|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; PARTIAL (ANTERIOR)
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31254
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING FRONTAL SINUS EXPLORATION, WITH REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31257
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH LIGATION OF SPHENOPALATINE ARTERY
|
Facility
|
OP
|
$4,734.21
|
|
|
Service Code
|
CPT 31241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$901.47 |
| Max. Negotiated Rate |
$4,734.21 |
| Rate for Payer: Aetna Medicare |
$1,749.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,102.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,102.30
|
| Rate for Payer: BCBS Complete |
$946.54
|
| Rate for Payer: BCBS MAPPO |
$1,681.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,681.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,681.84
|
| Rate for Payer: Mclaren Medicaid |
$901.47
|
| Rate for Payer: Mclaren Medicare |
$1,681.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,765.93
|
| Rate for Payer: Meridian Medicaid |
$946.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,934.12
|
| Rate for Payer: PACE Medicare |
$1,597.75
|
| Rate for Payer: PACE SWMI |
$1,681.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,681.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$901.47
|
| Rate for Payer: Priority Health Medicare |
$1,681.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,681.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,734.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,681.84
|
| Rate for Payer: UHC Exchange |
$3,214.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,681.84
|
| Rate for Payer: UHCCP Medicaid |
$901.47
|
| Rate for Payer: VA VA |
$1,681.84
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY;
|
Facility
|
OP
|
$10,121.85
|
|
|
Service Code
|
CPT 31256
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,927.35 |
| Max. Negotiated Rate |
$10,121.85 |
| Rate for Payer: Aetna Medicare |
$3,739.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,494.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,494.76
|
| Rate for Payer: BCBS Complete |
$2,023.72
|
| Rate for Payer: BCBS MAPPO |
$3,595.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,595.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,595.81
|
| Rate for Payer: Mclaren Medicaid |
$1,927.35
|
| Rate for Payer: Mclaren Medicare |
$3,595.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,775.60
|
| Rate for Payer: Meridian Medicaid |
$2,023.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,135.18
|
| Rate for Payer: PACE Medicare |
$3,416.02
|
| Rate for Payer: PACE SWMI |
$3,595.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,595.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,927.35
|
| Rate for Payer: Priority Health Medicare |
$3,595.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3,595.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,595.81
|
| Rate for Payer: UHC Exchange |
$6,871.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,595.81
|
| Rate for Payer: UHCCP Medicaid |
$1,927.35
|
| Rate for Payer: VA VA |
$3,595.81
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$19,004.38
|
|
|
Service Code
|
CPT 31288
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,618.72 |
| Max. Negotiated Rate |
$19,004.38 |
| Rate for Payer: Aetna Medicare |
$7,021.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,439.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,439.19
|
| Rate for Payer: BCBS Complete |
$3,799.66
|
| Rate for Payer: BCBS MAPPO |
$6,751.35
|
| Rate for Payer: BCN Medicare Advantage |
$6,751.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,751.35
|
| Rate for Payer: Mclaren Medicaid |
$3,618.72
|
| Rate for Payer: Mclaren Medicare |
$6,751.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,088.92
|
| Rate for Payer: Meridian Medicaid |
$3,799.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,764.05
|
| Rate for Payer: PACE Medicare |
$6,413.78
|
| Rate for Payer: PACE SWMI |
$6,751.35
|
| Rate for Payer: PHP Medicare Advantage |
$6,751.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,618.72
|
| Rate for Payer: Priority Health Medicare |
$6,751.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6,751.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,004.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,751.35
|
| Rate for Payer: UHC Exchange |
$12,902.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,751.35
|
| Rate for Payer: UHCCP Medicaid |
$3,618.72
|
| Rate for Payer: VA VA |
$6,751.35
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); BILATERAL
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 69706
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
NASOPHARYNGOSCOPY, SURGICAL, WITH DILATION OF EUSTACHIAN TUBE (IE, BALLOON DILATION); UNILATERAL
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 69705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22,198.06
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$19,978.25 |
| Rate for Payer: Aetna American Axle |
$14,428.74
|
| Rate for Payer: Aetna Commercial |
$18,868.35
|
| Rate for Payer: Aetna Medicare |
$24.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,428.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.00
|
| Rate for Payer: BCBS Complete |
$13.51
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCN Medicare Advantage |
$24.00
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cofinity Commercial |
$19,090.33
|
| Rate for Payer: Cofinity Commercial |
$15,538.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,538.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,758.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$19,978.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,538.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,648.54
|
| Rate for Payer: Mclaren Medicaid |
$12.86
|
| Rate for Payer: Mclaren Medicare |
$24.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.20
|
| Rate for Payer: Meridian Medicaid |
$13.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,868.35
|
| Rate for Payer: PACE Medicare |
$22.80
|
| Rate for Payer: PACE SWMI |
$24.00
|
| Rate for Payer: PHP Commercial |
$18,868.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,428.74
|
| Rate for Payer: Priority Health Medicare |
$24.00
|
| Rate for Payer: Priority Health SBD |
$13,984.78
|
| Rate for Payer: Railroad Medicare Medicare |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.00
|
| Rate for Payer: UHC Exchange |
$45.87
|
| Rate for Payer: UHC Medicare Advantage |
$24.00
|
| Rate for Payer: UHCCP Medicaid |
$12.86
|
| Rate for Payer: UMR Bronson Commercial |
$8,213.28
|
| Rate for Payer: VA VA |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,648.54
|
|
|
NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22,198.06
|
|
|
Service Code
|
HCPCS J2323
|
| Hospital Charge Code |
40120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,767.15 |
| Max. Negotiated Rate |
$19,978.25 |
| Rate for Payer: Aetna American Axle |
$14,428.74
|
| Rate for Payer: Aetna Commercial |
$18,868.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,428.74
|
| Rate for Payer: Cash Price |
$17,758.45
|
| Rate for Payer: Cofinity Commercial |
$15,538.64
|
| Rate for Payer: Cofinity Commercial |
$19,090.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,538.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,758.45
|
| Rate for Payer: Healthscope Commercial |
$19,978.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,538.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,648.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,868.35
|
| Rate for Payer: PHP Commercial |
$18,868.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,428.74
|
| Rate for Payer: Priority Health SBD |
$13,984.78
|
| Rate for Payer: UMR Bronson Commercial |
$9,767.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,648.54
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$264.20
|
|
|
Service Code
|
NDC 16571075809
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.75 |
| Max. Negotiated Rate |
$237.78 |
| Rate for Payer: Aetna American Axle |
$171.73
|
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna Medicare |
$132.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.73
|
| Rate for Payer: BCBS Complete |
$105.68
|
| Rate for Payer: Cash Price |
$211.36
|
| Rate for Payer: Cofinity Commercial |
$184.94
|
| Rate for Payer: Cofinity Commercial |
$227.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.36
|
| Rate for Payer: Healthscope Commercial |
$237.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.57
|
| Rate for Payer: PHP Commercial |
$224.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.73
|
| Rate for Payer: Priority Health SBD |
$166.45
|
| Rate for Payer: UMR Bronson Commercial |
$97.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.15
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$530.88
|
|
|
Service Code
|
NDC 49884098401
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.59 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna American Axle |
$345.07
|
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.07
|
| Rate for Payer: Cash Price |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$371.62
|
| Rate for Payer: Cofinity Commercial |
$456.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.70
|
| Rate for Payer: Healthscope Commercial |
$477.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.25
|
| Rate for Payer: PHP Commercial |
$451.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.07
|
| Rate for Payer: Priority Health SBD |
$334.45
|
| Rate for Payer: UMR Bronson Commercial |
$233.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.16
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$530.88
|
|
|
Service Code
|
NDC 49884098401
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.43 |
| Max. Negotiated Rate |
$477.79 |
| Rate for Payer: Aetna American Axle |
$345.07
|
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Medicare |
$265.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.07
|
| Rate for Payer: BCBS Complete |
$212.35
|
| Rate for Payer: Cash Price |
$424.70
|
| Rate for Payer: Cofinity Commercial |
$371.62
|
| Rate for Payer: Cofinity Commercial |
$456.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$424.70
|
| Rate for Payer: Healthscope Commercial |
$477.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.25
|
| Rate for Payer: PHP Commercial |
$451.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.07
|
| Rate for Payer: Priority Health SBD |
$334.45
|
| Rate for Payer: UMR Bronson Commercial |
$196.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.16
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$264.20
|
|
|
Service Code
|
NDC 16571075809
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.25 |
| Max. Negotiated Rate |
$237.78 |
| Rate for Payer: Aetna American Axle |
$171.73
|
| Rate for Payer: Aetna Commercial |
$224.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.73
|
| Rate for Payer: Cash Price |
$211.36
|
| Rate for Payer: Cofinity Commercial |
$184.94
|
| Rate for Payer: Cofinity Commercial |
$227.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.36
|
| Rate for Payer: Healthscope Commercial |
$237.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.57
|
| Rate for Payer: PHP Commercial |
$224.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.73
|
| Rate for Payer: Priority Health SBD |
$166.45
|
| Rate for Payer: UMR Bronson Commercial |
$116.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.15
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
IP
|
$413.25
|
|
|
Service Code
|
NDC 75834020501
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.83 |
| Max. Negotiated Rate |
$371.93 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.27
|
| Rate for Payer: Cofinity Commercial |
$355.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.61
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$181.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
|
NATEGLINIDE 60 MG TABLET
|
Facility
|
OP
|
$413.25
|
|
|
Service Code
|
NDC 75834020501
|
| Hospital Charge Code |
29437
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.90 |
| Max. Negotiated Rate |
$371.93 |
| Rate for Payer: Aetna American Axle |
$268.61
|
| Rate for Payer: Aetna Commercial |
$351.26
|
| Rate for Payer: Aetna Medicare |
$206.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.61
|
| Rate for Payer: BCBS Complete |
$165.30
|
| Rate for Payer: Cash Price |
$330.60
|
| Rate for Payer: Cofinity Commercial |
$289.27
|
| Rate for Payer: Cofinity Commercial |
$355.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$289.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$330.60
|
| Rate for Payer: Healthscope Commercial |
$371.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$289.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$309.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$351.26
|
| Rate for Payer: PHP Commercial |
$351.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$268.61
|
| Rate for Payer: Priority Health SBD |
$260.35
|
| Rate for Payer: UMR Bronson Commercial |
$152.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$309.94
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8,553.86 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,608.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,524.49
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,636.38
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: UMR Bronson Commercial |
$8,553.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.43
|
|
|
NECITUMUMAB 800 MG/50 ML (16 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19,440.58
|
|
|
Service Code
|
HCPCS J9295
|
| Hospital Charge Code |
176602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$17,496.52 |
| Rate for Payer: Aetna American Axle |
$12,636.38
|
| Rate for Payer: Aetna Commercial |
$16,524.49
|
| Rate for Payer: Aetna Medicare |
$5.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,636.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.16
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: BCBS MAPPO |
$5.73
|
| Rate for Payer: BCN Medicare Advantage |
$5.73
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cash Price |
$15,552.46
|
| Rate for Payer: Cofinity Commercial |
$16,718.90
|
| Rate for Payer: Cofinity Commercial |
$13,608.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$13,608.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,552.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.73
|
| Rate for Payer: Healthscope Commercial |
$17,496.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13,608.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,580.43
|
| Rate for Payer: Mclaren Medicaid |
$3.07
|
| Rate for Payer: Mclaren Medicare |
$5.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.02
|
| Rate for Payer: Meridian Medicaid |
$3.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,524.49
|
| Rate for Payer: PACE Medicare |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.73
|
| Rate for Payer: PHP Commercial |
$16,524.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,636.38
|
| Rate for Payer: Priority Health Medicare |
$5.73
|
| Rate for Payer: Priority Health SBD |
$12,247.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.73
|
| Rate for Payer: UHC Exchange |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$5.73
|
| Rate for Payer: UHCCP Medicaid |
$3.07
|
| Rate for Payer: UMR Bronson Commercial |
$7,193.01
|
| Rate for Payer: VA VA |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,580.43
|
|
|
NEEDLE INSERTION(S) WITHOUT INJECTION(S); 1 OR 2 MUSCLE(S)
|
Facility
|
OP
|
$67.22
|
|
|
Service Code
|
CPT 20560
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$67.22 |
| Rate for Payer: Aetna Medicare |
$24.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.85
|
| Rate for Payer: BCBS Complete |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$23.88
|
| Rate for Payer: BCN Medicare Advantage |
$23.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.88
|
| Rate for Payer: Mclaren Medicaid |
$12.80
|
| Rate for Payer: Mclaren Medicare |
$23.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.07
|
| Rate for Payer: Meridian Medicaid |
$13.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.46
|
| Rate for Payer: PACE Medicare |
$22.69
|
| Rate for Payer: PACE SWMI |
$23.88
|
| Rate for Payer: PHP Medicare Advantage |
$23.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.80
|
| Rate for Payer: Priority Health Medicare |
$23.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.88
|
| Rate for Payer: UHC Exchange |
$45.64
|
| Rate for Payer: UHC Medicare Advantage |
$23.88
|
| Rate for Payer: UHCCP Medicaid |
$12.80
|
| Rate for Payer: VA VA |
$23.88
|
|
|
NEGATIVE PRESSURE WOUND THERAPY, (EG, VACUUM ASSISTED DRAINAGE COLLECTION), UTILIZING DISPOSABLE, NON-DURABLE MEDICAL EQUIPMENT INCLUDING PROVISION OF EXUDATE MANAGEMENT COLLECTION SYSTEM, TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 97608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
