|
ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,639.86
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
185456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$3,275.87 |
| Rate for Payer: Aetna Commercial |
$3,093.88
|
| Rate for Payer: Aetna Medicare |
$16.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,365.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.73
|
| Rate for Payer: BCBS Complete |
$9.07
|
| Rate for Payer: BCBS MAPPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$46.72
|
| Rate for Payer: BCN Medicare Advantage |
$15.78
|
| Rate for Payer: Cash Price |
$2,911.89
|
| Rate for Payer: Cash Price |
$2,911.89
|
| Rate for Payer: Cofinity Commercial |
$2,547.90
|
| Rate for Payer: Cofinity Commercial |
$3,130.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.78
|
| Rate for Payer: Healthscope Commercial |
$3,275.87
|
| Rate for Payer: Mclaren Medicaid |
$8.63
|
| Rate for Payer: Mclaren Medicare |
$15.78
|
| Rate for Payer: Meridian Medicaid |
$9.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,093.88
|
| Rate for Payer: PACE Medicare |
$14.99
|
| Rate for Payer: PACE SWMI |
$15.78
|
| Rate for Payer: PHP Commercial |
$3,093.88
|
| Rate for Payer: PHP Medicare Advantage |
$15.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,547.90
|
| Rate for Payer: Priority Health Medicare |
$15.78
|
| Rate for Payer: Priority Health SBD |
$2,293.11
|
| Rate for Payer: Railroad Medicare Medicare |
$15.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.78
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: VA VA |
$15.78
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION
|
Facility
|
OP
|
$15,411.76
|
|
|
Service Code
|
CPT 36820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.76 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,635.37
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$768.64
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$698.76
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$15,411.76
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$702.36 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,210.31
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.60
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$702.36
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$15,411.76
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$15,411.76 |
| Rate for Payer: Aetna Medicare |
$5,085.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,112.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,112.15
|
| Rate for Payer: BCBS Complete |
$2,808.66
|
| Rate for Payer: BCBS MAPPO |
$4,889.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.79
|
| Rate for Payer: BCN Medicare Advantage |
$4,889.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,889.72
|
| Rate for Payer: Mclaren Medicaid |
$2,674.68
|
| Rate for Payer: Mclaren Medicare |
$4,889.72
|
| Rate for Payer: Meridian Medicaid |
$2,808.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,134.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,623.18
|
| Rate for Payer: PACE Medicare |
$4,645.23
|
| Rate for Payer: PACE SWMI |
$4,889.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,889.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,674.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,411.76
|
| Rate for Payer: Priority Health Medicare |
$4,889.72
|
| Rate for Payer: Priority Health Narrow Network |
$12,329.41
|
| Rate for Payer: Railroad Medicare Medicare |
$4,889.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.74
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,889.72
|
| Rate for Payer: UHC Exchange |
$663.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,036.41
|
| Rate for Payer: VA VA |
$4,889.72
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,913.25
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$634.91 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,505.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.40
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$634.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.62
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.98
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.04 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$274.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.42
|
| Rate for Payer: BCBS Complete |
$151.38
|
| Rate for Payer: BCBS MAPPO |
$263.54
|
| Rate for Payer: BCBS Trust/PPO |
$169.96
|
| Rate for Payer: BCN Medicare Advantage |
$263.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.54
|
| Rate for Payer: Mclaren Medicaid |
$144.16
|
| Rate for Payer: Mclaren Medicare |
$263.54
|
| Rate for Payer: Meridian Medicaid |
$151.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.07
|
| Rate for Payer: PACE Medicare |
$250.36
|
| Rate for Payer: PACE SWMI |
$263.54
|
| Rate for Payer: PHP Medicare Advantage |
$263.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.49
|
| Rate for Payer: Priority Health Medicare |
$263.54
|
| Rate for Payer: Priority Health Narrow Network |
$650.79
|
| Rate for Payer: Railroad Medicare Medicare |
$263.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.54
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.54
|
| Rate for Payer: UHC Exchange |
$35.04
|
| Rate for Payer: UHC Medicare Advantage |
$271.45
|
| Rate for Payer: VA VA |
$263.54
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$38,393.11
|
|
|
Service Code
|
CPT 27870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$996.41 |
| Max. Negotiated Rate |
$38,393.11 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,792.69
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,393.11
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$30,714.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.05
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$996.41
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2
|
Facility
|
OP
|
$38,393.11
|
|
|
Service Code
|
CPT 22551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.33 |
| Max. Negotiated Rate |
$38,393.11 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$16,423.73
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,393.11
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$30,714.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,854.96
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$1,686.33
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$19,136.76
|
|
|
Service Code
|
CPT 22552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.02 |
| Max. Negotiated Rate |
$19,136.76 |
| Rate for Payer: BCBS Trust/PPO |
$19,136.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.82
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Exchange |
$388.02
|
|
|
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 28755
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$332.35 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,299.99
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$365.58
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$332.35
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 28750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.73 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,273.60
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.80
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$570.73
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 28730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$718.08 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,090.89
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.89
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$718.08
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT CORRECTION)
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 28735
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.20 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,813.33
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.92
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$767.20
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT
|
Facility
|
OP
|
$7,957.04
|
|
|
Service Code
|
CPT 28740
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$610.68 |
| Max. Negotiated Rate |
$7,957.04 |
| Rate for Payer: Aetna Medicare |
$6,620.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,957.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,957.04
|
| Rate for Payer: BCBS Complete |
$3,656.42
|
| Rate for Payer: BCBS MAPPO |
$6,365.63
|
| Rate for Payer: BCBS Trust/PPO |
$4,197.87
|
| Rate for Payer: BCN Medicare Advantage |
$6,365.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,365.63
|
| Rate for Payer: Mclaren Medicaid |
$3,482.00
|
| Rate for Payer: Mclaren Medicare |
$6,365.63
|
| Rate for Payer: Meridian Medicaid |
$3,656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,683.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,320.47
|
| Rate for Payer: PACE Medicare |
$6,047.35
|
| Rate for Payer: PACE SWMI |
$6,365.63
|
| Rate for Payer: PHP Medicare Advantage |
$6,365.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,482.00
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.75
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$610.68
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$16,361.74
|
|
|
Service Code
|
CPT 22614
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$383.11 |
| Max. Negotiated Rate |
$16,361.74 |
| Rate for Payer: BCBS Trust/PPO |
$16,361.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.42
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$383.11
|
|
|
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE INTERSPACE; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED)
|
Facility
|
OP
|
$38,393.11
|
|
|
Service Code
|
CPT 22612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,564.85 |
| Max. Negotiated Rate |
$38,393.11 |
| Rate for Payer: Aetna Medicare |
$17,245.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,727.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,727.79
|
| Rate for Payer: BCBS Complete |
$9,524.83
|
| Rate for Payer: BCBS MAPPO |
$16,582.23
|
| Rate for Payer: BCBS Trust/PPO |
$12,310.82
|
| Rate for Payer: BCN Medicare Advantage |
$16,582.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,582.23
|
| Rate for Payer: Mclaren Medicaid |
$9,070.48
|
| Rate for Payer: Mclaren Medicare |
$16,582.23
|
| Rate for Payer: Meridian Medicaid |
$9,524.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,411.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,069.56
|
| Rate for Payer: PACE Medicare |
$15,753.12
|
| Rate for Payer: PACE SWMI |
$16,582.23
|
| Rate for Payer: PHP Medicare Advantage |
$16,582.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,070.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,393.11
|
| Rate for Payer: Priority Health Medicare |
$16,582.23
|
| Rate for Payer: Priority Health Narrow Network |
$30,714.49
|
| Rate for Payer: Railroad Medicare Medicare |
$16,582.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,721.34
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,582.23
|
| Rate for Payer: UHC Exchange |
$1,564.85
|
| Rate for Payer: UHC Medicare Advantage |
$17,079.70
|
| Rate for Payer: VA VA |
$16,582.23
|
|
|
ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXING DEVICE
|
Facility
|
OP
|
$50,344.18
|
|
|
Service Code
|
CPT 27279
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$791.10 |
| Max. Negotiated Rate |
$50,344.18 |
| Rate for Payer: Aetna Medicare |
$17,245.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,727.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,727.79
|
| Rate for Payer: BCBS Complete |
$9,524.83
|
| Rate for Payer: BCBS MAPPO |
$16,582.23
|
| Rate for Payer: BCBS Trust/PPO |
$7,982.51
|
| Rate for Payer: BCN Medicare Advantage |
$16,582.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,582.23
|
| Rate for Payer: Mclaren Medicaid |
$9,070.48
|
| Rate for Payer: Mclaren Medicare |
$16,582.23
|
| Rate for Payer: Meridian Medicaid |
$9,524.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,411.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,069.56
|
| Rate for Payer: PACE Medicare |
$15,753.12
|
| Rate for Payer: PACE SWMI |
$16,582.23
|
| Rate for Payer: PHP Medicare Advantage |
$16,582.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,070.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,344.18
|
| Rate for Payer: Priority Health Medicare |
$16,582.23
|
| Rate for Payer: Priority Health Narrow Network |
$40,275.34
|
| Rate for Payer: Railroad Medicare Medicare |
$16,582.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.21
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,582.23
|
| Rate for Payer: UHC Exchange |
$791.10
|
| Rate for Payer: UHC Medicare Advantage |
$17,079.70
|
| Rate for Payer: VA VA |
$16,582.23
|
|
|
ARTHRODESIS; SUBTALAR
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 28725
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$771.45 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$4,093.05
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.60
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$771.45
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS; TRIPLE
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 28715
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$929.61 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$6,029.19
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.57
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$929.61
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT, MIDTARSAL, TARSAL NAVICULAR-CUNEIFORM (EG, MILLER TYPE PROCEDURE)
|
Facility
|
OP
|
$14,638.36
|
|
|
Service Code
|
CPT 28737
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$684.03 |
| Max. Negotiated Rate |
$14,638.36 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.03
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$752.43
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$684.03
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$38,393.11
|
|
|
Service Code
|
CPT 27130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,264.91 |
| Max. Negotiated Rate |
$38,393.11 |
| Rate for Payer: Aetna Medicare |
$12,179.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,638.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,638.36
|
| Rate for Payer: BCBS Complete |
$6,726.62
|
| Rate for Payer: BCBS MAPPO |
$11,710.69
|
| Rate for Payer: BCBS Trust/PPO |
$10,064.11
|
| Rate for Payer: BCN Medicare Advantage |
$11,710.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,710.69
|
| Rate for Payer: Mclaren Medicaid |
$6,405.75
|
| Rate for Payer: Mclaren Medicare |
$11,710.69
|
| Rate for Payer: Meridian Medicaid |
$6,726.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,296.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,467.29
|
| Rate for Payer: PACE Medicare |
$11,125.16
|
| Rate for Payer: PACE SWMI |
$11,710.69
|
| Rate for Payer: PHP Medicare Advantage |
$11,710.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,405.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,393.11
|
| Rate for Payer: Priority Health Medicare |
$11,710.69
|
| Rate for Payer: Priority Health Narrow Network |
$30,714.49
|
| Rate for Payer: Railroad Medicare Medicare |
$11,710.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,391.40
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,710.69
|
| Rate for Payer: UHC Exchange |
$1,264.91
|
| Rate for Payer: UHC Medicare Advantage |
$12,062.01
|
| Rate for Payer: VA VA |
$11,710.69
|
|
|
ARTHROPLASTY, ANKLE; WITH IMPLANT (TOTAL ANKLE)
|
Facility
|
OP
|
$65,660.92
|
|
|
Service Code
|
CPT 27702
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$950.89 |
| Max. Negotiated Rate |
$65,660.92 |
| Rate for Payer: Aetna Medicare |
$17,245.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,727.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,727.79
|
| Rate for Payer: BCBS Complete |
$9,524.83
|
| Rate for Payer: BCBS MAPPO |
$16,582.23
|
| Rate for Payer: BCBS Trust/PPO |
$12,915.21
|
| Rate for Payer: BCN Medicare Advantage |
$16,582.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,582.23
|
| Rate for Payer: Mclaren Medicaid |
$9,070.48
|
| Rate for Payer: Mclaren Medicare |
$16,582.23
|
| Rate for Payer: Meridian Medicaid |
$9,524.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,411.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,069.56
|
| Rate for Payer: PACE Medicare |
$15,753.12
|
| Rate for Payer: PACE SWMI |
$16,582.23
|
| Rate for Payer: PHP Medicare Advantage |
$16,582.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,070.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65,660.92
|
| Rate for Payer: Priority Health Medicare |
$16,582.23
|
| Rate for Payer: Priority Health Narrow Network |
$52,528.74
|
| Rate for Payer: Railroad Medicare Medicare |
$16,582.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.98
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,582.23
|
| Rate for Payer: UHC Exchange |
$950.89
|
| Rate for Payer: UHC Medicare Advantage |
$17,079.70
|
| Rate for Payer: VA VA |
$16,582.23
|
|
