Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,154.08
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna New Business (MI Preferred)	$1,190.72
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Commercial	$1,282.31
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Cofinity Medicare Advantage	$1,282.31
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health Cigna Priority Health	$1,190.72
Rate for Payer: Priority Health SBD	$1,154.08

ARIPIPRAZOLE 5 MG TABLET

Facility

$204.45

Service Code	NDC 16729027901
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$81.78
Max. Negotiated Rate	$184.00
Rate for Payer: Aetna Commercial	$173.78
Rate for Payer: Aetna Medicare	$102.22
Rate for Payer: Aetna New Business (MI Preferred)	$132.89
Rate for Payer: BCBS Complete	$81.78
Rate for Payer: Cash Price	$163.56
Rate for Payer: Cofinity Commercial	$143.12
Rate for Payer: Cofinity Commercial	$175.83
Rate for Payer: Cofinity Medicare Advantage	$143.12
Rate for Payer: Encore Health Key Benefits Commercial	$163.56
Rate for Payer: Healthscope Commercial	$184.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$173.78
Rate for Payer: PHP Commercial	$173.78
Rate for Payer: Priority Health Cigna Priority Health	$132.89
Rate for Payer: Priority Health SBD	$128.80

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,821.51

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,147.55
Max. Negotiated Rate	$1,639.36
Rate for Payer: Aetna Commercial	$1,548.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,183.98
Rate for Payer: Cash Price	$1,457.21
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Cofinity Commercial	$1,566.50
Rate for Payer: Cofinity Medicare Advantage	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,457.21
Rate for Payer: Healthscope Commercial	$1,639.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,548.28
Rate for Payer: PHP Commercial	$1,548.28
Rate for Payer: Priority Health Cigna Priority Health	$1,183.98
Rate for Payer: Priority Health SBD	$1,147.55

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,821.51

Service Code	NDC 00904736761
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$728.60
Max. Negotiated Rate	$1,639.36
Rate for Payer: Aetna Commercial	$1,548.28
Rate for Payer: Aetna Medicare	$910.75
Rate for Payer: Aetna New Business (MI Preferred)	$1,183.98
Rate for Payer: BCBS Complete	$728.60
Rate for Payer: Cash Price	$1,457.21
Rate for Payer: Cofinity Commercial	$1,275.06
Rate for Payer: Cofinity Commercial	$1,566.50
Rate for Payer: Cofinity Medicare Advantage	$1,275.06
Rate for Payer: Encore Health Key Benefits Commercial	$1,457.21
Rate for Payer: Healthscope Commercial	$1,639.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,548.28
Rate for Payer: PHP Commercial	$1,548.28
Rate for Payer: Priority Health Cigna Priority Health	$1,183.98
Rate for Payer: Priority Health SBD	$1,147.55

ARSENIC TRIOXIDE 2 MG/ML INTRAVENOUS SOLUTION

Facility

$3,982.01

Service Code	HCPCS J9017
Hospital Charge Code	185456
Hospital Revenue Code	636
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$3,583.81
Rate for Payer: Aetna Commercial	$3,384.71
Rate for Payer: Aetna Medicare	$8.48
Rate for Payer: Aetna New Business (MI Preferred)	$2,588.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$10.19
Rate for Payer: Amish Plain Church Group Commercial	$10.19
Rate for Payer: BCBS Complete	$4.59
Rate for Payer: BCBS MAPPO	$8.15
Rate for Payer: BCN Medicare Advantage	$8.15
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cash Price	$3,185.61
Rate for Payer: Cofinity Commercial	$2,787.41
Rate for Payer: Cofinity Commercial	$3,424.53
Rate for Payer: Cofinity Medicare Advantage	$2,787.41
Rate for Payer: Encore Health Key Benefits Commercial	$3,185.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$8.15
Rate for Payer: Healthscope Commercial	$3,583.81
Rate for Payer: Mclaren Medicaid	$4.37
Rate for Payer: Mclaren Medicare	$8.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.56
Rate for Payer: Meridian Medicaid	$4.59
Rate for Payer: MI Amish Medical Board Commercial	$9.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,384.71
Rate for Payer: PACE Medicare	$7.74
Rate for Payer: PACE SWMI	$8.15
Rate for Payer: PHP Commercial	$3,384.71
Rate for Payer: PHP Medicare Advantage	$8.15
Rate for Payer: Priority Health Choice Medicaid	$4.37
Rate for Payer: Priority Health Cigna Priority Health	$2,588.31
Rate for Payer: Priority Health Medicare	$8.15
Rate for Payer: Priority Health SBD	$2,508.67
Rate for Payer: Railroad Medicare Medicare	$8.15
Rate for Payer: UHC All Payor (Choice/PPO)	$22.94
Rate for Payer: UHC Dual Complete DSNP	$8.15
Rate for Payer: UHC Medicare Advantage	$8.15
Rate for Payer: UHCCP Medicaid	$4.59
Rate for Payer: VA VA	$8.15

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY FOREARM VEIN TRANSPOSITION

Facility

$14,840.35

Service Code	CPT 36820
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION

Facility

$14,840.35

Service Code	CPT 36819
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION

Facility

$14,840.35

Service Code	CPT 36818
Hospital Revenue Code	360
Min. Negotiated Rate	$2,825.83
Max. Negotiated Rate	$14,840.35
Rate for Payer: Aetna Medicare	$5,482.95
Rate for Payer: Allen County Amish Medical Aid Commercial	$6,590.09
Rate for Payer: Amish Plain Church Group Commercial	$6,590.09
Rate for Payer: BCBS Complete	$2,967.12
Rate for Payer: BCBS MAPPO	$5,272.07
Rate for Payer: BCN Medicare Advantage	$5,272.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$5,272.07
Rate for Payer: Mclaren Medicaid	$2,825.83
Rate for Payer: Mclaren Medicare	$5,272.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5,535.67
Rate for Payer: Meridian Medicaid	$2,967.12
Rate for Payer: MI Amish Medical Board Commercial	$6,062.88
Rate for Payer: PACE Medicare	$5,008.47
Rate for Payer: PACE SWMI	$5,272.07
Rate for Payer: PHP Medicare Advantage	$5,272.07
Rate for Payer: Priority Health Choice Medicaid	$2,825.83
Rate for Payer: Priority Health Medicare	$5,272.07
Rate for Payer: Railroad Medicare Medicare	$5,272.07
Rate for Payer: UHC All Payor (Choice/PPO)	$14,840.35
Rate for Payer: UHC Dual Complete DSNP	$5,272.07
Rate for Payer: UHC Medicare Advantage	$5,272.07
Rate for Payer: UHCCP Medicaid	$2,968.18
Rate for Payer: VA VA	$5,272.07

ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)

Facility

$8,640.87

Service Code	CPT 36821
Hospital Revenue Code	360
Min. Negotiated Rate	$1,645.35
Max. Negotiated Rate	$8,640.87
Rate for Payer: Aetna Medicare	$3,192.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,837.11
Rate for Payer: Amish Plain Church Group Commercial	$3,837.11
Rate for Payer: BCBS Complete	$1,727.62
Rate for Payer: BCBS MAPPO	$3,069.69
Rate for Payer: BCN Medicare Advantage	$3,069.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,069.69
Rate for Payer: Mclaren Medicaid	$1,645.35
Rate for Payer: Mclaren Medicare	$3,069.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,223.17
Rate for Payer: Meridian Medicaid	$1,727.62
Rate for Payer: MI Amish Medical Board Commercial	$3,530.14
Rate for Payer: PACE Medicare	$2,916.21
Rate for Payer: PACE SWMI	$3,069.69
Rate for Payer: PHP Medicare Advantage	$3,069.69
Rate for Payer: Priority Health Choice Medicaid	$1,645.35
Rate for Payer: Priority Health Medicare	$3,069.69
Rate for Payer: Railroad Medicare Medicare	$3,069.69
Rate for Payer: UHC All Payor (Choice/PPO)	$8,640.87
Rate for Payer: UHC Dual Complete DSNP	$3,069.69
Rate for Payer: UHC Medicare Advantage	$3,069.69
Rate for Payer: UHCCP Medicaid	$1,728.24
Rate for Payer: VA VA	$3,069.69

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$810.38

Service Code	CPT 20605
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$359.86
Rate for Payer: Amish Plain Church Group Commercial	$359.86
Rate for Payer: BCBS Complete	$162.02
Rate for Payer: BCBS MAPPO	$287.89
Rate for Payer: BCN Medicare Advantage	$287.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$287.89
Rate for Payer: Mclaren Medicaid	$154.31
Rate for Payer: Mclaren Medicare	$287.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$302.28
Rate for Payer: Meridian Medicaid	$162.02
Rate for Payer: MI Amish Medical Board Commercial	$331.07
Rate for Payer: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
Rate for Payer: Railroad Medicare Medicare	$287.89
Rate for Payer: UHC All Payor (Choice/PPO)	$810.38
Rate for Payer: UHC Dual Complete DSNP	$287.89
Rate for Payer: UHC Medicare Advantage	$287.89
Rate for Payer: UHCCP Medicaid	$162.08
Rate for Payer: VA VA	$287.89

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$810.38

Service Code	CPT 20610
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$359.86
Rate for Payer: Amish Plain Church Group Commercial	$359.86
Rate for Payer: BCBS Complete	$162.02
Rate for Payer: BCBS MAPPO	$287.89
Rate for Payer: BCN Medicare Advantage	$287.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$287.89
Rate for Payer: Mclaren Medicaid	$154.31
Rate for Payer: Mclaren Medicare	$287.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$302.28
Rate for Payer: Meridian Medicaid	$162.02
Rate for Payer: MI Amish Medical Board Commercial	$331.07
Rate for Payer: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
Rate for Payer: Railroad Medicare Medicare	$287.89
Rate for Payer: UHC All Payor (Choice/PPO)	$810.38
Rate for Payer: UHC Dual Complete DSNP	$287.89
Rate for Payer: UHC Medicare Advantage	$287.89
Rate for Payer: UHCCP Medicaid	$162.08
Rate for Payer: VA VA	$287.89

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$810.38

Service Code	CPT 20610
Hospital Revenue Code	361
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$359.86
Rate for Payer: Amish Plain Church Group Commercial	$359.86
Rate for Payer: BCBS Complete	$162.02
Rate for Payer: BCBS MAPPO	$287.89
Rate for Payer: BCN Medicare Advantage	$287.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$287.89
Rate for Payer: Mclaren Medicaid	$154.31
Rate for Payer: Mclaren Medicare	$287.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$302.28
Rate for Payer: Meridian Medicaid	$162.02
Rate for Payer: MI Amish Medical Board Commercial	$331.07
Rate for Payer: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
Rate for Payer: Railroad Medicare Medicare	$287.89
Rate for Payer: UHC All Payor (Choice/PPO)	$810.38
Rate for Payer: UHC Dual Complete DSNP	$287.89
Rate for Payer: UHC Medicare Advantage	$287.89
Rate for Payer: UHCCP Medicaid	$162.08
Rate for Payer: VA VA	$287.89

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE

Facility

$810.38

Service Code	CPT 20600
Hospital Revenue Code	360
Min. Negotiated Rate	$154.31
Max. Negotiated Rate	$810.38
Rate for Payer: Aetna Medicare	$299.41
Rate for Payer: Allen County Amish Medical Aid Commercial	$359.86
Rate for Payer: Amish Plain Church Group Commercial	$359.86
Rate for Payer: BCBS Complete	$162.02
Rate for Payer: BCBS MAPPO	$287.89
Rate for Payer: BCN Medicare Advantage	$287.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$287.89
Rate for Payer: Mclaren Medicaid	$154.31
Rate for Payer: Mclaren Medicare	$287.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$302.28
Rate for Payer: Meridian Medicaid	$162.02
Rate for Payer: MI Amish Medical Board Commercial	$331.07
Rate for Payer: PACE Medicare	$273.50
Rate for Payer: PACE SWMI	$287.89
Rate for Payer: PHP Medicare Advantage	$287.89
Rate for Payer: Priority Health Choice Medicaid	$154.31
Rate for Payer: Priority Health Medicare	$287.89
Rate for Payer: Railroad Medicare Medicare	$287.89
Rate for Payer: UHC All Payor (Choice/PPO)	$810.38
Rate for Payer: UHC Dual Complete DSNP	$287.89
Rate for Payer: UHC Medicare Advantage	$287.89
Rate for Payer: UHCCP Medicaid	$162.08
Rate for Payer: VA VA	$287.89

ARTHRODESIS, ANKLE, OPEN

Facility

$35,323.48

Service Code	CPT 27870
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2

Facility

$35,323.48

Service Code	CPT 22551
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT

Facility

$19,611.80

Service Code	CPT 28755
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT

Facility

$19,611.80

Service Code	CPT 28750
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE;

Facility

$35,323.48

Service Code	CPT 28730
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE OR TRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT CORRECTION)

Facility

$35,323.48

Service Code	CPT 28735
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT

Facility

$19,611.80

Service Code	CPT 28740
Hospital Revenue Code	360
Min. Negotiated Rate	$3,734.39
Max. Negotiated Rate	$19,611.80
Rate for Payer: Aetna Medicare	$7,245.83
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,708.92
Rate for Payer: Amish Plain Church Group Commercial	$8,708.92
Rate for Payer: BCBS Complete	$3,921.11
Rate for Payer: BCBS MAPPO	$6,967.14
Rate for Payer: BCN Medicare Advantage	$6,967.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,967.14
Rate for Payer: Mclaren Medicaid	$3,734.39
Rate for Payer: Mclaren Medicare	$6,967.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7,315.50
Rate for Payer: Meridian Medicaid	$3,921.11
Rate for Payer: MI Amish Medical Board Commercial	$8,012.21
Rate for Payer: PACE Medicare	$6,618.78
Rate for Payer: PACE SWMI	$6,967.14
Rate for Payer: PHP Medicare Advantage	$6,967.14
Rate for Payer: Priority Health Choice Medicaid	$3,734.39
Rate for Payer: Priority Health Medicare	$6,967.14
Rate for Payer: Railroad Medicare Medicare	$6,967.14
Rate for Payer: UHC All Payor (Choice/PPO)	$19,611.80
Rate for Payer: UHC Dual Complete DSNP	$6,967.14
Rate for Payer: UHC Medicare Advantage	$6,967.14
Rate for Payer: UHCCP Medicaid	$3,922.50
Rate for Payer: VA VA	$6,967.14

ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE INTERSPACE; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED)

Facility

$50,486.50

Service Code	CPT 22612
Hospital Revenue Code	360
Min. Negotiated Rate	$9,613.40
Max. Negotiated Rate	$50,486.50
Rate for Payer: Aetna Medicare	$18,652.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,419.31
Rate for Payer: Amish Plain Church Group Commercial	$22,419.31
Rate for Payer: BCBS Complete	$10,094.07
Rate for Payer: BCBS MAPPO	$17,935.45
Rate for Payer: BCN Medicare Advantage	$17,935.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,935.45
Rate for Payer: Mclaren Medicaid	$9,613.40
Rate for Payer: Mclaren Medicare	$17,935.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,832.22
Rate for Payer: Meridian Medicaid	$10,094.07
Rate for Payer: MI Amish Medical Board Commercial	$20,625.77
Rate for Payer: PACE Medicare	$17,038.68
Rate for Payer: PACE SWMI	$17,935.45
Rate for Payer: PHP Medicare Advantage	$17,935.45
Rate for Payer: Priority Health Choice Medicaid	$9,613.40
Rate for Payer: Priority Health Medicare	$17,935.45
Rate for Payer: Railroad Medicare Medicare	$17,935.45
Rate for Payer: UHC All Payor (Choice/PPO)	$50,486.50
Rate for Payer: UHC Dual Complete DSNP	$17,935.45
Rate for Payer: UHC Medicare Advantage	$17,935.45
Rate for Payer: UHCCP Medicaid	$10,097.66
Rate for Payer: VA VA	$17,935.45

ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXATION DEVICE

Facility

$50,486.50

Service Code	CPT 27279
Hospital Revenue Code	360
Min. Negotiated Rate	$9,613.40
Max. Negotiated Rate	$50,486.50
Rate for Payer: Aetna Medicare	$18,652.87
Rate for Payer: Allen County Amish Medical Aid Commercial	$22,419.31
Rate for Payer: Amish Plain Church Group Commercial	$22,419.31
Rate for Payer: BCBS Complete	$10,094.07
Rate for Payer: BCBS MAPPO	$17,935.45
Rate for Payer: BCN Medicare Advantage	$17,935.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$17,935.45
Rate for Payer: Mclaren Medicaid	$9,613.40
Rate for Payer: Mclaren Medicare	$17,935.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$18,832.22
Rate for Payer: Meridian Medicaid	$10,094.07
Rate for Payer: MI Amish Medical Board Commercial	$20,625.77
Rate for Payer: PACE Medicare	$17,038.68
Rate for Payer: PACE SWMI	$17,935.45
Rate for Payer: PHP Medicare Advantage	$17,935.45
Rate for Payer: Priority Health Choice Medicaid	$9,613.40
Rate for Payer: Priority Health Medicare	$17,935.45
Rate for Payer: Railroad Medicare Medicare	$17,935.45
Rate for Payer: UHC All Payor (Choice/PPO)	$50,486.50
Rate for Payer: UHC Dual Complete DSNP	$17,935.45
Rate for Payer: UHC Medicare Advantage	$17,935.45
Rate for Payer: UHCCP Medicaid	$10,097.66
Rate for Payer: VA VA	$17,935.45

ARTHRODESIS; SUBTALAR

Facility

$35,323.48

Service Code	CPT 28725
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

ARTHRODESIS; TRIPLE

Facility

$35,323.48

Service Code	CPT 28715
Hospital Revenue Code	360
Min. Negotiated Rate	$6,726.13
Max. Negotiated Rate	$35,323.48
Rate for Payer: Aetna Medicare	$13,050.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$15,685.94
Rate for Payer: Amish Plain Church Group Commercial	$15,685.94
Rate for Payer: BCBS Complete	$7,062.44
Rate for Payer: BCBS MAPPO	$12,548.75
Rate for Payer: BCN Medicare Advantage	$12,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$12,548.75
Rate for Payer: Mclaren Medicaid	$6,726.13
Rate for Payer: Mclaren Medicare	$12,548.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13,176.19
Rate for Payer: Meridian Medicaid	$7,062.44
Rate for Payer: MI Amish Medical Board Commercial	$14,431.06
Rate for Payer: PACE Medicare	$11,921.31
Rate for Payer: PACE SWMI	$12,548.75
Rate for Payer: PHP Medicare Advantage	$12,548.75
Rate for Payer: Priority Health Choice Medicaid	$6,726.13
Rate for Payer: Priority Health Medicare	$12,548.75
Rate for Payer: Railroad Medicare Medicare	$12,548.75
Rate for Payer: UHC All Payor (Choice/PPO)	$35,323.48
Rate for Payer: UHC Dual Complete DSNP	$12,548.75
Rate for Payer: UHC Medicare Advantage	$12,548.75
Rate for Payer: UHCCP Medicaid	$7,064.95
Rate for Payer: VA VA	$12,548.75

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