|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED
|
Facility
|
OP
|
$2,850.01
|
|
|
Service Code
|
CPT 64417
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$649.65
|
| Rate for Payer: BCN Commercial |
$649.65
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 64450
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$873.08
|
| Rate for Payer: BCN Commercial |
$873.08
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE OR BRANCH
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 64450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$873.08
|
| Rate for Payer: BCN Commercial |
$873.08
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE
|
Facility
|
OP
|
$2,850.01
|
|
|
Service Code
|
CPT 64430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.70
|
| Rate for Payer: BCN Commercial |
$1,066.70
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$378.56
|
|
|
Service Code
|
CPT 64484
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$378.56 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: BCBS Trust/PPO |
$378.56
|
| Rate for Payer: BCN Commercial |
$378.56
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL, SINGLE LEVEL
|
Facility
|
OP
|
$2,850.01
|
|
|
Service Code
|
CPT 64483
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.79
|
| Rate for Payer: BCN Commercial |
$1,007.79
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; TRIGEMINAL NERVE, EACH BRANCH (IE, OPHTHALMIC, MAXILLARY, MANDIBULAR)
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 64400
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$372.44
|
|
|
Service Code
|
CPT 64494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.44 |
| Max. Negotiated Rate |
$372.44 |
| Rate for Payer: BCBS Trust/PPO |
$372.44
|
| Rate for Payer: BCN Commercial |
$372.44
|
|
|
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
|
Facility
|
OP
|
$2,850.01
|
|
|
Service Code
|
CPT 64493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$460.91 |
| Max. Negotiated Rate |
$2,850.01 |
| Rate for Payer: Aetna Medicare |
$916.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,101.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,101.61
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$881.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,235.94
|
| Rate for Payer: BCN Commercial |
$1,235.94
|
| Rate for Payer: BCN Medicare Advantage |
$881.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.29
|
| Rate for Payer: Mclaren Medicaid |
$881.29
|
| Rate for Payer: Mclaren Medicare |
$881.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.35
|
| Rate for Payer: Meridian Medicaid |
$925.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,013.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$969.42
|
| Rate for Payer: Nomi Health Commercial |
$2,643.87
|
| Rate for Payer: PACE Medicare |
$837.23
|
| Rate for Payer: PACE SWMI |
$881.29
|
| Rate for Payer: PHP Medicare Advantage |
$881.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.01
|
| Rate for Payer: Priority Health Medicare |
$881.29
|
| Rate for Payer: Priority Health Tiered Network |
$2,280.01
|
| Rate for Payer: Railroad Medicare Medicare |
$881.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$881.29
|
| Rate for Payer: UHC Medicaid |
$460.91
|
| Rate for Payer: UHCCP Medicaid |
$460.91
|
| Rate for Payer: VA VA |
$881.29
|
|
|
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)
|
Facility
|
OP
|
$2,274.56
|
|
|
Service Code
|
CPT 62323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$367.85 |
| Max. Negotiated Rate |
$2,274.56 |
| Rate for Payer: Aetna Medicare |
$731.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$879.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$879.17
|
| Rate for Payer: BCBS Complete |
$386.27
|
| Rate for Payer: BCBS MAPPO |
$703.34
|
| Rate for Payer: BCBS Trust/PPO |
$713.94
|
| Rate for Payer: BCN Commercial |
$713.94
|
| Rate for Payer: BCN Medicare Advantage |
$703.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.34
|
| Rate for Payer: Mclaren Medicaid |
$703.34
|
| Rate for Payer: Mclaren Medicare |
$703.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.51
|
| Rate for Payer: Meridian Medicaid |
$738.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$808.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$773.67
|
| Rate for Payer: Nomi Health Commercial |
$2,110.02
|
| Rate for Payer: PACE Medicare |
$668.17
|
| Rate for Payer: PACE SWMI |
$703.34
|
| Rate for Payer: PHP Medicare Advantage |
$703.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,274.56
|
| Rate for Payer: Priority Health Medicare |
$703.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,819.65
|
| Rate for Payer: Railroad Medicare Medicare |
$703.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$703.34
|
| Rate for Payer: UHC Medicaid |
$367.85
|
| Rate for Payer: UHCCP Medicaid |
$367.85
|
| Rate for Payer: VA VA |
$703.34
|
|
|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), 3 OR MORE MUSCLES
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
OP
|
$109,530.28
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
184358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,473.17 |
| Max. Negotiated Rate |
$98,577.25 |
| Rate for Payer: Aetna American Axle |
$71,194.68
|
| Rate for Payer: Aetna Commercial |
$93,100.74
|
| Rate for Payer: Aetna Medicare |
$2,929.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71,194.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,520.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,520.96
|
| Rate for Payer: BCBS Complete |
$1,546.97
|
| Rate for Payer: BCBS MAPPO |
$2,816.77
|
| Rate for Payer: BCBS Trust/PPO |
$9,133.78
|
| Rate for Payer: BCN Commercial |
$9,133.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,816.77
|
| Rate for Payer: Cash Price |
$87,624.22
|
| Rate for Payer: Cash Price |
$87,624.22
|
| Rate for Payer: Cofinity Advantage |
$76,671.20
|
| Rate for Payer: Cofinity Commercial |
$94,196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,624.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,816.77
|
| Rate for Payer: Healthscope Commercial |
$98,577.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,671.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82,147.71
|
| Rate for Payer: Mclaren Medicaid |
$2,816.77
|
| Rate for Payer: Mclaren Medicare |
$2,816.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,957.61
|
| Rate for Payer: Meridian Medicaid |
$2,957.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,239.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,098.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93,100.74
|
| Rate for Payer: Nomi Health Commercial |
$8,450.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82,147.71
|
| Rate for Payer: PACE Medicare |
$2,675.93
|
| Rate for Payer: PACE SWMI |
$2,816.77
|
| Rate for Payer: PHP Commercial |
$93,100.74
|
| Rate for Payer: PHP Medicare Advantage |
$2,816.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,473.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,509.56
|
| Rate for Payer: Priority Health Medicare |
$2,816.77
|
| Rate for Payer: Priority Health SBD |
$69,004.08
|
| Rate for Payer: Priority Health Tiered Network |
$6,807.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2,816.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,647.67
|
| Rate for Payer: UHC Core |
$4,647.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,816.77
|
| Rate for Payer: UHC Exchange |
$4,647.67
|
| Rate for Payer: UHC Medicaid |
$1,473.17
|
| Rate for Payer: UHCCP Medicaid |
$1,473.17
|
| Rate for Payer: UMR Bronson Commercial |
$40,526.20
|
| Rate for Payer: VA VA |
$2,816.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82,147.71
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
IP
|
$109,530.28
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
184358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48,193.32 |
| Max. Negotiated Rate |
$98,577.25 |
| Rate for Payer: Aetna American Axle |
$71,194.68
|
| Rate for Payer: Aetna Commercial |
$93,100.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71,194.68
|
| Rate for Payer: Cash Price |
$87,624.22
|
| Rate for Payer: Cofinity Advantage |
$76,671.20
|
| Rate for Payer: Cofinity Commercial |
$94,196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87,624.22
|
| Rate for Payer: Healthscope Commercial |
$98,577.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76,671.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82,147.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93,100.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82,147.71
|
| Rate for Payer: PHP Commercial |
$93,100.74
|
| Rate for Payer: Priority Health SBD |
$69,004.08
|
| Rate for Payer: UMR Bronson Commercial |
$48,193.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82,147.71
|
|
|
INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)
|
Facility
|
OP
|
$428.73
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$428.73 |
| Rate for Payer: Aetna Medicare |
$137.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$165.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$165.71
|
| Rate for Payer: BCBS Complete |
$72.81
|
| Rate for Payer: BCBS MAPPO |
$132.57
|
| Rate for Payer: BCBS Trust/PPO |
$157.33
|
| Rate for Payer: BCN Commercial |
$157.33
|
| Rate for Payer: BCN Medicare Advantage |
$132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.57
|
| Rate for Payer: Mclaren Medicaid |
$132.57
|
| Rate for Payer: Mclaren Medicare |
$132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Medicaid |
$139.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.83
|
| Rate for Payer: Nomi Health Commercial |
$397.71
|
| Rate for Payer: PACE Medicare |
$125.94
|
| Rate for Payer: PACE SWMI |
$132.57
|
| Rate for Payer: PHP Medicare Advantage |
$132.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$428.73
|
| Rate for Payer: Priority Health Medicare |
$132.57
|
| Rate for Payer: Priority Health Tiered Network |
$342.98
|
| Rate for Payer: Railroad Medicare Medicare |
$132.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.57
|
| Rate for Payer: UHC Medicaid |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$69.33
|
| Rate for Payer: VA VA |
$132.57
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$26,336.97
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,259.31 |
| Max. Negotiated Rate |
$26,336.97 |
| Rate for Payer: Aetna Medicare |
$8,469.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,180.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,180.00
|
| Rate for Payer: BCBS Complete |
$4,472.68
|
| Rate for Payer: BCBS MAPPO |
$8,144.00
|
| Rate for Payer: BCBS Trust/PPO |
$11,369.02
|
| Rate for Payer: BCN Commercial |
$11,369.02
|
| Rate for Payer: BCN Medicare Advantage |
$8,144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,144.00
|
| Rate for Payer: Mclaren Medicaid |
$8,144.00
|
| Rate for Payer: Mclaren Medicare |
$8,144.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,551.20
|
| Rate for Payer: Meridian Medicaid |
$8,551.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,365.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,958.40
|
| Rate for Payer: Nomi Health Commercial |
$24,432.00
|
| Rate for Payer: PACE Medicare |
$7,736.80
|
| Rate for Payer: PACE SWMI |
$8,144.00
|
| Rate for Payer: PHP Medicare Advantage |
$8,144.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,259.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26,336.97
|
| Rate for Payer: Priority Health Medicare |
$8,144.00
|
| Rate for Payer: Priority Health Tiered Network |
$21,069.58
|
| Rate for Payer: Railroad Medicare Medicare |
$8,144.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,144.00
|
| Rate for Payer: UHC Medicaid |
$4,259.31
|
| Rate for Payer: UHCCP Medicaid |
$4,259.31
|
| Rate for Payer: VA VA |
$8,144.00
|
|
|
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$981.93
|
|
|
Service Code
|
CPT 59200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$981.93 |
| Rate for Payer: Aetna Medicare |
$315.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.54
|
| Rate for Payer: BCBS Complete |
$166.75
|
| Rate for Payer: BCBS MAPPO |
$303.63
|
| Rate for Payer: BCBS Trust/PPO |
$395.61
|
| Rate for Payer: BCN Commercial |
$395.61
|
| Rate for Payer: BCN Medicare Advantage |
$303.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.63
|
| Rate for Payer: Mclaren Medicaid |
$303.63
|
| Rate for Payer: Mclaren Medicare |
$303.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.81
|
| Rate for Payer: Meridian Medicaid |
$318.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.99
|
| Rate for Payer: Nomi Health Commercial |
$910.89
|
| Rate for Payer: PACE Medicare |
$288.45
|
| Rate for Payer: PACE SWMI |
$303.63
|
| Rate for Payer: PHP Medicare Advantage |
$303.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$981.93
|
| Rate for Payer: Priority Health Medicare |
$303.63
|
| Rate for Payer: Priority Health Tiered Network |
$785.54
|
| Rate for Payer: Railroad Medicare Medicare |
$303.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.63
|
| Rate for Payer: UHC Medicaid |
$158.80
|
| Rate for Payer: UHCCP Medicaid |
$158.80
|
| Rate for Payer: VA VA |
$303.63
|
|
|
INSERTION OF GASTROSTOMY TUBE, PERCUTANEOUS, UNDER FLUOROSCOPIC GUIDANCE INCLUDING CONTRAST INJECTION(S), IMAGE DOCUMENTATION AND REPORT
|
Facility
|
OP
|
$6,183.25
|
|
|
Service Code
|
CPT 49440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.98 |
| Max. Negotiated Rate |
$6,183.25 |
| Rate for Payer: Aetna Medicare |
$1,988.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,390.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,390.01
|
| Rate for Payer: BCBS Complete |
$1,050.08
|
| Rate for Payer: BCBS MAPPO |
$1,912.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,359.85
|
| Rate for Payer: BCN Commercial |
$2,359.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,912.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,912.01
|
| Rate for Payer: Mclaren Medicaid |
$1,912.01
|
| Rate for Payer: Mclaren Medicare |
$1,912.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,007.61
|
| Rate for Payer: Meridian Medicaid |
$2,007.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,198.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,103.21
|
| Rate for Payer: Nomi Health Commercial |
$5,736.03
|
| Rate for Payer: PACE Medicare |
$1,816.41
|
| Rate for Payer: PACE SWMI |
$1,912.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,912.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$999.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,183.25
|
| Rate for Payer: Priority Health Medicare |
$1,912.01
|
| Rate for Payer: Priority Health Tiered Network |
$4,946.60
|
| Rate for Payer: Railroad Medicare Medicare |
$1,912.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,912.01
|
| Rate for Payer: UHC Medicaid |
$999.98
|
| Rate for Payer: UHCCP Medicaid |
$999.98
|
| Rate for Payer: VA VA |
$1,912.01
|
|
|
INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,166.17
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,166.17 |
| Max. Negotiated Rate |
$1,166.17 |
| Rate for Payer: BCBS Trust/PPO |
$1,166.17
|
| Rate for Payer: BCN Commercial |
$1,166.17
|
|
|
INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO VERTEBRAL CORPECTOMY(IES) (VERTEBRAL BODY RESECTION, PARTIAL OR COMPLETE) DEFECT, IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH CONTIGUOUS DEFECT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,509.62
|
|
|
Service Code
|
CPT 22854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,509.62 |
| Max. Negotiated Rate |
$1,509.62 |
| Rate for Payer: BCBS Trust/PPO |
$1,509.62
|
| Rate for Payer: BCN Commercial |
$1,509.62
|
|
|
INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL
|
Facility
|
OP
|
$7,436.46
|
|
|
Service Code
|
CPT 66985
|
|
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 |
$2,376.16
|
| Rate for Payer: BCN Commercial |
$2,376.16
|
| 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
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$915.84
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.08 |
| Max. Negotiated Rate |
$915.84 |
| Rate for Payer: BCBS Trust/PPO |
$915.84
|
| Rate for Payer: BCN Commercial |
$915.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$146.35
|
| Rate for Payer: Priority Health Tiered Network |
$117.08
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,566.24
|
| Rate for Payer: BCN Commercial |
$3,566.24
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
