|
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM
|
Facility
|
OP
|
$1,118.65
|
|
|
Service Code
|
CPT 13131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$894.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.70
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$236.09
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 13132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$294.70 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$527.45
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.17
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$294.70
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 13133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$121.81 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$358.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.99
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$121.81
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 13121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.63
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$251.48
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 13122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$80.22 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$777.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.24
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$80.22
|
|
|
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$1,757.43
|
|
|
Service Code
|
CPT 13101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$241.00 |
| Max. Negotiated Rate |
$1,757.43 |
| Rate for Payer: Aetna Medicare |
$581.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$698.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$698.54
|
| Rate for Payer: BCBS Complete |
$320.99
|
| Rate for Payer: BCBS MAPPO |
$558.83
|
| Rate for Payer: BCBS Trust/PPO |
$363.15
|
| Rate for Payer: BCN Medicare Advantage |
$558.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.83
|
| Rate for Payer: Mclaren Medicaid |
$305.68
|
| Rate for Payer: Mclaren Medicare |
$558.83
|
| Rate for Payer: Meridian Medicaid |
$320.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$642.65
|
| Rate for Payer: PACE Medicare |
$530.89
|
| Rate for Payer: PACE SWMI |
$558.83
|
| Rate for Payer: PHP Medicare Advantage |
$558.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,757.43
|
| Rate for Payer: Priority Health Medicare |
$558.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,405.94
|
| Rate for Payer: Railroad Medicare Medicare |
$558.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.10
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.83
|
| Rate for Payer: UHC Exchange |
$241.00
|
| Rate for Payer: UHC Medicare Advantage |
$575.59
|
| Rate for Payer: VA VA |
$558.83
|
|
|
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 13102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: BCBS Trust/PPO |
$242.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.72
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Exchange |
$69.75
|
|
|
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$4,301.45
|
|
|
Service Code
|
CPT 26410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$599.55 |
| Max. Negotiated Rate |
$4,301.45 |
| Rate for Payer: Aetna Medicare |
$1,487.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,787.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,787.60
|
| Rate for Payer: BCBS Complete |
$821.44
|
| Rate for Payer: BCBS MAPPO |
$1,430.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.08
|
| Rate for Payer: Mclaren Medicaid |
$782.25
|
| Rate for Payer: Mclaren Medicare |
$1,430.08
|
| Rate for Payer: Meridian Medicaid |
$821.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,501.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,644.59
|
| Rate for Payer: PACE Medicare |
$1,358.58
|
| Rate for Payer: PACE SWMI |
$1,430.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,301.45
|
| Rate for Payer: Priority Health Medicare |
$1,430.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,441.16
|
| Rate for Payer: Railroad Medicare Medicare |
$1,430.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$659.50
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.08
|
| Rate for Payer: UHC Exchange |
$599.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,472.98
|
| Rate for Payer: VA VA |
$1,430.08
|
|
|
REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$19,834.21
|
|
|
Service Code
|
CPT 27665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.06 |
| Max. Negotiated Rate |
$19,834.21 |
| 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 HMO/PPO/Tiered Network |
$19,834.21
|
| Rate for Payer: Priority Health Medicare |
$6,365.63
|
| Rate for Payer: Priority Health Narrow Network |
$15,867.37
|
| Rate for Payer: Railroad Medicare Medicare |
$6,365.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.37
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,365.63
|
| Rate for Payer: UHC Exchange |
$423.06
|
| Rate for Payer: UHC Medicare Advantage |
$6,556.60
|
| Rate for Payer: VA VA |
$6,365.63
|
|
|
REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$8,925.64
|
|
|
Service Code
|
CPT 27658
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.04 |
| Max. Negotiated Rate |
$8,925.64 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,925.64
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,140.51
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.84
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$368.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 49553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$625.41 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.95
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$625.41
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 49550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$572.04 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,472.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.24
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$572.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 49507
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.86 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,273.08
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.05
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$581.86
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 49505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$518.01 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$3,201.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,847.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,847.99
|
| Rate for Payer: BCBS Complete |
$1,768.23
|
| Rate for Payer: BCBS MAPPO |
$3,078.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.81
|
| Rate for Payer: BCN Medicare Advantage |
$3,078.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,078.39
|
| Rate for Payer: Mclaren Medicaid |
$1,683.88
|
| Rate for Payer: Mclaren Medicare |
$3,078.39
|
| Rate for Payer: Meridian Medicaid |
$1,768.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,232.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,540.15
|
| Rate for Payer: PACE Medicare |
$2,924.47
|
| Rate for Payer: PACE SWMI |
$3,078.39
|
| Rate for Payer: PHP Medicare Advantage |
$3,078.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,683.88
|
| Rate for Payer: Priority Health Medicare |
$3,078.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,078.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.81
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,078.39
|
| Rate for Payer: UHC Exchange |
$518.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,170.74
|
| Rate for Payer: VA VA |
$3,078.39
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS
|
Facility
|
OP
|
$1,118.65
|
|
|
Service Code
|
CPT 12051
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.63 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$137.63
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$894.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.97
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$166.34
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM
|
Facility
|
OP
|
$1,118.65
|
|
|
Service Code
|
CPT 12052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$248.53
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Priority Health Narrow Network |
$894.92
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.03
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$195.48
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.44 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$254.30
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.68
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$142.44
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$191.88 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$249.39
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.07
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$191.88
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.78
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$237.07
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12031
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.66 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$233.21
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.53
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$148.66
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12032
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$186.64 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$312.51
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.30
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$186.64
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$312.72
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.52
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
|
Facility
|
OP
|
$878.00
|
|
|
Service Code
|
CPT 12034
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$194.08 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Medicare |
$368.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$443.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$443.50
|
| Rate for Payer: BCBS Complete |
$203.80
|
| Rate for Payer: BCBS MAPPO |
$354.80
|
| Rate for Payer: BCBS Trust/PPO |
$312.72
|
| Rate for Payer: BCN Medicare Advantage |
$354.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.80
|
| Rate for Payer: Mclaren Medicaid |
$194.08
|
| Rate for Payer: Mclaren Medicare |
$354.80
|
| Rate for Payer: Meridian Medicaid |
$203.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.02
|
| Rate for Payer: PACE Medicare |
$337.06
|
| Rate for Payer: PACE SWMI |
$354.80
|
| Rate for Payer: PHP Medicare Advantage |
$354.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.08
|
| Rate for Payer: Priority Health Medicare |
$354.80
|
| Rate for Payer: Railroad Medicare Medicare |
$354.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.52
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.80
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UHC Medicare Advantage |
$365.44
|
| Rate for Payer: VA VA |
$354.80
|
|
|
REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); OVER 30.0 CM
|
Facility
|
OP
|
$3,138.00
|
|
|
Service Code
|
CPT 12037
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.20 |
| Max. Negotiated Rate |
$3,138.00 |
| Rate for Payer: Aetna Medicare |
$1,687.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,028.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,028.30
|
| Rate for Payer: BCBS Complete |
$932.04
|
| Rate for Payer: BCBS MAPPO |
$1,622.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,174.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.64
|
| Rate for Payer: Mclaren Medicaid |
$887.58
|
| Rate for Payer: Mclaren Medicare |
$1,622.64
|
| Rate for Payer: Meridian Medicaid |
$932.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,866.04
|
| Rate for Payer: PACE Medicare |
$1,541.51
|
| Rate for Payer: PACE SWMI |
$1,622.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$887.58
|
| Rate for Payer: Priority Health Medicare |
$1,622.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,622.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.42
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.64
|
| Rate for Payer: UHC Exchange |
$322.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.32
|
| Rate for Payer: VA VA |
$1,622.64
|
|
|
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, WITH LOCAL TISSUE
|
Facility
|
OP
|
$5,427.00
|
|
|
Service Code
|
CPT 24343
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$714.15 |
| Max. Negotiated Rate |
$5,427.00 |
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.62
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.56
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$714.15
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
