|
INJECTION(S); SINGLE TENDON SHEATH, OR LIGAMENT, APONEUROSIS (EG, PLANTAR "FASCIA")
|
Facility
|
OP
|
$810.38
|
|
|
Service Code
|
CPT 20550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
|
Facility
|
OP
|
$810.38
|
|
|
Service Code
|
CPT 20526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC, CORTICOSTEROID), CARPAL TUNNEL
|
Facility
|
OP
|
$810.38
|
|
|
Service Code
|
CPT 20526
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$154.31 |
| Max. Negotiated Rate |
$810.38 |
| Rate for Payer: Aetna Medicare |
$299.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$359.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$359.86
|
| Rate for Payer: BCBS Complete |
$162.02
|
| Rate for Payer: BCBS MAPPO |
$287.89
|
| Rate for Payer: BCN Medicare Advantage |
$287.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.89
|
| Rate for Payer: Mclaren Medicaid |
$154.31
|
| Rate for Payer: Mclaren Medicare |
$287.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.28
|
| Rate for Payer: Meridian Medicaid |
$162.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$331.07
|
| Rate for Payer: PACE Medicare |
$273.50
|
| Rate for Payer: PACE SWMI |
$287.89
|
| Rate for Payer: PHP Medicare Advantage |
$287.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.31
|
| Rate for Payer: Priority Health Medicare |
$287.89
|
| Rate for Payer: Railroad Medicare Medicare |
$287.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.89
|
| Rate for Payer: UHC Exchange |
$550.19
|
| Rate for Payer: UHC Medicare Advantage |
$287.89
|
| Rate for Payer: UHCCP Medicaid |
$154.31
|
| Rate for Payer: VA VA |
$287.89
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
OP
|
$102,856.92
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
184358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,446.15 |
| Max. Negotiated Rate |
$92,571.23 |
| Rate for Payer: Aetna American Axle |
$66,857.00
|
| Rate for Payer: Aetna Commercial |
$87,428.38
|
| Rate for Payer: Aetna Medicare |
$2,805.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66,857.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,372.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,372.56
|
| Rate for Payer: BCBS Complete |
$1,518.46
|
| Rate for Payer: BCBS MAPPO |
$2,698.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,698.05
|
| Rate for Payer: Cash Price |
$82,285.54
|
| Rate for Payer: Cash Price |
$82,285.54
|
| Rate for Payer: Cofinity Commercial |
$88,456.95
|
| Rate for Payer: Cofinity Commercial |
$71,999.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$71,999.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82,285.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,698.05
|
| Rate for Payer: Healthscope Commercial |
$92,571.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71,999.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77,142.69
|
| Rate for Payer: Mclaren Medicaid |
$1,446.15
|
| Rate for Payer: Mclaren Medicare |
$2,698.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,832.95
|
| Rate for Payer: Meridian Medicaid |
$1,518.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,102.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87,428.38
|
| Rate for Payer: PACE Medicare |
$2,563.15
|
| Rate for Payer: PACE SWMI |
$2,698.05
|
| Rate for Payer: PHP Commercial |
$87,428.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,698.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66,857.00
|
| Rate for Payer: Priority Health Medicare |
$2,698.05
|
| Rate for Payer: Priority Health SBD |
$64,799.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,698.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,594.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,698.05
|
| Rate for Payer: UHC Exchange |
$5,156.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,698.05
|
| Rate for Payer: UHCCP Medicaid |
$1,446.15
|
| Rate for Payer: UMR Bronson Commercial |
$38,057.06
|
| Rate for Payer: VA VA |
$2,698.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77,142.69
|
|
|
INOTUZUMAB OZOGAMICIN 0.9 MG(0.25 MG/ML INITIAL CONCENTRATION) IV SOLN
|
Facility
|
IP
|
$102,856.92
|
|
|
Service Code
|
HCPCS J9229
|
| Hospital Charge Code |
184358
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45,257.04 |
| Max. Negotiated Rate |
$92,571.23 |
| Rate for Payer: Aetna American Axle |
$66,857.00
|
| Rate for Payer: Aetna Commercial |
$87,428.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66,857.00
|
| Rate for Payer: Cash Price |
$82,285.54
|
| Rate for Payer: Cofinity Commercial |
$71,999.84
|
| Rate for Payer: Cofinity Commercial |
$88,456.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$71,999.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82,285.54
|
| Rate for Payer: Healthscope Commercial |
$92,571.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71,999.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77,142.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87,428.38
|
| Rate for Payer: PHP Commercial |
$87,428.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66,857.00
|
| Rate for Payer: Priority Health SBD |
$64,799.86
|
| Rate for Payer: UMR Bronson Commercial |
$45,257.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77,142.69
|
|
|
INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 11981
|
|
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
|
|
|
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, EXTERNAL APPROACH
|
Facility
|
OP
|
$11,044.01
|
|
|
Service Code
|
CPT 66183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,102.95 |
| Max. Negotiated Rate |
$11,044.01 |
| Rate for Payer: Aetna Medicare |
$4,080.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,904.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,904.26
|
| Rate for Payer: BCBS Complete |
$2,208.10
|
| Rate for Payer: BCBS MAPPO |
$3,923.41
|
| Rate for Payer: BCN Medicare Advantage |
$3,923.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,923.41
|
| Rate for Payer: Mclaren Medicaid |
$2,102.95
|
| Rate for Payer: Mclaren Medicare |
$3,923.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,119.58
|
| Rate for Payer: Meridian Medicaid |
$2,208.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,511.92
|
| Rate for Payer: PACE Medicare |
$3,727.24
|
| Rate for Payer: PACE SWMI |
$3,923.41
|
| Rate for Payer: PHP Medicare Advantage |
$3,923.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,102.95
|
| Rate for Payer: Priority Health Medicare |
$3,923.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3,923.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,044.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,923.41
|
| Rate for Payer: UHC Exchange |
$7,498.03
|
| Rate for Payer: UHC Medicare Advantage |
$3,923.41
|
| Rate for Payer: UHCCP Medicaid |
$2,102.95
|
| Rate for Payer: VA VA |
$3,923.41
|
|
|
INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; INITIAL DEVICE
|
Facility
|
OP
|
$14,165.03
|
|
|
Service Code
|
CPT 0449T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,697.24 |
| Max. Negotiated Rate |
$14,165.03 |
| Rate for Payer: Aetna Medicare |
$5,233.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,290.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,290.20
|
| Rate for Payer: BCBS Complete |
$2,832.10
|
| Rate for Payer: BCBS MAPPO |
$5,032.16
|
| Rate for Payer: BCN Medicare Advantage |
$5,032.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,032.16
|
| Rate for Payer: Mclaren Medicaid |
$2,697.24
|
| Rate for Payer: Mclaren Medicare |
$5,032.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,283.77
|
| Rate for Payer: Meridian Medicaid |
$2,832.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,786.98
|
| Rate for Payer: PACE Medicare |
$4,780.55
|
| Rate for Payer: PACE SWMI |
$5,032.16
|
| Rate for Payer: PHP Medicare Advantage |
$5,032.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,697.24
|
| Rate for Payer: Priority Health Medicare |
$5,032.16
|
| Rate for Payer: Railroad Medicare Medicare |
$5,032.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,165.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,032.16
|
| Rate for Payer: UHC Exchange |
$9,616.96
|
| Rate for Payer: UHC Medicare Advantage |
$5,032.16
|
| Rate for Payer: UHCCP Medicaid |
$2,697.24
|
| Rate for Payer: VA VA |
$5,032.16
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$17,903.47
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,409.09 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$12,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$835.10
|
|
|
Service Code
|
CPT 59200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.02 |
| Max. Negotiated Rate |
$835.10 |
| Rate for Payer: Aetna Medicare |
$308.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$370.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$370.84
|
| Rate for Payer: BCBS Complete |
$166.97
|
| Rate for Payer: BCBS MAPPO |
$296.67
|
| Rate for Payer: BCN Medicare Advantage |
$296.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.67
|
| Rate for Payer: Mclaren Medicaid |
$159.02
|
| Rate for Payer: Mclaren Medicare |
$296.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.50
|
| Rate for Payer: Meridian Medicaid |
$166.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.17
|
| Rate for Payer: PACE Medicare |
$281.84
|
| Rate for Payer: PACE SWMI |
$296.67
|
| Rate for Payer: PHP Medicare Advantage |
$296.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.02
|
| Rate for Payer: Priority Health Medicare |
$296.67
|
| Rate for Payer: Railroad Medicare Medicare |
$296.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.67
|
| Rate for Payer: UHC Exchange |
$566.97
|
| Rate for Payer: UHC Medicare Advantage |
$296.67
|
| Rate for Payer: UHCCP Medicaid |
$159.02
|
| Rate for Payer: VA VA |
$296.67
|
|
|
INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 32550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP, RESERVOIR, AND CUFF
|
Facility
|
OP
|
$55,259.25
|
|
|
Service Code
|
CPT 53445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,522.21 |
| Max. Negotiated Rate |
$55,259.25 |
| Rate for Payer: Aetna Medicare |
$20,416.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,538.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,538.72
|
| Rate for Payer: BCBS Complete |
$11,048.32
|
| Rate for Payer: BCBS MAPPO |
$19,630.98
|
| Rate for Payer: BCN Medicare Advantage |
$19,630.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,630.98
|
| Rate for Payer: Mclaren Medicaid |
$10,522.21
|
| Rate for Payer: Mclaren Medicare |
$19,630.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,612.53
|
| Rate for Payer: Meridian Medicaid |
$11,048.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,575.63
|
| Rate for Payer: PACE Medicare |
$18,649.43
|
| Rate for Payer: PACE SWMI |
$19,630.98
|
| Rate for Payer: PHP Medicare Advantage |
$19,630.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,522.21
|
| Rate for Payer: Priority Health Medicare |
$19,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,630.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,259.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,630.98
|
| Rate for Payer: UHC Exchange |
$37,516.77
|
| Rate for Payer: UHC Medicare Advantage |
$19,630.98
|
| Rate for Payer: UHCCP Medicaid |
$10,522.21
|
| Rate for Payer: VA VA |
$19,630.98
|
|
|
INSERTION OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 37191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
INSERTION OF MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDERS, AND RESERVOIR
|
Facility
|
OP
|
$55,259.25
|
|
|
Service Code
|
CPT 54405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,522.21 |
| Max. Negotiated Rate |
$55,259.25 |
| Rate for Payer: Aetna Medicare |
$20,416.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,538.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,538.72
|
| Rate for Payer: BCBS Complete |
$11,048.32
|
| Rate for Payer: BCBS MAPPO |
$19,630.98
|
| Rate for Payer: BCN Medicare Advantage |
$19,630.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,630.98
|
| Rate for Payer: Mclaren Medicaid |
$10,522.21
|
| Rate for Payer: Mclaren Medicare |
$19,630.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,612.53
|
| Rate for Payer: Meridian Medicaid |
$11,048.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,575.63
|
| Rate for Payer: PACE Medicare |
$18,649.43
|
| Rate for Payer: PACE SWMI |
$19,630.98
|
| Rate for Payer: PHP Medicare Advantage |
$19,630.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,522.21
|
| Rate for Payer: Priority Health Medicare |
$19,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$19,630.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55,259.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,630.98
|
| Rate for Payer: UHC Exchange |
$37,516.77
|
| Rate for Payer: UHC Medicare Advantage |
$19,630.98
|
| Rate for Payer: UHCCP Medicaid |
$10,522.21
|
| Rate for Payer: VA VA |
$19,630.98
|
|
|
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)
|
Facility
|
OP
|
$35,668.30
|
|
|
Service Code
|
CPT 54400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,791.79 |
| Max. Negotiated Rate |
$35,668.30 |
| Rate for Payer: Aetna Medicare |
$13,178.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,839.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,839.06
|
| Rate for Payer: BCBS Complete |
$7,131.38
|
| Rate for Payer: BCBS MAPPO |
$12,671.25
|
| Rate for Payer: BCN Medicare Advantage |
$12,671.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,671.25
|
| Rate for Payer: Mclaren Medicaid |
$6,791.79
|
| Rate for Payer: Mclaren Medicare |
$12,671.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,304.81
|
| Rate for Payer: Meridian Medicaid |
$7,131.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,571.94
|
| Rate for Payer: PACE Medicare |
$12,037.69
|
| Rate for Payer: PACE SWMI |
$12,671.25
|
| Rate for Payer: PHP Medicare Advantage |
$12,671.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,791.79
|
| Rate for Payer: Priority Health Medicare |
$12,671.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12,671.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,668.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,671.25
|
| Rate for Payer: UHC Exchange |
$24,216.03
|
| Rate for Payer: UHC Medicare Advantage |
$12,671.25
|
| Rate for Payer: UHCCP Medicaid |
$6,791.79
|
| Rate for Payer: VA VA |
$12,671.25
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP, WITHOUT IMAGING GUIDANCE; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$4,264.69
|
|
|
Service Code
|
CPT 36569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$812.06 |
| Max. Negotiated Rate |
$4,264.69 |
| Rate for Payer: Aetna Medicare |
$1,575.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,893.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,893.80
|
| Rate for Payer: BCBS Complete |
$852.66
|
| Rate for Payer: BCBS MAPPO |
$1,515.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,515.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,515.04
|
| Rate for Payer: Mclaren Medicaid |
$812.06
|
| Rate for Payer: Mclaren Medicare |
$1,515.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,590.79
|
| Rate for Payer: Meridian Medicaid |
$852.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,742.30
|
| Rate for Payer: PACE Medicare |
$1,439.29
|
| Rate for Payer: PACE SWMI |
$1,515.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,515.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$812.06
|
| Rate for Payer: Priority Health Medicare |
$1,515.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,515.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,264.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,515.04
|
| Rate for Payer: UHC Exchange |
$2,895.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,515.04
|
| Rate for Payer: UHCCP Medicaid |
$812.06
|
| Rate for Payer: VA VA |
$1,515.04
|
|
|
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
|
Facility
|
OP
|
$353.86
|
|
|
Service Code
|
CPT 51702
|
|
Hospital Revenue Code
|
361
|
| 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
|
|
|
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$13,956.13
|
|
|
Service Code
|
CPT 54660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,657.46 |
| Max. Negotiated Rate |
$13,956.13 |
| Rate for Payer: Aetna Medicare |
$5,156.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,197.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,197.44
|
| Rate for Payer: BCBS Complete |
$2,790.33
|
| Rate for Payer: BCBS MAPPO |
$4,957.95
|
| Rate for Payer: BCN Medicare Advantage |
$4,957.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,957.95
|
| Rate for Payer: Mclaren Medicaid |
$2,657.46
|
| Rate for Payer: Mclaren Medicare |
$4,957.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,205.85
|
| Rate for Payer: Meridian Medicaid |
$2,790.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,701.64
|
| Rate for Payer: PACE Medicare |
$4,710.05
|
| Rate for Payer: PACE SWMI |
$4,957.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,957.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,657.46
|
| Rate for Payer: Priority Health Medicare |
$4,957.95
|
| Rate for Payer: Railroad Medicare Medicare |
$4,957.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,956.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,957.95
|
| Rate for Payer: UHC Exchange |
$9,475.14
|
| Rate for Payer: UHC Medicare Advantage |
$4,957.95
|
| Rate for Payer: UHCCP Medicaid |
$2,657.46
|
| Rate for Payer: VA VA |
$4,957.95
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; YOUNGER THAN 5 YEARS OF AGE
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$8,640.87
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.35 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Exchange |
$5,866.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,645.35
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HORI PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 25430
|
|
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
|
|
