|
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 69000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLAR STRUCTURES
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 41800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.38 |
| Max. Negotiated Rate |
$353.86 |
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.14
|
| Rate for Payer: BCBS Complete |
$70.75
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Mclaren Medicaid |
$67.38
|
| Rate for Payer: Mclaren Medicare |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$70.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.57
|
| Rate for Payer: PACE Medicare |
$119.42
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.38
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.71
|
| Rate for Payer: UHC Exchange |
$240.24
|
| Rate for Payer: UHC Medicare Advantage |
$125.71
|
| Rate for Payer: UHCCP Medicaid |
$67.38
|
| Rate for Payer: VA VA |
$125.71
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; COMPLICATED
|
Facility
|
OP
|
$1,398.05
|
|
|
Service Code
|
CPT 40801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.21 |
| Max. Negotiated Rate |
$1,398.05 |
| Rate for Payer: Aetna Medicare |
$516.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$620.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$620.83
|
| Rate for Payer: BCBS Complete |
$279.52
|
| Rate for Payer: BCBS MAPPO |
$496.66
|
| Rate for Payer: BCN Medicare Advantage |
$496.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.66
|
| Rate for Payer: Mclaren Medicaid |
$266.21
|
| Rate for Payer: Mclaren Medicare |
$496.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$521.49
|
| Rate for Payer: Meridian Medicaid |
$279.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$571.16
|
| Rate for Payer: PACE Medicare |
$471.83
|
| Rate for Payer: PACE SWMI |
$496.66
|
| Rate for Payer: PHP Medicare Advantage |
$496.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.21
|
| Rate for Payer: Priority Health Medicare |
$496.66
|
| Rate for Payer: Railroad Medicare Medicare |
$496.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,398.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.66
|
| Rate for Payer: UHC Exchange |
$949.17
|
| Rate for Payer: UHC Medicare Advantage |
$496.66
|
| Rate for Payer: UHCCP Medicaid |
$266.21
|
| Rate for Payer: VA VA |
$496.66
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 40800
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; SIMPLE
|
Facility
|
OP
|
$1,931.58
|
|
|
Service Code
|
CPT 40800
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.80 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Exchange |
$1,311.40
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$367.80
|
| Rate for Payer: VA VA |
$686.20
|
|
|
DRAINAGE OF ABSCESS OF PALATE, UVULA
|
Facility
|
OP
|
$637.52
|
|
|
Service Code
|
CPT 42000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.39 |
| Max. Negotiated Rate |
$637.52 |
| Rate for Payer: Aetna Medicare |
$235.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.10
|
| Rate for Payer: BCBS Complete |
$127.46
|
| Rate for Payer: BCBS MAPPO |
$226.48
|
| Rate for Payer: BCN Medicare Advantage |
$226.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.48
|
| Rate for Payer: Mclaren Medicaid |
$121.39
|
| Rate for Payer: Mclaren Medicare |
$226.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.80
|
| Rate for Payer: Meridian Medicaid |
$127.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.45
|
| Rate for Payer: PACE Medicare |
$215.16
|
| Rate for Payer: PACE SWMI |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$226.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.39
|
| Rate for Payer: Priority Health Medicare |
$226.48
|
| Rate for Payer: Railroad Medicare Medicare |
$226.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.48
|
| Rate for Payer: UHC Exchange |
$432.83
|
| Rate for Payer: UHC Medicare Advantage |
$226.48
|
| Rate for Payer: UHCCP Medicaid |
$121.39
|
| Rate for Payer: VA VA |
$226.48
|
|
|
DRAINAGE OF ABSCESS; PAROTID, COMPLICATED
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
DRAINAGE OF DEEP PERIURETHRAL ABSCESS
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 53040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 26011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 26011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
DRAINAGE OF FINGER ABSCESS; SIMPLE
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 26010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DRAINAGE OF LYMPH NODE ABSCESS OR LYMPHADENITIS; SIMPLE
|
Facility
|
OP
|
$7,857.23
|
|
|
Service Code
|
CPT 38300
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,496.14 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$5,334.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
DRAINAGE OF SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$4,448.08
|
|
|
Service Code
|
CPT 55100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$846.98 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; SMALL (LESS THAN 5% TOTAL BODY SURFACE AREA)
|
Facility
|
OP
|
$545.50
|
|
|
Service Code
|
CPT 16020
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Exchange |
$370.35
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$103.87
|
| Rate for Payer: VA VA |
$193.79
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.67 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna American Axle |
$428.06
|
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: Aetna Medicare |
$329.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.06
|
| Rate for Payer: BCBS Complete |
$263.42
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$460.99
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health SBD |
$414.89
|
| Rate for Payer: UMR Bronson Commercial |
$243.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.90 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna Medicare |
$402.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$563.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.34
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UMR Bronson Commercial |
$297.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$805.14
|
|
|
Service Code
|
NDC 42858086706
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$724.63 |
| Rate for Payer: Aetna American Axle |
$523.34
|
| Rate for Payer: Aetna Commercial |
$684.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.34
|
| Rate for Payer: Cash Price |
$644.11
|
| Rate for Payer: Cofinity Commercial |
$563.60
|
| Rate for Payer: Cofinity Commercial |
$692.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$563.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$724.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$563.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$603.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$684.37
|
| Rate for Payer: PHP Commercial |
$684.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.34
|
| Rate for Payer: Priority Health SBD |
$507.24
|
| Rate for Payer: UMR Bronson Commercial |
$354.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$603.86
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna Medicare |
$10.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: BCBS Complete |
$8.69
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Commercial |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.42
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UMR Bronson Commercial |
$286.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
OP
|
$651.42
|
|
|
Service Code
|
NDC 60687037521
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.03 |
| Max. Negotiated Rate |
$586.28 |
| Rate for Payer: Aetna American Axle |
$423.42
|
| Rate for Payer: Aetna Commercial |
$553.71
|
| Rate for Payer: Aetna Medicare |
$325.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.42
|
| Rate for Payer: BCBS Complete |
$260.57
|
| Rate for Payer: Cash Price |
$521.14
|
| Rate for Payer: Cofinity Commercial |
$455.99
|
| Rate for Payer: Cofinity Commercial |
$560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$521.14
|
| Rate for Payer: Healthscope Commercial |
$586.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.71
|
| Rate for Payer: PHP Commercial |
$553.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.42
|
| Rate for Payer: Priority Health SBD |
$410.39
|
| Rate for Payer: UMR Bronson Commercial |
$241.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.56
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$21.72
|
|
|
Service Code
|
NDC 60687037511
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$19.55 |
| Rate for Payer: Aetna American Axle |
$14.12
|
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.12
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cofinity Commercial |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.38
|
| Rate for Payer: Healthscope Commercial |
$19.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.46
|
| Rate for Payer: PHP Commercial |
$18.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.12
|
| Rate for Payer: Priority Health SBD |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.29
|
|
|
DRONABINOL 2.5 MG CAPSULE
|
Facility
|
IP
|
$658.56
|
|
|
Service Code
|
NDC 67877075360
|
| Hospital Charge Code |
9904
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.77 |
| Max. Negotiated Rate |
$592.70 |
| Rate for Payer: Aetna American Axle |
$428.06
|
| Rate for Payer: Aetna Commercial |
$559.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.06
|
| Rate for Payer: Cash Price |
$526.85
|
| Rate for Payer: Cofinity Commercial |
$460.99
|
| Rate for Payer: Cofinity Commercial |
$566.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$460.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$526.85
|
| Rate for Payer: Healthscope Commercial |
$592.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$460.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$493.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.78
|
| Rate for Payer: PHP Commercial |
$559.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.06
|
| Rate for Payer: Priority Health SBD |
$414.89
|
| Rate for Payer: UMR Bronson Commercial |
$289.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$493.92
|
|
|
DRONEDARONE 400 MG TABLET
|
Facility
|
IP
|
$2,731.49
|
|
|
Service Code
|
NDC 00024414260
|
| Hospital Charge Code |
98329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,201.86 |
| Max. Negotiated Rate |
$2,458.34 |
| Rate for Payer: Aetna American Axle |
$1,775.47
|
| Rate for Payer: Aetna Commercial |
$2,321.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,775.47
|
| Rate for Payer: Cash Price |
$2,185.19
|
| Rate for Payer: Cofinity Commercial |
$1,912.04
|
| Rate for Payer: Cofinity Commercial |
$2,349.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,912.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,185.19
|
| Rate for Payer: Healthscope Commercial |
$2,458.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,912.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,048.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,321.77
|
| Rate for Payer: PHP Commercial |
$2,321.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.47
|
| Rate for Payer: Priority Health SBD |
$1,720.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,201.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,048.62
|
|
