|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$201,597.40
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$63,077.46 |
| Max. Negotiated Rate |
$201,597.40 |
| Rate for Payer: Aetna Medicare |
$69,053.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82,996.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82,996.66
|
| Rate for Payer: BCBS MAPPO |
$66,397.33
|
| Rate for Payer: BCBS Trust/PPO |
$201,597.40
|
| Rate for Payer: BCN Commercial |
$201,597.40
|
| Rate for Payer: BCN Medicare Advantage |
$66,397.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66,397.33
|
| Rate for Payer: Mclaren Medicare |
$66,397.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69,717.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76,356.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$73,037.06
|
| Rate for Payer: Nomi Health Commercial |
$101,507.52
|
| Rate for Payer: PACE Medicare |
$63,077.46
|
| Rate for Payer: PACE SWMI |
$66,397.33
|
| Rate for Payer: PHP Medicare Advantage |
$66,397.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$126,861.90
|
| Rate for Payer: Priority Health Medicare |
$66,397.33
|
| Rate for Payer: Priority Health Tiered Network |
$101,489.50
|
| Rate for Payer: Railroad Medicare Medicare |
$66,397.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128,261.44
|
| Rate for Payer: UHC Core |
$107,306.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66,397.33
|
| Rate for Payer: UHC Exchange |
$87,634.83
|
| Rate for Payer: VA VA |
$66,397.33
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$95,216.54
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$25,806.36 |
| Max. Negotiated Rate |
$95,216.54 |
| Rate for Payer: Aetna Medicare |
$28,251.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,955.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,955.74
|
| Rate for Payer: BCBS MAPPO |
$27,164.59
|
| Rate for Payer: BCBS Trust/PPO |
$95,216.54
|
| Rate for Payer: BCN Commercial |
$95,216.54
|
| Rate for Payer: BCN Medicare Advantage |
$27,164.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,164.59
|
| Rate for Payer: Mclaren Medicare |
$27,164.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,522.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,239.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,881.05
|
| Rate for Payer: Nomi Health Commercial |
$39,668.79
|
| Rate for Payer: PACE Medicare |
$25,806.36
|
| Rate for Payer: PACE SWMI |
$27,164.59
|
| Rate for Payer: PHP Medicare Advantage |
$27,164.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,226.49
|
| Rate for Payer: Priority Health Medicare |
$27,164.59
|
| Rate for Payer: Priority Health Tiered Network |
$40,981.18
|
| Rate for Payer: Railroad Medicare Medicare |
$27,164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,124.13
|
| Rate for Payer: UHC Core |
$41,935.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,164.59
|
| Rate for Payer: UHC Exchange |
$34,247.39
|
| Rate for Payer: VA VA |
$27,164.59
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$31,618.06
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$14,927.87 |
| Max. Negotiated Rate |
$31,618.06 |
| Rate for Payer: Aetna Medicare |
$16,342.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,641.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,641.94
|
| Rate for Payer: BCBS MAPPO |
$15,713.55
|
| Rate for Payer: BCBS Trust/PPO |
$31,618.06
|
| Rate for Payer: BCN Commercial |
$31,618.06
|
| Rate for Payer: BCN Medicare Advantage |
$15,713.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,713.55
|
| Rate for Payer: Mclaren Medicare |
$15,713.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,499.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,070.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,284.90
|
| Rate for Payer: Nomi Health Commercial |
$23,324.49
|
| Rate for Payer: PACE Medicare |
$14,927.87
|
| Rate for Payer: PACE SWMI |
$15,713.55
|
| Rate for Payer: PHP Medicare Advantage |
$15,713.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,150.44
|
| Rate for Payer: Priority Health Medicare |
$15,713.55
|
| Rate for Payer: Priority Health Tiered Network |
$23,320.35
|
| Rate for Payer: Railroad Medicare Medicare |
$15,713.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,472.03
|
| Rate for Payer: UHC Core |
$24,657.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,713.55
|
| Rate for Payer: UHC Exchange |
$20,136.81
|
| Rate for Payer: VA VA |
$15,713.55
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,295.31
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$9,182.38 |
| Max. Negotiated Rate |
$26,295.31 |
| Rate for Payer: Aetna Medicare |
$10,052.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,082.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,082.08
|
| Rate for Payer: BCBS MAPPO |
$9,665.66
|
| Rate for Payer: BCBS Trust/PPO |
$26,295.31
|
| Rate for Payer: BCN Commercial |
$26,295.31
|
| Rate for Payer: BCN Medicare Advantage |
$9,665.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,665.66
|
| Rate for Payer: Mclaren Medicare |
$9,665.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,148.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,115.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,632.23
|
| Rate for Payer: Nomi Health Commercial |
$13,995.21
|
| Rate for Payer: PACE Medicare |
$9,182.38
|
| Rate for Payer: PACE SWMI |
$9,665.66
|
| Rate for Payer: PHP Medicare Advantage |
$9,665.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,490.91
|
| Rate for Payer: Priority Health Medicare |
$9,665.66
|
| Rate for Payer: Priority Health Tiered Network |
$13,992.73
|
| Rate for Payer: Railroad Medicare Medicare |
$9,665.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,683.87
|
| Rate for Payer: UHC Core |
$14,794.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,665.66
|
| Rate for Payer: UHC Exchange |
$12,082.53
|
| Rate for Payer: VA VA |
$9,665.66
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$897.51
|
|
|
Service Code
|
CPT 37253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$897.51 |
| Max. Negotiated Rate |
$897.51 |
| Rate for Payer: BCBS Trust/PPO |
$897.51
|
| Rate for Payer: BCN Commercial |
$897.51
|
|
|
INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$6,082.80
|
|
|
Service Code
|
CPT 37252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,082.80 |
| Max. Negotiated Rate |
$6,082.80 |
| Rate for Payer: BCBS Trust/PPO |
$6,082.80
|
| Rate for Payer: BCN Commercial |
$6,082.80
|
|
|
INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL SEQUENTIAL INFUSION OF A NEW DRUG/SUBSTANCE, UP TO 1 HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$232.01
|
|
|
Service Code
|
CPT 96367
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.52 |
| Max. Negotiated Rate |
$232.01 |
| Rate for Payer: Aetna Medicare |
$74.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.67
|
| Rate for Payer: BCBS Complete |
$39.40
|
| Rate for Payer: BCBS MAPPO |
$71.74
|
| Rate for Payer: BCBS Trust/PPO |
$138.98
|
| Rate for Payer: BCN Commercial |
$138.98
|
| Rate for Payer: BCN Medicare Advantage |
$71.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.74
|
| Rate for Payer: Mclaren Medicaid |
$71.74
|
| Rate for Payer: Mclaren Medicare |
$71.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.33
|
| Rate for Payer: Meridian Medicaid |
$75.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.91
|
| Rate for Payer: Nomi Health Commercial |
$215.22
|
| Rate for Payer: PACE Medicare |
$68.15
|
| Rate for Payer: PACE SWMI |
$71.74
|
| Rate for Payer: PHP Medicare Advantage |
$71.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.01
|
| Rate for Payer: Priority Health Medicare |
$71.74
|
| Rate for Payer: Priority Health Tiered Network |
$185.61
|
| Rate for Payer: Railroad Medicare Medicare |
$71.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.74
|
| Rate for Payer: UHC Medicaid |
$37.52
|
| Rate for Payer: UHCCP Medicaid |
$37.52
|
| Rate for Payer: VA VA |
$71.74
|
|
|
INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$150.88
|
|
|
Service Code
|
CPT 96366
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$150.88 |
| Rate for Payer: Aetna Medicare |
$48.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.33
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$46.66
|
| Rate for Payer: BCBS Trust/PPO |
$101.72
|
| Rate for Payer: BCN Commercial |
$101.72
|
| Rate for Payer: BCN Medicare Advantage |
$46.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.66
|
| Rate for Payer: Mclaren Medicaid |
$46.66
|
| Rate for Payer: Mclaren Medicare |
$46.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.99
|
| Rate for Payer: Meridian Medicaid |
$48.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.33
|
| Rate for Payer: Nomi Health Commercial |
$139.98
|
| Rate for Payer: PACE Medicare |
$44.33
|
| Rate for Payer: PACE SWMI |
$46.66
|
| Rate for Payer: PHP Medicare Advantage |
$46.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.88
|
| Rate for Payer: Priority Health Medicare |
$46.66
|
| Rate for Payer: Priority Health Tiered Network |
$120.70
|
| Rate for Payer: Railroad Medicare Medicare |
$46.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.66
|
| Rate for Payer: UHC Medicaid |
$24.40
|
| Rate for Payer: UHCCP Medicaid |
$24.40
|
| Rate for Payer: VA VA |
$46.66
|
|
|
INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, OR DIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); INITIAL, UP TO 1 HOUR
|
Facility
|
OP
|
$685.39
|
|
|
Service Code
|
CPT 96365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$110.84 |
| Max. Negotiated Rate |
$685.39 |
| Rate for Payer: Aetna Medicare |
$220.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$264.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$264.93
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$211.94
|
| Rate for Payer: BCBS Trust/PPO |
$303.43
|
| Rate for Payer: BCN Commercial |
$303.43
|
| Rate for Payer: BCN Medicare Advantage |
$211.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.94
|
| Rate for Payer: Mclaren Medicaid |
$211.94
|
| Rate for Payer: Mclaren Medicare |
$211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.54
|
| Rate for Payer: Meridian Medicaid |
$222.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$243.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.13
|
| Rate for Payer: Nomi Health Commercial |
$635.82
|
| Rate for Payer: PACE Medicare |
$201.34
|
| Rate for Payer: PACE SWMI |
$211.94
|
| Rate for Payer: PHP Medicare Advantage |
$211.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$685.39
|
| Rate for Payer: Priority Health Medicare |
$211.94
|
| Rate for Payer: Priority Health Tiered Network |
$548.31
|
| Rate for Payer: Railroad Medicare Medicare |
$211.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.94
|
| Rate for Payer: UHC Medicaid |
$110.84
|
| Rate for Payer: UHCCP Medicaid |
$110.84
|
| Rate for Payer: VA VA |
$211.94
|
|
|
INTRAVENOUS INJECTION OF AGENT (EG, FLUORESCEIN) TO TEST VASCULAR FLOW IN FLAP OR GRAFT
|
Facility
|
OP
|
$1,439.47
|
|
|
Service Code
|
CPT 15860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,439.47 |
| Rate for Payer: Aetna Medicare |
$462.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$556.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$556.40
|
| Rate for Payer: BCBS Complete |
$244.46
|
| Rate for Payer: BCBS MAPPO |
$445.12
|
| Rate for Payer: BCBS Trust/PPO |
$297.46
|
| Rate for Payer: BCN Commercial |
$297.46
|
| Rate for Payer: BCN Medicare Advantage |
$445.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.12
|
| Rate for Payer: Mclaren Medicaid |
$445.12
|
| Rate for Payer: Mclaren Medicare |
$445.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.38
|
| Rate for Payer: Meridian Medicaid |
$467.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$511.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.63
|
| Rate for Payer: Nomi Health Commercial |
$1,335.36
|
| Rate for Payer: PACE Medicare |
$422.86
|
| Rate for Payer: PACE SWMI |
$445.12
|
| Rate for Payer: PHP Medicare Advantage |
$445.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,439.47
|
| Rate for Payer: Priority Health Medicare |
$445.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$445.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.12
|
| Rate for Payer: UHC Medicaid |
$232.80
|
| Rate for Payer: UHCCP Medicaid |
$232.80
|
| Rate for Payer: VA VA |
$445.12
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$2,323.19
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,323.19 |
| Max. Negotiated Rate |
$2,323.19 |
| Rate for Payer: BCBS Trust/PPO |
$2,323.19
|
| Rate for Payer: BCN Commercial |
$2,323.19
|
|
|
INTRODUCTION OF CATHETER, AORTA
|
Facility
|
OP
|
$2,323.19
|
|
|
Service Code
|
CPT 36200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.19 |
| Max. Negotiated Rate |
$2,323.19 |
| Rate for Payer: BCBS Trust/PPO |
$2,323.19
|
| Rate for Payer: BCN Commercial |
$2,323.19
|
|
|
INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA
|
Facility
|
OP
|
$2,092.68
|
|
|
Service Code
|
CPT 36010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,092.68 |
| Max. Negotiated Rate |
$2,092.68 |
| Rate for Payer: BCBS Trust/PPO |
$2,092.68
|
| Rate for Payer: BCN Commercial |
$2,092.68
|
|
|
INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
|
Facility
|
OP
|
$1,830.16
|
|
|
Service Code
|
CPT 36140
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,830.16 |
| Max. Negotiated Rate |
$1,830.16 |
| Rate for Payer: BCBS Trust/PPO |
$1,830.16
|
| Rate for Payer: BCN Commercial |
$1,830.16
|
|
|
INTRODUCTION OF NEEDLE OR INTRACATHETER, UPPER OR LOWER EXTREMITY ARTERY
|
Facility
|
OP
|
$1,830.16
|
|
|
Service Code
|
CPT 36140
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,830.16 |
| Max. Negotiated Rate |
$1,830.16 |
| Rate for Payer: BCBS Trust/PPO |
$1,830.16
|
| Rate for Payer: BCN Commercial |
$1,830.16
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT;
|
Facility
|
OP
|
$5,072.36
|
|
|
Service Code
|
CPT 36901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$820.32 |
| Max. Negotiated Rate |
$5,072.36 |
| Rate for Payer: Aetna Medicare |
$1,631.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.61
|
| Rate for Payer: BCBS Complete |
$861.41
|
| Rate for Payer: BCBS MAPPO |
$1,568.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,016.04
|
| Rate for Payer: BCN Commercial |
$2,016.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.49
|
| Rate for Payer: Mclaren Medicaid |
$1,568.49
|
| Rate for Payer: Mclaren Medicare |
$1,568.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.91
|
| Rate for Payer: Meridian Medicaid |
$1,646.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,725.34
|
| Rate for Payer: Nomi Health Commercial |
$4,705.47
|
| Rate for Payer: PACE Medicare |
$1,490.07
|
| Rate for Payer: PACE SWMI |
$1,568.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$820.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,072.36
|
| Rate for Payer: Priority Health Medicare |
$1,568.49
|
| Rate for Payer: Priority Health Tiered Network |
$4,057.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,568.49
|
| Rate for Payer: UHC Medicaid |
$820.32
|
| Rate for Payer: UHCCP Medicaid |
$820.32
|
| Rate for Payer: VA VA |
$1,568.49
|
|
|
INTRODUCTION OF NEEDLE(S) AND/OR CATHETER(S), DIALYSIS CIRCUIT, WITH DIAGNOSTIC ANGIOGRAPHY OF THE DIALYSIS CIRCUIT, INCLUDING ALL DIRECT PUNCTURE(S) AND CATHETER PLACEMENT(S), INJECTION(S) OF CONTRAST, ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA, FLUOROSCOPIC GUIDANCE, RADIOLOGICAL SUPERVISION AND INTERPRETATION AND IMAGE DOCUMENTATION AND REPORT; WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$18,339.80
|
|
|
Service Code
|
CPT 36902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,965.99 |
| Max. Negotiated Rate |
$18,339.80 |
| Rate for Payer: Aetna Medicare |
$5,897.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,088.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,088.88
|
| Rate for Payer: BCBS Complete |
$3,114.57
|
| Rate for Payer: BCBS MAPPO |
$5,671.10
|
| Rate for Payer: BCBS Trust/PPO |
$4,484.21
|
| Rate for Payer: BCN Commercial |
$4,484.21
|
| Rate for Payer: BCN Medicare Advantage |
$5,671.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,671.10
|
| Rate for Payer: Mclaren Medicaid |
$5,671.10
|
| Rate for Payer: Mclaren Medicare |
$5,671.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,954.65
|
| Rate for Payer: Meridian Medicaid |
$5,954.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,521.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,238.21
|
| Rate for Payer: Nomi Health Commercial |
$17,013.30
|
| Rate for Payer: PACE Medicare |
$5,387.55
|
| Rate for Payer: PACE SWMI |
$5,671.10
|
| Rate for Payer: PHP Medicare Advantage |
$5,671.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,965.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$18,339.80
|
| Rate for Payer: Priority Health Medicare |
$5,671.10
|
| Rate for Payer: Priority Health Tiered Network |
$14,671.84
|
| Rate for Payer: Railroad Medicare Medicare |
$5,671.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,671.10
|
| Rate for Payer: UHC Medicaid |
$2,965.99
|
| Rate for Payer: UHCCP Medicaid |
$2,965.99
|
| Rate for Payer: VA VA |
$5,671.10
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$115.89
|
|
|
Service Code
|
NDC 00395121316
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$104.30 |
| Rate for Payer: Aetna American Axle |
$75.33
|
| Rate for Payer: Aetna Commercial |
$98.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.33
|
| Rate for Payer: Cash Price |
$92.71
|
| Rate for Payer: Cofinity Advantage |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$99.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.71
|
| Rate for Payer: Healthscope Commercial |
$104.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.92
|
| Rate for Payer: PHP Commercial |
$98.51
|
| Rate for Payer: Priority Health SBD |
$73.01
|
| Rate for Payer: UMR Bronson Commercial |
$50.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.92
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$13.23
|
|
|
Service Code
|
NDC 00869385110
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna Medicare |
$6.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.60
|
| Rate for Payer: UHC Core |
$6.89
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$4.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$13.23
|
|
|
Service Code
|
NDC 00869385110
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.91 |
| Rate for Payer: Aetna American Axle |
$8.60
|
| Rate for Payer: Aetna Commercial |
$11.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.60
|
| Rate for Payer: Cash Price |
$10.58
|
| Rate for Payer: Cofinity Advantage |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$11.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$11.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.92
|
| Rate for Payer: PHP Commercial |
$11.25
|
| Rate for Payer: Priority Health SBD |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.92
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$0.84
|
|
|
Service Code
|
NDC 00990000077
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna American Axle |
$0.55
|
| Rate for Payer: Aetna Commercial |
$0.71
|
| Rate for Payer: Aetna Medicare |
$0.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.55
|
| Rate for Payer: BCBS Complete |
$0.34
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cofinity Advantage |
$0.59
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$0.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.63
|
| Rate for Payer: PHP Commercial |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.55
|
| Rate for Payer: UHC Core |
$0.44
|
| Rate for Payer: UHC Exchange |
$0.33
|
| Rate for Payer: UMR Bronson Commercial |
$0.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.63
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
IP
|
$0.84
|
|
|
Service Code
|
NDC 00990000077
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$0.76 |
| Rate for Payer: Aetna American Axle |
$0.55
|
| Rate for Payer: Aetna Commercial |
$0.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.55
|
| Rate for Payer: Cash Price |
$0.67
|
| Rate for Payer: Cofinity Advantage |
$0.59
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$0.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.63
|
| Rate for Payer: PHP Commercial |
$0.71
|
| Rate for Payer: Priority Health SBD |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$0.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.63
|
|
|
IODINE-SODIUM IODIDE 2 % TOPICAL TINCTURE
|
Facility
|
OP
|
$115.89
|
|
|
Service Code
|
NDC 00395121316
|
| Hospital Charge Code |
19490
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.88 |
| Max. Negotiated Rate |
$104.30 |
| Rate for Payer: Aetna American Axle |
$75.33
|
| Rate for Payer: Aetna Commercial |
$98.51
|
| Rate for Payer: Aetna Medicare |
$57.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.33
|
| Rate for Payer: BCBS Complete |
$46.36
|
| Rate for Payer: Cash Price |
$92.71
|
| Rate for Payer: Cofinity Advantage |
$81.12
|
| Rate for Payer: Cofinity Commercial |
$99.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.71
|
| Rate for Payer: Healthscope Commercial |
$104.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.92
|
| Rate for Payer: PHP Commercial |
$98.51
|
| Rate for Payer: Priority Health SBD |
$73.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.33
|
| Rate for Payer: UHC Core |
$60.38
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UMR Bronson Commercial |
$42.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.92
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
OP
|
$411.28
|
|
|
Service Code
|
NDC 00395277516
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.17 |
| Max. Negotiated Rate |
$370.15 |
| Rate for Payer: Aetna American Axle |
$267.33
|
| Rate for Payer: Aetna Commercial |
$349.59
|
| Rate for Payer: Aetna Medicare |
$205.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.33
|
| Rate for Payer: BCBS Complete |
$164.51
|
| Rate for Payer: Cash Price |
$329.02
|
| Rate for Payer: Cofinity Advantage |
$287.90
|
| Rate for Payer: Cofinity Commercial |
$353.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.02
|
| Rate for Payer: Healthscope Commercial |
$370.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$287.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$308.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$329.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.46
|
| Rate for Payer: PHP Commercial |
$349.59
|
| Rate for Payer: Priority Health SBD |
$259.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.33
|
| Rate for Payer: UHC Core |
$214.28
|
| Rate for Payer: UHC Exchange |
$161.63
|
| Rate for Payer: UMR Bronson Commercial |
$152.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$308.46
|
|
|
IODINE STRONG (LUGOLS) 5 % ORAL SOLUTION
|
Facility
|
IP
|
$128.05
|
|
|
Service Code
|
NDC 48433023015
|
| Hospital Charge Code |
108150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.34 |
| Max. Negotiated Rate |
$115.25 |
| Rate for Payer: Aetna American Axle |
$83.23
|
| Rate for Payer: Aetna Commercial |
$108.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.23
|
| Rate for Payer: Cash Price |
$102.44
|
| Rate for Payer: Cofinity Advantage |
$89.64
|
| Rate for Payer: Cofinity Commercial |
$110.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.44
|
| Rate for Payer: Healthscope Commercial |
$115.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.04
|
| Rate for Payer: PHP Commercial |
$108.84
|
| Rate for Payer: Priority Health SBD |
$80.67
|
| Rate for Payer: UMR Bronson Commercial |
$56.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.04
|
|
