|
COMPUTER-ASSISTED SURGICAL NAVIGATIONAL PROCEDURE FOR MUSCULOSKELETAL PROCEDURES, IMAGE-LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 20985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$153.92 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.92
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$940.00
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.10 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.79
|
| Rate for Payer: BCCCP Commercial |
$342.31
|
| Rate for Payer: BCN Commercial |
$1,708.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.10
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.49 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,324.88
|
| Rate for Payer: BCCCP Commercial |
$293.81
|
| Rate for Payer: BCN Commercial |
$1,324.88
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.49
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
IP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,607.22 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.25
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$1,785.80
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health SBD |
$1,607.22
|
|
|
CONJUGATED ESTROGENS 0.3 MG TABLET
|
Facility
|
OP
|
$2,551.15
|
|
|
Service Code
|
NDC 00046110081
|
| Hospital Charge Code |
9973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,020.46 |
| Max. Negotiated Rate |
$2,296.04 |
| Rate for Payer: Aetna Commercial |
$2,168.48
|
| Rate for Payer: Aetna Medicare |
$1,275.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,658.25
|
| Rate for Payer: BCBS Complete |
$1,020.46
|
| Rate for Payer: Cash Price |
$2,040.92
|
| Rate for Payer: Cofinity Commercial |
$1,785.80
|
| Rate for Payer: Cofinity Commercial |
$2,193.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,785.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,040.92
|
| Rate for Payer: Healthscope Commercial |
$2,296.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,168.48
|
| Rate for Payer: PHP Commercial |
$2,168.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.25
|
| Rate for Payer: Priority Health SBD |
$1,607.22
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
IP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$990.79 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.25
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,100.88
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health SBD |
$990.79
|
|
|
CONJUGATED ESTROGENS 0.625 MG/GRAM VAGINAL CREAM
|
Facility
|
OP
|
$1,572.69
|
|
|
Service Code
|
NDC 00046087221
|
| Hospital Charge Code |
9977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$629.08 |
| Max. Negotiated Rate |
$1,415.42 |
| Rate for Payer: Aetna Commercial |
$1,336.79
|
| Rate for Payer: Aetna Medicare |
$786.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.25
|
| Rate for Payer: BCBS Complete |
$629.08
|
| Rate for Payer: Cash Price |
$1,258.15
|
| Rate for Payer: Cofinity Commercial |
$1,100.88
|
| Rate for Payer: Cofinity Commercial |
$1,352.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,100.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,258.15
|
| Rate for Payer: Healthscope Commercial |
$1,415.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,336.79
|
| Rate for Payer: PHP Commercial |
$1,336.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.25
|
| Rate for Payer: Priority Health SBD |
$990.79
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$1,175.88
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.24 |
| Max. Negotiated Rate |
$1,148.73 |
| Rate for Payer: Aetna Commercial |
$999.50
|
| Rate for Payer: Aetna Medicare |
$398.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$478.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$478.64
|
| Rate for Payer: BCBS Complete |
$215.50
|
| Rate for Payer: BCBS MAPPO |
$382.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,081.64
|
| Rate for Payer: BCN Commercial |
$1,081.64
|
| Rate for Payer: BCN Medicare Advantage |
$382.91
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,011.26
|
| Rate for Payer: Cofinity Commercial |
$823.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.91
|
| Rate for Payer: Healthscope Commercial |
$1,058.29
|
| Rate for Payer: Mclaren Medicaid |
$205.24
|
| Rate for Payer: Mclaren Medicare |
$382.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$402.06
|
| Rate for Payer: Meridian Medicaid |
$215.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$440.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.50
|
| Rate for Payer: Nomi Health Commercial |
$1,148.73
|
| Rate for Payer: PACE Medicare |
$363.76
|
| Rate for Payer: PACE SWMI |
$382.91
|
| Rate for Payer: PHP Commercial |
$999.50
|
| Rate for Payer: PHP Medicare Advantage |
$382.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.66
|
| Rate for Payer: Priority Health Medicare |
$382.91
|
| Rate for Payer: Priority Health Narrow Network |
$881.33
|
| Rate for Payer: Priority Health SBD |
$740.80
|
| Rate for Payer: Railroad Medicare Medicare |
$382.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.91
|
| Rate for Payer: UHC Medicare Advantage |
$382.91
|
| Rate for Payer: UHCCP Medicaid |
$215.58
|
| Rate for Payer: VA VA |
$382.91
|
|
|
CONJUGATED ESTROGENS 25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$1,175.88
|
|
|
Service Code
|
HCPCS J1410
|
| Hospital Charge Code |
9972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$740.80 |
| Max. Negotiated Rate |
$1,058.29 |
| Rate for Payer: Aetna Commercial |
$999.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.32
|
| Rate for Payer: Cash Price |
$940.70
|
| Rate for Payer: Cofinity Commercial |
$1,011.26
|
| Rate for Payer: Cofinity Commercial |
$823.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$823.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.70
|
| Rate for Payer: Healthscope Commercial |
$1,058.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$999.50
|
| Rate for Payer: PHP Commercial |
$999.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$764.32
|
| Rate for Payer: Priority Health SBD |
$740.80
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVE CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 30903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$67.69 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$134.13
|
| Rate for Payer: BCN Commercial |
$134.13
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$265.21
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.86
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERY AND/OR PACKING) ANY METHOD
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 30901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$60.78 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$131.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$157.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$157.86
|
| Rate for Payer: BCBS Complete |
$71.08
|
| Rate for Payer: BCBS MAPPO |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$103.06
|
| Rate for Payer: BCN Commercial |
$103.06
|
| Rate for Payer: BCN Medicare Advantage |
$126.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.29
|
| Rate for Payer: Mclaren Medicaid |
$67.69
|
| Rate for Payer: Mclaren Medicare |
$126.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.60
|
| Rate for Payer: Meridian Medicaid |
$71.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.23
|
| Rate for Payer: Nomi Health Commercial |
$378.87
|
| Rate for Payer: PACE Medicare |
$119.98
|
| Rate for Payer: PACE SWMI |
$126.29
|
| Rate for Payer: PHP Medicare Advantage |
$126.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.95
|
| Rate for Payer: Priority Health Medicare |
$126.29
|
| Rate for Payer: Priority Health Narrow Network |
$317.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.78
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$126.29
|
| Rate for Payer: UHCCP Medicaid |
$71.10
|
| Rate for Payer: VA VA |
$126.29
|
|
|
CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$9,445.00
|
|
|
Service Code
|
CPT 27132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,778.07 |
| Max. Negotiated Rate |
$9,445.00 |
| Rate for Payer: BCBS Trust/PPO |
$6,537.26
|
| Rate for Payer: BCN Commercial |
$6,537.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.07
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$9,445.00
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
OP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$920.08 |
| Max. Negotiated Rate |
$3,190.73 |
| Rate for Payer: Aetna Commercial |
$2,286.42
|
| Rate for Payer: Aetna Medicare |
$1,344.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.44
|
| Rate for Payer: BCBS Complete |
$1,075.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,190.73
|
| Rate for Payer: BCN Commercial |
$3,190.73
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Cofinity Commercial |
$1,882.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,882.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.42
|
| Rate for Payer: PHP Commercial |
$2,286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,748.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.10
|
| Rate for Payer: Priority Health Narrow Network |
$920.08
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
|
|
COPPER 380 SQUARE MM INTRAUTERINE DEVICE
|
Facility
|
IP
|
$2,689.90
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
167586
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,694.64 |
| Max. Negotiated Rate |
$2,420.91 |
| Rate for Payer: Aetna Commercial |
$2,286.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,748.44
|
| Rate for Payer: Cash Price |
$2,151.92
|
| Rate for Payer: Cofinity Commercial |
$1,882.93
|
| Rate for Payer: Cofinity Commercial |
$2,313.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,882.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,151.92
|
| Rate for Payer: Healthscope Commercial |
$2,420.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,286.42
|
| Rate for Payer: PHP Commercial |
$2,286.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,748.44
|
| Rate for Payer: Priority Health SBD |
$1,694.64
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.30 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,528.58
|
| Rate for Payer: BCN Commercial |
$1,528.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.30
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$630.94 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,704.88
|
| Rate for Payer: BCN Commercial |
$2,704.88
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.94
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.31 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,780.83
|
| Rate for Payer: BCN Commercial |
$3,780.83
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.31
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$7,097.54
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,713.81
|
| Rate for Payer: BCN Commercial |
$1,713.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.26
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL PHALANX OSTEOTOMY, ANY METHOD
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$538.37 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,425.10
|
| Rate for Payer: BCN Commercial |
$2,425.10
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.37
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$513.84 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,110.11
|
| Rate for Payer: BCN Commercial |
$2,110.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.84
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$408.48 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,862.82
|
| Rate for Payer: BCN Commercial |
$1,862.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$408.48
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$291.09
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$183.39 |
| Max. Negotiated Rate |
$261.98 |
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$183.39
|
| Rate for Payer: Priority Health SBD |
$83.05
|
|
|
COSYNTROPIN 0.25 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$82.77
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
9686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$81.10 |
| Rate for Payer: Aetna Commercial |
$70.35
|
| Rate for Payer: Aetna Commercial |
$112.05
|
| Rate for Payer: Aetna Commercial |
$247.43
|
| Rate for Payer: Aetna Medicare |
$65.91
|
| Rate for Payer: Aetna Medicare |
$145.54
|
| Rate for Payer: Aetna Medicare |
$41.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.80
|
| Rate for Payer: BCBS Complete |
$116.44
|
| Rate for Payer: BCBS Complete |
$52.73
|
| Rate for Payer: BCBS Complete |
$33.11
|
| Rate for Payer: BCBS Trust/PPO |
$81.10
|
| Rate for Payer: BCBS Trust/PPO |
$81.10
|
| Rate for Payer: BCBS Trust/PPO |
$81.10
|
| Rate for Payer: BCN Commercial |
$81.10
|
| Rate for Payer: BCN Commercial |
$81.10
|
| Rate for Payer: BCN Commercial |
$81.10
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$232.87
|
| Rate for Payer: Cash Price |
$105.46
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$203.76
|
| Rate for Payer: Cofinity Commercial |
$113.37
|
| Rate for Payer: Cofinity Commercial |
$92.27
|
| Rate for Payer: Cofinity Commercial |
$250.34
|
| Rate for Payer: Cofinity Commercial |
$57.94
|
| Rate for Payer: Cofinity Commercial |
$71.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Healthscope Commercial |
$261.98
|
| Rate for Payer: Healthscope Commercial |
$118.64
|
| Rate for Payer: Healthscope Commercial |
$74.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$247.43
|
| Rate for Payer: PHP Commercial |
$70.35
|
| Rate for Payer: PHP Commercial |
$112.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.68
|
| Rate for Payer: Priority Health SBD |
$83.05
|
| Rate for Payer: Priority Health SBD |
$52.15
|
| Rate for Payer: Priority Health SBD |
$183.39
|
|
|
CPT 0255T
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 0255T
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
|
|
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECT ARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 36825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$843.93 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.99
|
| Rate for Payer: BCN Commercial |
$1,579.99
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$843.93
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,981.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
