|
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 Commercial |
$219.37
|
| Rate for Payer: Cofinity Commercial |
$269.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$219.37
|
| 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: PHP Commercial |
$266.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.70
|
| 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 Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| 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: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| 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 |
$209.32
|
| 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 Commercial |
$293.04
|
| Rate for Payer: Cofinity Commercial |
$360.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$293.04
|
| 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: PHP Commercial |
$355.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.11
|
| Rate for Payer: Priority Health SBD |
$263.74
|
| Rate for Payer: UMR Bronson Commercial |
$154.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.97
|
|
|
REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS AT THE SAME OPERATIVE SESSION
|
Facility
|
OP
|
$61,984.57
|
|
|
Service Code
|
CPT 54416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$690.10 |
| Max. Negotiated Rate |
$61,984.57 |
| Rate for Payer: Aetna Medicare |
$20,510.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,651.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,651.95
|
| Rate for Payer: BCBS Complete |
$11,099.29
|
| Rate for Payer: BCBS MAPPO |
$19,721.56
|
| Rate for Payer: BCBS Trust/PPO |
$16,890.06
|
| Rate for Payer: BCN Commercial |
$16,890.06
|
| Rate for Payer: BCN Medicare Advantage |
$19,721.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,721.56
|
| Rate for Payer: Mclaren Medicaid |
$10,570.76
|
| Rate for Payer: Mclaren Medicare |
$19,721.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,707.64
|
| Rate for Payer: Meridian Medicaid |
$11,099.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,679.79
|
| Rate for Payer: Nomi Health Commercial |
$41,415.28
|
| Rate for Payer: PACE Medicare |
$18,735.48
|
| Rate for Payer: PACE SWMI |
$19,721.56
|
| Rate for Payer: PHP Medicare Advantage |
$19,721.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,570.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,984.57
|
| Rate for Payer: Priority Health Medicare |
$19,721.56
|
| Rate for Payer: Priority Health Narrow Network |
$49,587.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19,721.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$759.11
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,721.56
|
| Rate for Payer: UHC Exchange |
$690.10
|
| Rate for Payer: UHC Medicare Advantage |
$19,721.56
|
| Rate for Payer: UHCCP Medicaid |
$10,570.76
|
| Rate for Payer: VA VA |
$19,721.56
|
|
|
REMOVAL BY CONTOURING OF BENIGN TUMOR OF FACIAL BONE (EG, FIBROUS DYSPLASIA)
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 21029
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$599.01 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.60
|
| Rate for Payer: BCN Commercial |
$2,005.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.91
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$599.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITH GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,989.41
|
|
|
Service Code
|
CPT 69205
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.89 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.91
|
| Rate for Payer: BCN Commercial |
$1,949.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.98
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$90.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 30310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$196.27 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,464.71
|
| Rate for Payer: BCN Commercial |
$1,464.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.90
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$196.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$107.80
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION, UNILATERAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 69210
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$107.80
|
| Rate for Payer: BCN Commercial |
$107.80
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.54
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$31.40
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$70.62
|
| Rate for Payer: BCN Commercial |
$70.62
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$14.40
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 69209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$60.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$72.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$72.75
|
| Rate for Payer: BCBS Complete |
$32.75
|
| Rate for Payer: BCBS MAPPO |
$58.20
|
| Rate for Payer: BCBS Trust/PPO |
$70.62
|
| Rate for Payer: BCN Commercial |
$70.62
|
| Rate for Payer: BCN Medicare Advantage |
$58.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.20
|
| Rate for Payer: Mclaren Medicaid |
$31.20
|
| Rate for Payer: Mclaren Medicare |
$58.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.11
|
| Rate for Payer: Meridian Medicaid |
$32.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.93
|
| Rate for Payer: Nomi Health Commercial |
$174.60
|
| Rate for Payer: PACE Medicare |
$55.29
|
| Rate for Payer: PACE SWMI |
$58.20
|
| Rate for Payer: PHP Medicare Advantage |
$58.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.90
|
| Rate for Payer: Priority Health Medicare |
$58.20
|
| Rate for Payer: Priority Health Narrow Network |
$146.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.20
|
| Rate for Payer: UHC Exchange |
$14.40
|
| Rate for Payer: UHC Medicare Advantage |
$58.20
|
| Rate for Payer: UHCCP Medicaid |
$31.20
|
| Rate for Payer: VA VA |
$58.20
|
|
|
REMOVAL, IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$2,166.65
|
|
|
Service Code
|
CPT 11976
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$727.88
|
| Rate for Payer: BCN Commercial |
$727.88
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$2,068.08
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.43
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$90.39
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$1,228.82
|
|
|
Service Code
|
CPT 11982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.99 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$521.71
|
| Rate for Payer: BCN Commercial |
$521.71
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.09
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$70.99
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
REMOVAL OF ALL COMPONENTS OF A MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS WITHOUT REPLACEMENT OF PROSTHESIS
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 54406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$703.80 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.03
|
| Rate for Payer: BCN Commercial |
$2,299.03
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$10,137.69
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$774.18
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$703.80
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,811.27
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
REMOVAL OF ANAL SETON, OTHER MARKER
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 46030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$83.63 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$546.02
|
| Rate for Payer: BCN Commercial |
$546.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.99
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$83.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
REMOVAL OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING BILIARY STENTS), INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$2,887.15
|
|
|
Service Code
|
CPT 47537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.81 |
| Max. Negotiated Rate |
$2,887.15 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$674.57
|
| Rate for Payer: BCN Commercial |
$674.57
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$2,755.80
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.89
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$90.81
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$492.37
|
| Rate for Payer: VA VA |
$918.60
|
|
|
REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 59871
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$131.79 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.74
|
| Rate for Payer: BCN Commercial |
$1,660.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$9,345.72
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.97
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$131.79
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
REMOVAL OF COMPLETE CEREBROSPINAL FLUID SHUNT SYSTEM; WITH REPLACEMENT BY SIMILAR OR OTHER SHUNT AT SAME OPERATION
|
Facility
|
OP
|
$4,137.87
|
|
|
Service Code
|
CPT 62258
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,113.11 |
| Max. Negotiated Rate |
$4,137.87 |
| Rate for Payer: BCBS Trust/PPO |
$4,137.87
|
| Rate for Payer: BCN Commercial |
$4,137.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.42
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,113.11
|
|
|
REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA)
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 65436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$275.42 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$275.42
|
| Rate for Payer: BCN Commercial |
$275.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.98
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$345.44
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR
|
Facility
|
OP
|
$19,720.92
|
|
|
Service Code
|
CPT 64570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.11 |
| Max. Negotiated Rate |
$19,720.92 |
| Rate for Payer: Aetna Medicare |
$6,525.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,843.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,843.22
|
| Rate for Payer: BCBS Complete |
$3,531.33
|
| Rate for Payer: BCBS MAPPO |
$6,274.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,428.32
|
| Rate for Payer: BCN Commercial |
$3,428.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,274.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,274.58
|
| Rate for Payer: Mclaren Medicaid |
$3,363.17
|
| Rate for Payer: Mclaren Medicare |
$6,274.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,588.31
|
| Rate for Payer: Meridian Medicaid |
$3,531.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,215.77
|
| Rate for Payer: Nomi Health Commercial |
$18,823.74
|
| Rate for Payer: PACE Medicare |
$5,960.85
|
| Rate for Payer: PACE SWMI |
$6,274.58
|
| Rate for Payer: PHP Medicare Advantage |
$6,274.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,363.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,720.92
|
| Rate for Payer: Priority Health Medicare |
$6,274.58
|
| Rate for Payer: Priority Health Narrow Network |
$15,776.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6,274.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$806.42
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,274.58
|
| Rate for Payer: UHC Exchange |
$733.11
|
| Rate for Payer: UHC Medicare Advantage |
$6,274.58
|
| Rate for Payer: UHCCP Medicaid |
$3,363.17
|
| Rate for Payer: VA VA |
$6,274.58
|
|
|
REMOVAL OF DRUG-DELIVERY DEVICE(S), INTRA-ARTICULAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.03 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$427.35
|
| Rate for Payer: BCN Commercial |
$427.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.03
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$120.03
|
|
|
REMOVAL OF DRUG-DELIVERY DEVICE(S), INTRAMEDULLARY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 20703
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.89 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$357.35
|
| Rate for Payer: BCN Commercial |
$357.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.98
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$100.89
|
|
|
REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 45915
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$219.97 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.71
|
| Rate for Payer: BCN Commercial |
$2,147.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.97
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$219.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$619.21
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 27372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.33 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.25
|
| Rate for Payer: BCN Commercial |
$1,874.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$427.16
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$388.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP
|
Facility
|
OP
|
$1,228.82
|
|
|
Service Code
|
CPT 65220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$178.68
|
| Rate for Payer: BCN Commercial |
$178.68
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.48
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$39.53
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
