|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$313.39
|
|
|
Service Code
|
NDC 67457019805
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: BCBS Complete |
$125.36
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$250.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.04
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.70
|
| Rate for Payer: UHC Core |
$163.28
|
| Rate for Payer: UHC Exchange |
$123.16
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457019899
|
| 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 Advantage |
$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 Commercial |
$266.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.04
|
| Rate for Payer: PHP Commercial |
$266.38
|
| 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
|
$418.63
|
|
|
Service Code
|
NDC 63323072401
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Advantage |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.97
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$184.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$418.63
|
|
|
Service Code
|
NDC 63323072401
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.89 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna Medicare |
$209.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: BCBS Complete |
$167.45
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Advantage |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.97
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.11
|
| Rate for Payer: UHC Core |
$218.11
|
| Rate for Payer: UHC Exchange |
$164.52
|
| Rate for Payer: UMR Bronson Commercial |
$154.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$313.39
|
|
|
Service Code
|
NDC 67457019899
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$282.05 |
| Rate for Payer: Aetna American Axle |
$203.70
|
| Rate for Payer: Aetna Commercial |
$266.38
|
| Rate for Payer: Aetna Medicare |
$156.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.70
|
| Rate for Payer: BCBS Complete |
$125.36
|
| Rate for Payer: Cash Price |
$250.71
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$250.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.04
|
| Rate for Payer: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health SBD |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.70
|
| Rate for Payer: UHC Core |
$163.28
|
| Rate for Payer: UHC Exchange |
$123.16
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.04
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$418.63
|
|
|
Service Code
|
NDC 63323072405
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Advantage |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.97
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$184.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$418.63
|
|
|
Service Code
|
NDC 63323072405
|
| Hospital Charge Code |
18400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$154.89 |
| Max. Negotiated Rate |
$376.77 |
| Rate for Payer: Aetna American Axle |
$272.11
|
| Rate for Payer: Aetna Commercial |
$355.84
|
| Rate for Payer: Aetna Medicare |
$209.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.11
|
| Rate for Payer: BCBS Complete |
$167.45
|
| Rate for Payer: Cash Price |
$334.90
|
| Rate for Payer: Cofinity Advantage |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.90
|
| Rate for Payer: Healthscope Commercial |
$376.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$293.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$334.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$313.97
|
| Rate for Payer: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$272.11
|
| Rate for Payer: UHC Core |
$218.11
|
| Rate for Payer: UHC Exchange |
$164.52
|
| Rate for Payer: UMR Bronson Commercial |
$154.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMIFENTANIL 2 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$313.39
|
|
|
Service Code
|
NDC 67457019805
|
| 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 Advantage |
$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 Commercial |
$266.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.04
|
| Rate for Payer: PHP Commercial |
$266.38
|
| 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 INFLATABLE URETHRAL/BLADDER NECK SPHINCTER INCLUDING PUMP, RESERVOIR, AND CUFF AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$66,785.41
|
|
|
Service Code
|
CPT 53447
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,800.78 |
| Max. Negotiated Rate |
$66,785.41 |
| Rate for Payer: Aetna Medicare |
$21,477.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25,814.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25,814.49
|
| Rate for Payer: BCBS Complete |
$11,341.85
|
| Rate for Payer: BCBS MAPPO |
$20,651.59
|
| Rate for Payer: BCBS Trust/PPO |
$20,404.81
|
| Rate for Payer: BCN Commercial |
$20,404.81
|
| Rate for Payer: BCN Medicare Advantage |
$20,651.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20,651.59
|
| Rate for Payer: Mclaren Medicaid |
$20,651.59
|
| Rate for Payer: Mclaren Medicare |
$20,651.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21,684.17
|
| Rate for Payer: Meridian Medicaid |
$21,684.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23,749.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$22,716.75
|
| Rate for Payer: Nomi Health Commercial |
$61,954.77
|
| Rate for Payer: PACE Medicare |
$19,619.01
|
| Rate for Payer: PACE SWMI |
$20,651.59
|
| Rate for Payer: PHP Medicare Advantage |
$20,651.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,800.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$66,785.41
|
| Rate for Payer: Priority Health Medicare |
$20,651.59
|
| Rate for Payer: Priority Health Tiered Network |
$53,428.33
|
| Rate for Payer: Railroad Medicare Medicare |
$20,651.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20,651.59
|
| Rate for Payer: UHC Medicaid |
$10,800.78
|
| Rate for Payer: UHCCP Medicaid |
$10,800.78
|
| Rate for Payer: VA VA |
$20,651.59
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,355.68
|
| Rate for Payer: BCN Commercial |
$2,355.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$10,683.35
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.51
|
| Rate for Payer: BCN Commercial |
$1,769.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$190.09
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$190.09
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$190.09
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Medicare |
$61.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.47
|
| Rate for Payer: BCBS Complete |
$32.28
|
| Rate for Payer: BCBS MAPPO |
$58.78
|
| Rate for Payer: BCBS Trust/PPO |
$85.31
|
| Rate for Payer: BCN Commercial |
$85.31
|
| Rate for Payer: BCN Medicare Advantage |
$58.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$58.78
|
| Rate for Payer: Mclaren Medicare |
$58.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.72
|
| Rate for Payer: Meridian Medicaid |
$61.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.66
|
| Rate for Payer: Nomi Health Commercial |
$176.34
|
| Rate for Payer: PACE Medicare |
$55.84
|
| Rate for Payer: PACE SWMI |
$58.78
|
| Rate for Payer: PHP Medicare Advantage |
$58.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.09
|
| Rate for Payer: Priority Health Medicare |
$58.78
|
| Rate for Payer: Priority Health Tiered Network |
$152.07
|
| Rate for Payer: Railroad Medicare Medicare |
$58.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$58.78
|
| Rate for Payer: UHC Medicaid |
$30.74
|
| Rate for Payer: UHCCP Medicaid |
$30.74
|
| Rate for Payer: VA VA |
$58.78
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$1,439.47
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$630.28
|
| Rate for Payer: BCN Commercial |
$630.28
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Mclaren Medicaid |
$445.12
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
REMOVAL OF ANAL SETON, OTHER MARKER
|
Facility
|
OP
|
$3,855.91
|
|
|
Service Code
|
CPT 46030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$623.59 |
| Max. Negotiated Rate |
$3,855.91 |
| Rate for Payer: Aetna Medicare |
$1,240.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,490.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,490.42
|
| Rate for Payer: BCBS Complete |
$654.83
|
| Rate for Payer: BCBS MAPPO |
$1,192.34
|
| Rate for Payer: BCBS Trust/PPO |
$659.64
|
| Rate for Payer: BCN Commercial |
$659.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.34
|
| Rate for Payer: Mclaren Medicaid |
$1,192.34
|
| Rate for Payer: Mclaren Medicare |
$1,192.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.96
|
| Rate for Payer: Meridian Medicaid |
$1,251.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,371.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,311.57
|
| Rate for Payer: Nomi Health Commercial |
$3,577.02
|
| Rate for Payer: PACE Medicare |
$1,132.72
|
| Rate for Payer: PACE SWMI |
$1,192.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,855.91
|
| Rate for Payer: Priority Health Medicare |
$1,192.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,084.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,192.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,192.34
|
| Rate for Payer: UHC Medicaid |
$623.59
|
| Rate for Payer: UHCCP Medicaid |
$623.59
|
| Rate for Payer: VA VA |
$1,192.34
|
|
|
REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT OF EYE
|
Facility
|
OP
|
$7,436.46
|
|
|
Service Code
|
CPT 65930
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.65 |
| Max. Negotiated Rate |
$7,436.46 |
| Rate for Payer: Aetna Medicare |
$2,391.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,874.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,874.40
|
| Rate for Payer: BCBS Complete |
$1,262.90
|
| Rate for Payer: BCBS MAPPO |
$2,299.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.78
|
| Rate for Payer: BCN Commercial |
$2,452.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,299.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,299.52
|
| Rate for Payer: Mclaren Medicaid |
$2,299.52
|
| Rate for Payer: Mclaren Medicare |
$2,299.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,414.50
|
| Rate for Payer: Meridian Medicaid |
$2,414.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,644.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,529.47
|
| Rate for Payer: Nomi Health Commercial |
$6,898.56
|
| Rate for Payer: PACE Medicare |
$2,184.54
|
| Rate for Payer: PACE SWMI |
$2,299.52
|
| Rate for Payer: PHP Medicare Advantage |
$2,299.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,202.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$7,436.46
|
| Rate for Payer: Priority Health Medicare |
$2,299.52
|
| Rate for Payer: Priority Health Tiered Network |
$5,949.17
|
| Rate for Payer: Railroad Medicare Medicare |
$2,299.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,299.52
|
| Rate for Payer: UHC Medicaid |
$1,202.65
|
| Rate for Payer: UHCCP Medicaid |
$1,202.65
|
| Rate for Payer: VA VA |
$2,299.52
|
|
|
REMOVAL OF DRUG-DELIVERY DEVICE(S), DEEP (EG, SUBFASCIAL) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$270.01
|
|
|
Service Code
|
CPT 20701
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$270.01 |
| Max. Negotiated Rate |
$270.01 |
| Rate for Payer: BCBS Trust/PPO |
$270.01
|
| Rate for Payer: BCN Commercial |
$270.01
|
|
|
REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
|
Facility
|
OP
|
$1,022.76
|
|
|
Service Code
|
CPT 67938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$1,022.76 |
| Rate for Payer: Aetna Medicare |
$328.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$395.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$395.32
|
| Rate for Payer: BCBS Complete |
$173.69
|
| Rate for Payer: BCBS MAPPO |
$316.26
|
| Rate for Payer: BCBS Trust/PPO |
$232.04
|
| Rate for Payer: BCN Commercial |
$232.04
|
| Rate for Payer: BCN Medicare Advantage |
$316.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.26
|
| Rate for Payer: Mclaren Medicaid |
$316.26
|
| Rate for Payer: Mclaren Medicare |
$316.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.07
|
| Rate for Payer: Meridian Medicaid |
$332.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$347.89
|
| Rate for Payer: Nomi Health Commercial |
$948.78
|
| Rate for Payer: PACE Medicare |
$300.45
|
| Rate for Payer: PACE SWMI |
$316.26
|
| Rate for Payer: PHP Medicare Advantage |
$316.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,022.76
|
| Rate for Payer: Priority Health Medicare |
$316.26
|
| Rate for Payer: Priority Health Tiered Network |
$818.21
|
| Rate for Payer: Railroad Medicare Medicare |
$316.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$316.26
|
| Rate for Payer: UHC Medicaid |
$165.40
|
| Rate for Payer: UHCCP Medicaid |
$165.40
|
| Rate for Payer: VA VA |
$316.26
|
|
|
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 27372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.27
|
| Rate for Payer: BCN Commercial |
$2,264.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; DEEP
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 28192
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,450.08
|
| Rate for Payer: BCN Commercial |
$1,450.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS
|
Facility
|
OP
|
$2,281.79
|
|
|
Service Code
|
CPT 28190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$369.02 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$879.35
|
| Rate for Payer: BCN Commercial |
$879.35
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Mclaren Medicaid |
$705.59
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED
|
Facility
|
OP
|
$9,359.82
|
|
|
Service Code
|
CPT 20525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,513.70 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.27
|
| Rate for Payer: BCN Commercial |
$2,264.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Mclaren Medicaid |
$2,894.27
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE
|
Facility
|
OP
|
$5,321.93
|
|
|
Service Code
|
CPT 20520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.68 |
| Max. Negotiated Rate |
$5,321.93 |
| Rate for Payer: Aetna Medicare |
$1,711.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,057.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,057.07
|
| Rate for Payer: BCBS Complete |
$903.80
|
| Rate for Payer: BCBS MAPPO |
$1,645.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.89
|
| Rate for Payer: BCN Commercial |
$2,031.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,645.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,645.66
|
| Rate for Payer: Mclaren Medicaid |
$1,645.66
|
| Rate for Payer: Mclaren Medicare |
$1,645.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,727.94
|
| Rate for Payer: Meridian Medicaid |
$1,727.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,892.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,810.23
|
| Rate for Payer: Nomi Health Commercial |
$4,936.98
|
| Rate for Payer: PACE Medicare |
$1,563.38
|
| Rate for Payer: PACE SWMI |
$1,645.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,645.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,321.93
|
| Rate for Payer: Priority Health Medicare |
$1,645.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,257.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,645.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,645.66
|
| Rate for Payer: UHC Medicaid |
$860.68
|
| Rate for Payer: UHCCP Medicaid |
$860.68
|
| Rate for Payer: VA VA |
$1,645.66
|
|
|
REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,006.33
|
| Rate for Payer: BCN Commercial |
$2,006.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
