|
REPAIR OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,539.27 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,539.27
|
| Rate for Payer: BCN Commercial |
$3,539.27
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 30465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,091.91
|
| Rate for Payer: BCN Commercial |
$3,091.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$3,084.94
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,943.95
|
|
|
Service Code
|
CPT 45560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,446.45 |
| Max. Negotiated Rate |
$8,943.95 |
| Rate for Payer: Aetna Medicare |
$2,876.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,457.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,457.10
|
| Rate for Payer: BCBS Complete |
$1,518.91
|
| Rate for Payer: BCBS MAPPO |
$2,765.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.72
|
| Rate for Payer: BCN Commercial |
$1,700.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,765.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,765.68
|
| Rate for Payer: Mclaren Medicaid |
$1,446.45
|
| Rate for Payer: Mclaren Medicare |
$2,765.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,903.96
|
| Rate for Payer: Meridian Medicaid |
$2,903.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,180.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,042.25
|
| Rate for Payer: Nomi Health Commercial |
$8,297.04
|
| Rate for Payer: PACE Medicare |
$2,627.40
|
| Rate for Payer: PACE SWMI |
$2,765.68
|
| Rate for Payer: PHP Medicare Advantage |
$2,765.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,446.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,943.95
|
| Rate for Payer: Priority Health Medicare |
$2,765.68
|
| Rate for Payer: Priority Health Tiered Network |
$7,155.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,765.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,765.68
|
| Rate for Payer: UHC Medicaid |
$1,446.45
|
| Rate for Payer: UHCCP Medicaid |
$1,446.45
|
| Rate for Payer: VA VA |
$2,765.68
|
|
|
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; ACUTE
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,877.02
|
| Rate for Payer: BCN Commercial |
$3,877.02
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 23412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,466.63 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,466.63
|
| Rate for Payer: BCN Commercial |
$3,466.63
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,372.21 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,372.21
|
| Rate for Payer: BCN Commercial |
$3,372.21
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$20,860.47
|
|
|
Service Code
|
CPT 49521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,942.23 |
| Max. Negotiated Rate |
$20,860.47 |
| Rate for Payer: Aetna Medicare |
$6,708.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,063.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,063.18
|
| Rate for Payer: BCBS Complete |
$3,542.64
|
| Rate for Payer: BCBS MAPPO |
$6,450.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,942.23
|
| Rate for Payer: BCN Commercial |
$1,942.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,450.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,450.54
|
| Rate for Payer: Mclaren Medicaid |
$3,373.63
|
| Rate for Payer: Mclaren Medicare |
$6,450.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,773.07
|
| Rate for Payer: Meridian Medicaid |
$6,773.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,418.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,095.59
|
| Rate for Payer: Nomi Health Commercial |
$19,351.62
|
| Rate for Payer: PACE Medicare |
$6,128.01
|
| Rate for Payer: PACE SWMI |
$6,450.54
|
| Rate for Payer: PHP Medicare Advantage |
$6,450.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,373.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20,860.47
|
| Rate for Payer: Priority Health Medicare |
$6,450.54
|
| Rate for Payer: Priority Health Tiered Network |
$16,688.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6,450.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,450.54
|
| Rate for Payer: UHC Medicaid |
$3,373.63
|
| Rate for Payer: UHCCP Medicaid |
$3,373.63
|
| Rate for Payer: VA VA |
$6,450.54
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,777.36
|
| Rate for Payer: BCN Commercial |
$2,777.36
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$1,865.82
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 28208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,395.52
|
| Rate for Payer: BCN Commercial |
$1,395.52
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,887.33
|
| Rate for Payer: BCN Commercial |
$1,887.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$1,645.43
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
REPLACEMENT OF GASTROSTOMY TUBE, PERCUTANEOUS, INCLUDES REMOVAL, WHEN PERFORMED, WITHOUT IMAGING OR ENDOSCOPIC GUIDANCE; NOT REQUIRING REVISION OF GASTROSTOMY TRACT
|
Facility
|
OP
|
$805.08
|
|
|
Service Code
|
CPT 43762
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$805.08 |
| Rate for Payer: Aetna Medicare |
$258.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$311.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$311.19
|
| Rate for Payer: BCBS Complete |
$136.72
|
| Rate for Payer: BCBS MAPPO |
$248.95
|
| Rate for Payer: BCBS Trust/PPO |
$319.98
|
| Rate for Payer: BCN Commercial |
$319.98
|
| Rate for Payer: BCN Medicare Advantage |
$248.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.95
|
| Rate for Payer: Mclaren Medicaid |
$130.20
|
| Rate for Payer: Mclaren Medicare |
$248.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.40
|
| Rate for Payer: Meridian Medicaid |
$261.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$286.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.85
|
| Rate for Payer: Nomi Health Commercial |
$746.85
|
| Rate for Payer: PACE Medicare |
$236.50
|
| Rate for Payer: PACE SWMI |
$248.95
|
| Rate for Payer: PHP Medicare Advantage |
$248.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$805.08
|
| Rate for Payer: Priority Health Medicare |
$248.95
|
| Rate for Payer: Priority Health Tiered Network |
$644.06
|
| Rate for Payer: Railroad Medicare Medicare |
$248.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.95
|
| Rate for Payer: UHC Medicaid |
$130.20
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
| Rate for Payer: VA VA |
$248.95
|
|
|
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT IMPLANT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 11970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,554.42
|
| Rate for Payer: BCN Commercial |
$4,554.42
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$3,781.35
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 43900035980
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.58
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$1.56
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 43900035983
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.58
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$1.56
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 43900035988
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 43900035988
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.58
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$1.56
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 43900035983
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
OP
|
$3.97
|
|
|
Service Code
|
NDC 43900035984
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.58
|
| Rate for Payer: UHC Core |
$2.07
|
| Rate for Payer: UHC Exchange |
$1.56
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 43900035980
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
|
|
RESOURCE ARGINAID ORAL PACKET CUSTOM
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
NDC 43900035984
|
| Hospital Charge Code |
150858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Advantage |
$2.78
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.50
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$3,674.28
|
|
|
Service Code
|
APR-DRG 1331
|
| Min. Negotiated Rate |
$3,499.31 |
| Max. Negotiated Rate |
$3,674.28 |
| Rate for Payer: BCBS Complete |
$3,674.28
|
| Rate for Payer: Mclaren Medicaid |
$3,499.31
|
| Rate for Payer: Meridian Medicaid |
$3,674.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,499.31
|
| Rate for Payer: UHC Medicaid |
$3,499.31
|
| Rate for Payer: UHCCP Medicaid |
$3,499.31
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$12,433.73
|
|
|
Service Code
|
APR-DRG 1334
|
| Min. Negotiated Rate |
$11,841.65 |
| Max. Negotiated Rate |
$12,433.73 |
| Rate for Payer: BCBS Complete |
$12,433.73
|
| Rate for Payer: Mclaren Medicaid |
$11,841.65
|
| Rate for Payer: Meridian Medicaid |
$12,433.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$11,841.65
|
| Rate for Payer: UHC Medicaid |
$11,841.65
|
| Rate for Payer: UHCCP Medicaid |
$11,841.65
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$7,760.19
|
|
|
Service Code
|
APR-DRG 1333
|
| Min. Negotiated Rate |
$7,390.66 |
| Max. Negotiated Rate |
$7,760.19 |
| Rate for Payer: BCBS Complete |
$7,760.19
|
| Rate for Payer: Mclaren Medicaid |
$7,390.66
|
| Rate for Payer: Meridian Medicaid |
$7,760.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,390.66
|
| Rate for Payer: UHC Medicaid |
$7,390.66
|
| Rate for Payer: UHCCP Medicaid |
$7,390.66
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$5,040.45
|
|
|
Service Code
|
APR-DRG 1332
|
| Min. Negotiated Rate |
$4,800.43 |
| Max. Negotiated Rate |
$5,040.45 |
| Rate for Payer: BCBS Complete |
$5,040.45
|
| Rate for Payer: Mclaren Medicaid |
$4,800.43
|
| Rate for Payer: Meridian Medicaid |
$5,040.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,800.43
|
| Rate for Payer: UHC Medicaid |
$4,800.43
|
| Rate for Payer: UHCCP Medicaid |
$4,800.43
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$17,757.31
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$7,715.66 |
| Max. Negotiated Rate |
$17,757.31 |
| Rate for Payer: Aetna Medicare |
$8,446.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,152.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,152.19
|
| Rate for Payer: BCBS MAPPO |
$8,121.75
|
| Rate for Payer: BCBS Trust/PPO |
$17,757.31
|
| Rate for Payer: BCN Commercial |
$17,757.31
|
| Rate for Payer: BCN Medicare Advantage |
$8,121.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,121.75
|
| Rate for Payer: Mclaren Medicare |
$8,121.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,527.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,340.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,933.92
|
| Rate for Payer: Nomi Health Commercial |
$12,590.40
|
| Rate for Payer: PACE Medicare |
$7,715.66
|
| Rate for Payer: PACE SWMI |
$8,121.75
|
| Rate for Payer: PHP Medicare Advantage |
$8,121.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15,735.21
|
| Rate for Payer: Priority Health Medicare |
$8,121.75
|
| Rate for Payer: Priority Health Tiered Network |
$12,588.16
|
| Rate for Payer: Railroad Medicare Medicare |
$8,121.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,908.80
|
| Rate for Payer: UHC Core |
$13,309.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,121.75
|
| Rate for Payer: UHC Exchange |
$10,869.71
|
| Rate for Payer: VA VA |
$8,121.75
|
|
