|
INSERTION, DRUG-DELIVERY IMPLANT (IE, BIORESORBABLE, BIODEGRADABLE, NON-BIODEGRADABLE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$130.23
|
| Rate for Payer: BCN Commercial |
$130.23
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.00
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$60.91
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, EXTERNAL APPROACH
|
Facility
|
OP
|
$12,388.13
|
|
|
Service Code
|
CPT 66183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$960.87 |
| Max. Negotiated Rate |
$12,388.13 |
| Rate for Payer: Aetna Medicare |
$4,099.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,926.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,926.90
|
| Rate for Payer: BCBS Complete |
$2,218.29
|
| Rate for Payer: BCBS MAPPO |
$3,941.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,178.15
|
| Rate for Payer: BCN Commercial |
$3,178.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,941.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,941.52
|
| Rate for Payer: Mclaren Medicaid |
$2,112.65
|
| Rate for Payer: Mclaren Medicare |
$3,941.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,138.60
|
| Rate for Payer: Meridian Medicaid |
$2,218.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,532.75
|
| Rate for Payer: Nomi Health Commercial |
$8,277.19
|
| Rate for Payer: PACE Medicare |
$3,744.44
|
| Rate for Payer: PACE SWMI |
$3,941.52
|
| Rate for Payer: PHP Medicare Advantage |
$3,941.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,112.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,388.13
|
| Rate for Payer: Priority Health Medicare |
$3,941.52
|
| Rate for Payer: Priority Health Narrow Network |
$9,910.50
|
| Rate for Payer: Railroad Medicare Medicare |
$3,941.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.96
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,941.52
|
| Rate for Payer: UHC Exchange |
$960.87
|
| Rate for Payer: UHC Medicare Advantage |
$3,941.52
|
| Rate for Payer: UHCCP Medicaid |
$2,112.65
|
| Rate for Payer: VA VA |
$3,941.52
|
|
|
INSERTION OF AQUEOUS DRAINAGE DEVICE, WITHOUT EXTRAOCULAR RESERVOIR, INTERNAL APPROACH, INTO THE SUBCONJUNCTIVAL SPACE; INITIAL DEVICE
|
Facility
|
OP
|
$15,888.99
|
|
|
Service Code
|
CPT 0449T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,709.68 |
| Max. Negotiated Rate |
$15,888.99 |
| Rate for Payer: Aetna Medicare |
$5,257.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,319.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,319.22
|
| Rate for Payer: BCBS Complete |
$2,845.17
|
| Rate for Payer: BCBS MAPPO |
$5,055.38
|
| Rate for Payer: BCBS Trust/PPO |
$4,285.11
|
| Rate for Payer: BCN Commercial |
$4,285.11
|
| Rate for Payer: BCN Medicare Advantage |
$5,055.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,055.38
|
| Rate for Payer: Mclaren Medicaid |
$2,709.68
|
| Rate for Payer: Mclaren Medicare |
$5,055.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,308.15
|
| Rate for Payer: Meridian Medicaid |
$2,845.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,813.69
|
| Rate for Payer: Nomi Health Commercial |
$10,616.30
|
| Rate for Payer: PACE Medicare |
$4,802.61
|
| Rate for Payer: PACE SWMI |
$5,055.38
|
| Rate for Payer: PHP Medicare Advantage |
$5,055.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,709.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,888.99
|
| Rate for Payer: Priority Health Medicare |
$5,055.38
|
| Rate for Payer: Priority Health Narrow Network |
$12,711.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,055.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,230.39
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,055.38
|
| Rate for Payer: UHC Exchange |
$9,661.34
|
| Rate for Payer: UHC Medicare Advantage |
$5,055.38
|
| Rate for Payer: UHCCP Medicaid |
$2,709.68
|
| Rate for Payer: VA VA |
$5,055.38
|
|
|
INSERTION OF BREAST IMPLANT ON SAME DAY OF MASTECTOMY (IE, IMMEDIATE)
|
Facility
|
OP
|
$20,082.39
|
|
|
Service Code
|
CPT 19340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$730.43 |
| Max. Negotiated Rate |
$20,082.39 |
| Rate for Payer: Aetna Medicare |
$6,645.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,987.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,987.00
|
| Rate for Payer: BCBS Complete |
$3,596.07
|
| Rate for Payer: BCBS MAPPO |
$6,389.60
|
| Rate for Payer: BCBS Trust/PPO |
$9,410.70
|
| Rate for Payer: BCN Commercial |
$9,410.70
|
| Rate for Payer: BCN Medicare Advantage |
$6,389.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,389.60
|
| Rate for Payer: Mclaren Medicaid |
$3,424.83
|
| Rate for Payer: Mclaren Medicare |
$6,389.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,709.08
|
| Rate for Payer: Meridian Medicaid |
$3,596.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,348.04
|
| Rate for Payer: Nomi Health Commercial |
$13,418.16
|
| Rate for Payer: PACE Medicare |
$6,070.12
|
| Rate for Payer: PACE SWMI |
$6,389.60
|
| Rate for Payer: PHP Medicare Advantage |
$6,389.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,424.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,082.39
|
| Rate for Payer: Priority Health Medicare |
$6,389.60
|
| Rate for Payer: Priority Health Narrow Network |
$16,065.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,389.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$803.47
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,389.60
|
| Rate for Payer: UHC Exchange |
$730.43
|
| Rate for Payer: UHC Medicare Advantage |
$6,389.60
|
| Rate for Payer: UHCCP Medicaid |
$3,424.83
|
| Rate for Payer: VA VA |
$6,389.60
|
|
|
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$936.74
|
|
|
Service Code
|
CPT 59200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.95 |
| Max. Negotiated Rate |
$936.74 |
| Rate for Payer: Aetna Medicare |
$309.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$372.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$372.55
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCBS MAPPO |
$298.04
|
| Rate for Payer: BCBS Trust/PPO |
$327.46
|
| Rate for Payer: BCN Commercial |
$327.46
|
| Rate for Payer: BCN Medicare Advantage |
$298.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.04
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Mclaren Medicare |
$298.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.94
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$342.75
|
| Rate for Payer: Nomi Health Commercial |
$625.88
|
| Rate for Payer: PACE Medicare |
$283.14
|
| Rate for Payer: PACE SWMI |
$298.04
|
| Rate for Payer: PHP Medicare Advantage |
$298.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$936.74
|
| Rate for Payer: Priority Health Medicare |
$298.04
|
| Rate for Payer: Priority Health Narrow Network |
$749.39
|
| Rate for Payer: Railroad Medicare Medicare |
$298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.34
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.04
|
| Rate for Payer: UHC Exchange |
$43.95
|
| Rate for Payer: UHC Medicare Advantage |
$298.04
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
| Rate for Payer: VA VA |
$298.04
|
|
|
INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 32550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$195.04 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$3,166.56
|
| Rate for Payer: BCN Commercial |
$3,166.56
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.54
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$195.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
INSERTION OF INFLATABLE URETHRAL/BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP, RESERVOIR, AND CUFF
|
Facility
|
OP
|
$61,984.57
|
|
|
Service Code
|
CPT 53445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$727.47 |
| Max. Negotiated Rate |
$61,984.57 |
| Rate for Payer: Aetna Medicare |
$20,510.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,651.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,651.95
|
| Rate for Payer: BCBS Complete |
$11,099.29
|
| Rate for Payer: BCBS MAPPO |
$19,721.56
|
| Rate for Payer: BCBS Trust/PPO |
$16,890.06
|
| Rate for Payer: BCN Commercial |
$16,890.06
|
| Rate for Payer: BCN Medicare Advantage |
$19,721.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,721.56
|
| Rate for Payer: Mclaren Medicaid |
$10,570.76
|
| Rate for Payer: Mclaren Medicare |
$19,721.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,707.64
|
| Rate for Payer: Meridian Medicaid |
$11,099.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,679.79
|
| Rate for Payer: Nomi Health Commercial |
$41,415.28
|
| Rate for Payer: PACE Medicare |
$18,735.48
|
| Rate for Payer: PACE SWMI |
$19,721.56
|
| Rate for Payer: PHP Medicare Advantage |
$19,721.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,570.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,984.57
|
| Rate for Payer: Priority Health Medicare |
$19,721.56
|
| Rate for Payer: Priority Health Narrow Network |
$49,587.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19,721.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$800.22
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,721.56
|
| Rate for Payer: UHC Exchange |
$727.47
|
| Rate for Payer: UHC Medicare Advantage |
$19,721.56
|
| Rate for Payer: UHCCP Medicaid |
$10,570.76
|
| Rate for Payer: VA VA |
$19,721.56
|
|
|
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
|
$965.29
|
|
|
Service Code
|
CPT 22853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.57 |
| Max. Negotiated Rate |
$965.29 |
| Rate for Payer: BCBS Trust/PPO |
$965.29
|
| Rate for Payer: BCN Commercial |
$965.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.93
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$253.57
|
|
|
INSERTION OF INTRAUTERINE DEVICE (IUD)
|
Facility
|
OP
|
$758.09
|
|
|
Service Code
|
CPT 58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$117.08 |
| Max. Negotiated Rate |
$758.09 |
| Rate for Payer: BCBS Trust/PPO |
$758.09
|
| Rate for Payer: BCN Commercial |
$758.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.35
|
| Rate for Payer: Priority Health Narrow Network |
$117.08
|
| Rate for Payer: UHC Core |
$700.00
|
|
|
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
|
$16,646.50
|
|
|
Service Code
|
CPT 37191
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.91 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,117.62
|
| Rate for Payer: BCN Commercial |
$4,117.62
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.90
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$209.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
INSERTION OF MULTI-COMPONENT, INFLATABLE PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDERS, AND RESERVOIR
|
Facility
|
OP
|
$61,984.57
|
|
|
Service Code
|
CPT 54405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$776.91 |
| Max. Negotiated Rate |
$61,984.57 |
| Rate for Payer: Aetna Medicare |
$20,510.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,651.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,651.95
|
| Rate for Payer: BCBS Complete |
$11,099.29
|
| Rate for Payer: BCBS MAPPO |
$19,721.56
|
| Rate for Payer: BCBS Trust/PPO |
$18,425.52
|
| Rate for Payer: BCN Commercial |
$18,425.52
|
| Rate for Payer: BCN Medicare Advantage |
$19,721.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,721.56
|
| Rate for Payer: Mclaren Medicaid |
$10,570.76
|
| Rate for Payer: Mclaren Medicare |
$19,721.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,707.64
|
| Rate for Payer: Meridian Medicaid |
$11,099.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,679.79
|
| Rate for Payer: Nomi Health Commercial |
$41,415.28
|
| Rate for Payer: PACE Medicare |
$18,735.48
|
| Rate for Payer: PACE SWMI |
$19,721.56
|
| Rate for Payer: PHP Medicare Advantage |
$19,721.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,570.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61,984.57
|
| Rate for Payer: Priority Health Medicare |
$19,721.56
|
| Rate for Payer: Priority Health Narrow Network |
$49,587.66
|
| Rate for Payer: Railroad Medicare Medicare |
$19,721.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.60
|
| Rate for Payer: UHC Core |
$18,337.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,721.56
|
| Rate for Payer: UHC Exchange |
$776.91
|
| Rate for Payer: UHC Medicare Advantage |
$19,721.56
|
| Rate for Payer: UHCCP Medicaid |
$10,570.76
|
| Rate for Payer: VA VA |
$19,721.56
|
|
|
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36556
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.35 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,341.21
|
| Rate for Payer: BCN Commercial |
$3,341.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.48
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$81.35
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID)
|
Facility
|
OP
|
$40,009.30
|
|
|
Service Code
|
CPT 54400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.50 |
| Max. Negotiated Rate |
$40,009.30 |
| Rate for Payer: Aetna Medicare |
$13,238.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,912.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,912.14
|
| Rate for Payer: BCBS Complete |
$7,164.28
|
| Rate for Payer: BCBS MAPPO |
$12,729.71
|
| Rate for Payer: BCBS Trust/PPO |
$10,524.48
|
| Rate for Payer: BCN Commercial |
$10,524.48
|
| Rate for Payer: BCN Medicare Advantage |
$12,729.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,729.71
|
| Rate for Payer: Mclaren Medicaid |
$6,823.12
|
| Rate for Payer: Mclaren Medicare |
$12,729.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,366.20
|
| Rate for Payer: Meridian Medicaid |
$7,164.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,639.17
|
| Rate for Payer: Nomi Health Commercial |
$26,732.39
|
| Rate for Payer: PACE Medicare |
$12,093.22
|
| Rate for Payer: PACE SWMI |
$12,729.71
|
| Rate for Payer: PHP Medicare Advantage |
$12,729.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,823.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40,009.30
|
| Rate for Payer: Priority Health Medicare |
$12,729.71
|
| Rate for Payer: Priority Health Narrow Network |
$32,007.44
|
| Rate for Payer: Railroad Medicare Medicare |
$12,729.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.75
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,729.71
|
| Rate for Payer: UHC Exchange |
$512.50
|
| Rate for Payer: UHC Medicare Advantage |
$12,729.71
|
| Rate for Payer: UHCCP Medicaid |
$6,823.12
|
| Rate for Payer: VA VA |
$12,729.71
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.05 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,951.95
|
| Rate for Payer: BCN Commercial |
$2,951.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$331.16
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$301.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP, WITHOUT IMAGING GUIDANCE; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$4,783.71
|
|
|
Service Code
|
CPT 36569
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.25 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,114.50
|
| Rate for Payer: BCN Commercial |
$1,114.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Nomi Health Commercial |
$3,196.26
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.38
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$91.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG, FOLEY)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 51702
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$24.34 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$253.95
|
| Rate for Payer: BCN Commercial |
$253.95
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.77
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$24.34
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$67.69
|
| Rate for Payer: VA VA |
$126.29
|
|
|
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 54660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,710.51
|
| Rate for Payer: BCN Commercial |
$2,710.51
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.71
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$345.19
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,669.72
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$317.74 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,560.84
|
| Rate for Payer: BCN Commercial |
$2,560.84
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.51
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$317.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; YOUNGER THAN 5 YEARS OF AGE
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$373.05 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,986.82
|
| Rate for Payer: BCN Commercial |
$1,986.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.36
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$373.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 36558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$246.47 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,208.61
|
| Rate for Payer: BCN Commercial |
$2,208.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.12
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$246.47
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 49421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$221.69 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,642.09
|
| Rate for Payer: BCN Commercial |
$2,642.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.86
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$221.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HORI PROCEDURE)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 25430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$711.26 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,815.08
|
| Rate for Payer: BCN Commercial |
$2,815.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.39
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$711.26
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
INSERTION OR REPLACEMENT OF BREAST IMPLANT ON SEPARATE DAY FROM MASTECTOMY
|
Facility
|
OP
|
$29,467.24
|
|
|
Service Code
|
CPT 19342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$731.27 |
| Max. Negotiated Rate |
$29,467.24 |
| Rate for Payer: Aetna Medicare |
$9,750.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,719.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,719.45
|
| Rate for Payer: BCBS Complete |
$5,276.57
|
| Rate for Payer: BCBS MAPPO |
$9,375.56
|
| Rate for Payer: BCBS Trust/PPO |
$7,097.08
|
| Rate for Payer: BCN Commercial |
$7,097.08
|
| Rate for Payer: BCN Medicare Advantage |
$9,375.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,375.56
|
| Rate for Payer: Mclaren Medicaid |
$5,025.30
|
| Rate for Payer: Mclaren Medicare |
$9,375.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,844.34
|
| Rate for Payer: Meridian Medicaid |
$5,276.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,781.89
|
| Rate for Payer: Nomi Health Commercial |
$19,688.68
|
| Rate for Payer: PACE Medicare |
$8,906.78
|
| Rate for Payer: PACE SWMI |
$9,375.56
|
| Rate for Payer: PHP Medicare Advantage |
$9,375.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,025.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29,467.24
|
| Rate for Payer: Priority Health Medicare |
$9,375.56
|
| Rate for Payer: Priority Health Narrow Network |
$23,573.79
|
| Rate for Payer: Railroad Medicare Medicare |
$9,375.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.40
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,375.56
|
| Rate for Payer: UHC Exchange |
$731.27
|
| Rate for Payer: UHC Medicare Advantage |
$9,375.56
|
| Rate for Payer: UHCCP Medicaid |
$5,025.30
|
| Rate for Payer: VA VA |
$9,375.56
|
|
|
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING; WITH CONNECTION TO 2 OR MORE ELECTRODE ARRAYS
|
Facility
|
OP
|
$93,841.38
|
|
|
Service Code
|
CPT 61886
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$870.42 |
| Max. Negotiated Rate |
$93,841.38 |
| Rate for Payer: Aetna Medicare |
$31,051.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,321.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,321.76
|
| Rate for Payer: BCBS Complete |
$16,803.75
|
| Rate for Payer: BCBS MAPPO |
$29,857.41
|
| Rate for Payer: BCBS Trust/PPO |
$30,334.29
|
| Rate for Payer: BCN Commercial |
$30,334.29
|
| Rate for Payer: BCN Medicare Advantage |
$29,857.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,857.41
|
| Rate for Payer: Mclaren Medicaid |
$16,003.57
|
| Rate for Payer: Mclaren Medicare |
$29,857.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,350.28
|
| Rate for Payer: Meridian Medicaid |
$16,803.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,336.02
|
| Rate for Payer: Nomi Health Commercial |
$62,700.56
|
| Rate for Payer: PACE Medicare |
$28,364.54
|
| Rate for Payer: PACE SWMI |
$29,857.41
|
| Rate for Payer: PHP Medicare Advantage |
$29,857.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$16,003.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93,841.38
|
| Rate for Payer: Priority Health Medicare |
$29,857.41
|
| Rate for Payer: Priority Health Narrow Network |
$75,073.10
|
| Rate for Payer: Railroad Medicare Medicare |
$29,857.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$957.46
|
| Rate for Payer: UHC Core |
$52,490.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,857.41
|
| Rate for Payer: UHC Exchange |
$870.42
|
| Rate for Payer: UHC Medicare Advantage |
$29,857.41
|
| Rate for Payer: UHCCP Medicaid |
$16,003.57
|
| Rate for Payer: VA VA |
$29,857.41
|
|
|
INSERTION OR REPLACEMENT OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$66,036.56
|
|
|
Service Code
|
CPT 64590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$284.52 |
| Max. Negotiated Rate |
$66,036.56 |
| Rate for Payer: Aetna Medicare |
$21,851.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,263.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,263.48
|
| Rate for Payer: BCBS Complete |
$11,824.87
|
| Rate for Payer: BCBS MAPPO |
$21,010.78
|
| Rate for Payer: BCBS Trust/PPO |
$25,546.66
|
| Rate for Payer: BCN Commercial |
$25,546.66
|
| Rate for Payer: BCN Medicare Advantage |
$21,010.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,010.78
|
| Rate for Payer: Mclaren Medicaid |
$11,261.78
|
| Rate for Payer: Mclaren Medicare |
$21,010.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22,061.32
|
| Rate for Payer: Meridian Medicaid |
$11,824.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,162.40
|
| Rate for Payer: Nomi Health Commercial |
$44,122.64
|
| Rate for Payer: PACE Medicare |
$19,960.24
|
| Rate for Payer: PACE SWMI |
$21,010.78
|
| Rate for Payer: PHP Medicare Advantage |
$21,010.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,261.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66,036.56
|
| Rate for Payer: Priority Health Medicare |
$21,010.78
|
| Rate for Payer: Priority Health Narrow Network |
$52,829.25
|
| Rate for Payer: Railroad Medicare Medicare |
$21,010.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.97
|
| Rate for Payer: UHC Core |
$30,600.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,010.78
|
| Rate for Payer: UHC Exchange |
$284.52
|
| Rate for Payer: UHC Medicare Advantage |
$21,010.78
|
| Rate for Payer: UHCCP Medicaid |
$11,261.78
|
| Rate for Payer: VA VA |
$21,010.78
|
|
