UMR Bronson Commercial |
$137.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$56,445.28
|
|
|
Service Code
|
CPT 54416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.66 |
| Max. Negotiated Rate |
$56,445.28 |
| Rate for Payer: Aetna Medicare |
$18,647.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,412.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,412.82
|
| Rate for Payer: BCBS Complete |
$10,299.14
|
| Rate for Payer: BCBS MAPPO |
$17,930.26
|
| Rate for Payer: BCBS Trust/PPO |
$16,103.99
|
| Rate for Payer: BCN Medicare Advantage |
$17,930.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,930.26
|
| Rate for Payer: Mclaren Medicaid |
$9,807.85
|
| Rate for Payer: Mclaren Medicare |
$17,930.26
|
| Rate for Payer: Meridian Medicaid |
$10,299.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,826.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,619.80
|
| Rate for Payer: PACE Medicare |
$17,033.75
|
| Rate for Payer: PACE SWMI |
$17,930.26
|
| Rate for Payer: PHP Medicare Advantage |
$17,930.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,807.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56,445.28
|
| Rate for Payer: Priority Health Medicare |
$17,930.26
|
| Rate for Payer: Priority Health Narrow Network |
$45,156.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,930.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$775.13
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,930.26
|
| Rate for Payer: UHC Exchange |
$704.66
|
| Rate for Payer: UHC Medicare Advantage |
$18,468.17
|
| Rate for Payer: VA VA |
$17,930.26
|
|
