|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$17,887.80
|
|
|
Service Code
|
MS-DRG 181
|
| Min. Negotiated Rate |
$8,001.50 |
| Max. Negotiated Rate |
$17,887.80 |
| Rate for Payer: Aetna Medicare |
$8,759.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,528.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,528.29
|
| Rate for Payer: BCBS MAPPO |
$8,422.63
|
| Rate for Payer: BCBS Trust/PPO |
$17,887.80
|
| Rate for Payer: BCN Medicare Advantage |
$8,422.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,422.63
|
| Rate for Payer: Mclaren Medicare |
$8,422.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,843.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,686.02
|
| Rate for Payer: PACE Medicare |
$8,001.50
|
| Rate for Payer: PACE SWMI |
$8,422.63
|
| Rate for Payer: PHP Medicare Advantage |
$8,422.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,800.70
|
| Rate for Payer: Priority Health Medicare |
$8,422.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,640.56
|
| Rate for Payer: Railroad Medicare Medicare |
$8,422.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,796.18
|
| Rate for Payer: UHC Core |
$10,306.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,422.63
|
| Rate for Payer: UHC Exchange |
$11,038.53
|
| Rate for Payer: UHC Medicare Advantage |
$8,675.31
|
| Rate for Payer: VA VA |
$8,422.63
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$28,748.72
|
|
|
Service Code
|
MS-DRG 180
|
| Min. Negotiated Rate |
$12,360.35 |
| Max. Negotiated Rate |
$28,748.72 |
| Rate for Payer: Aetna Medicare |
$13,531.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,263.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,263.61
|
| Rate for Payer: BCBS MAPPO |
$13,010.89
|
| Rate for Payer: BCBS Trust/PPO |
$28,748.72
|
| Rate for Payer: BCN Medicare Advantage |
$13,010.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,010.89
|
| Rate for Payer: Mclaren Medicare |
$13,010.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,661.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,962.52
|
| Rate for Payer: PACE Medicare |
$12,360.35
|
| Rate for Payer: PACE SWMI |
$13,010.89
|
| Rate for Payer: PHP Medicare Advantage |
$13,010.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,943.03
|
| Rate for Payer: Priority Health Medicare |
$13,010.89
|
| Rate for Payer: Priority Health Narrow Network |
$19,954.42
|
| Rate for Payer: Railroad Medicare Medicare |
$13,010.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26,514.50
|
| Rate for Payer: UHC Core |
$16,269.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,010.89
|
| Rate for Payer: UHC Exchange |
$17,425.46
|
| Rate for Payer: UHC Medicare Advantage |
$13,401.22
|
| Rate for Payer: VA VA |
$13,010.89
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$11,577.79
|
|
|
Service Code
|
MS-DRG 182
|
| Min. Negotiated Rate |
$5,933.23 |
| Max. Negotiated Rate |
$11,577.79 |
| Rate for Payer: Aetna Medicare |
$6,495.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,806.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,806.89
|
| Rate for Payer: BCBS MAPPO |
$6,245.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,803.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,245.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,245.51
|
| Rate for Payer: Mclaren Medicare |
$6,245.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,557.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,182.34
|
| Rate for Payer: PACE Medicare |
$5,933.23
|
| Rate for Payer: PACE SWMI |
$6,245.51
|
| Rate for Payer: PHP Medicare Advantage |
$6,245.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,891.59
|
| Rate for Payer: Priority Health Medicare |
$6,245.51
|
| Rate for Payer: Priority Health Narrow Network |
$8,713.27
|
| Rate for Payer: Railroad Medicare Medicare |
$6,245.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,577.79
|
| Rate for Payer: UHC Core |
$7,104.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,245.51
|
| Rate for Payer: UHC Exchange |
$7,608.98
|
| Rate for Payer: UHC Medicare Advantage |
$6,432.88
|
| Rate for Payer: VA VA |
$6,245.51
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$13,781.47
|
|
|
Service Code
|
MS-DRG 204
|
| Min. Negotiated Rate |
$6,098.14 |
| Max. Negotiated Rate |
$13,781.47 |
| Rate for Payer: Aetna Medicare |
$6,675.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,023.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,023.86
|
| Rate for Payer: BCBS MAPPO |
$6,419.09
|
| Rate for Payer: BCBS Trust/PPO |
$13,781.47
|
| Rate for Payer: BCN Medicare Advantage |
$6,419.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,419.09
|
| Rate for Payer: Mclaren Medicare |
$6,419.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,740.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,381.95
|
| Rate for Payer: PACE Medicare |
$6,098.14
|
| Rate for Payer: PACE SWMI |
$6,419.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,419.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,808.55
|
| Rate for Payer: Priority Health Medicare |
$6,419.09
|
| Rate for Payer: Priority Health Narrow Network |
$9,446.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6,419.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,552.52
|
| Rate for Payer: UHC Core |
$7,702.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,419.09
|
| Rate for Payer: UHC Exchange |
$8,249.57
|
| Rate for Payer: UHC Medicare Advantage |
$6,611.66
|
| Rate for Payer: VA VA |
$6,419.09
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$41,243.77
|
|
|
Service Code
|
MS-DRG 208
|
| Min. Negotiated Rate |
$18,966.68 |
| Max. Negotiated Rate |
$41,243.77 |
| Rate for Payer: Aetna Medicare |
$20,763.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,956.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,956.16
|
| Rate for Payer: BCBS MAPPO |
$19,964.93
|
| Rate for Payer: BCBS Trust/PPO |
$38,920.13
|
| Rate for Payer: BCN Medicare Advantage |
$19,964.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,964.93
|
| Rate for Payer: Mclaren Medicare |
$19,964.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,963.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,959.67
|
| Rate for Payer: PACE Medicare |
$18,966.68
|
| Rate for Payer: PACE SWMI |
$19,964.93
|
| Rate for Payer: PHP Medicare Advantage |
$19,964.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,799.31
|
| Rate for Payer: Priority Health Medicare |
$19,964.93
|
| Rate for Payer: Priority Health Narrow Network |
$31,039.45
|
| Rate for Payer: Railroad Medicare Medicare |
$19,964.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41,243.77
|
| Rate for Payer: UHC Core |
$25,307.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,964.93
|
| Rate for Payer: UHC Exchange |
$27,105.60
|
| Rate for Payer: UHC Medicare Advantage |
$20,563.88
|
| Rate for Payer: VA VA |
$19,964.93
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$121,134.63
|
|
|
Service Code
|
MS-DRG 207
|
| Min. Negotiated Rate |
$47,730.57 |
| Max. Negotiated Rate |
$121,134.63 |
| Rate for Payer: Aetna Medicare |
$52,252.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62,803.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62,803.39
|
| Rate for Payer: BCBS MAPPO |
$50,242.71
|
| Rate for Payer: BCBS Trust/PPO |
$121,134.63
|
| Rate for Payer: BCN Medicare Advantage |
$50,242.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50,242.71
|
| Rate for Payer: Mclaren Medicare |
$50,242.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52,754.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57,779.12
|
| Rate for Payer: PACE Medicare |
$47,730.57
|
| Rate for Payer: PACE SWMI |
$50,242.71
|
| Rate for Payer: PHP Medicare Advantage |
$50,242.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99,129.25
|
| Rate for Payer: Priority Health Medicare |
$50,242.71
|
| Rate for Payer: Priority Health Narrow Network |
$79,303.40
|
| Rate for Payer: Railroad Medicare Medicare |
$50,242.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105,374.63
|
| Rate for Payer: UHC Core |
$64,658.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$50,242.71
|
| Rate for Payer: UHC Exchange |
$69,252.70
|
| Rate for Payer: UHC Medicare Advantage |
$51,749.99
|
| Rate for Payer: VA VA |
$50,242.71
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC
|
Facility
|
IP
|
$15,931.25
|
|
|
Service Code
|
MS-DRG 815
|
| Min. Negotiated Rate |
$7,270.12 |
| Max. Negotiated Rate |
$15,931.25 |
| Rate for Payer: Aetna Medicare |
$7,958.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,565.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,565.95
|
| Rate for Payer: BCBS MAPPO |
$7,652.76
|
| Rate for Payer: BCBS Trust/PPO |
$15,931.25
|
| Rate for Payer: BCN Medicare Advantage |
$7,652.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,652.76
|
| Rate for Payer: Mclaren Medicare |
$7,652.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,035.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,800.67
|
| Rate for Payer: PACE Medicare |
$7,270.12
|
| Rate for Payer: PACE SWMI |
$7,652.76
|
| Rate for Payer: PHP Medicare Advantage |
$7,652.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14,266.69
|
| Rate for Payer: Priority Health Medicare |
$7,652.76
|
| Rate for Payer: Priority Health Narrow Network |
$11,413.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7,652.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,165.53
|
| Rate for Payer: UHC Core |
$9,305.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,652.76
|
| Rate for Payer: UHC Exchange |
$9,966.86
|
| Rate for Payer: UHC Medicare Advantage |
$7,882.34
|
| Rate for Payer: VA VA |
$7,652.76
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC
|
Facility
|
IP
|
$36,706.66
|
|
|
Service Code
|
MS-DRG 814
|
| Min. Negotiated Rate |
$15,027.92 |
| Max. Negotiated Rate |
$36,706.66 |
| Rate for Payer: Aetna Medicare |
$16,451.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,773.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,773.58
|
| Rate for Payer: BCBS MAPPO |
$15,818.86
|
| Rate for Payer: BCBS Trust/PPO |
$36,706.66
|
| Rate for Payer: BCN Medicare Advantage |
$15,818.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,818.86
|
| Rate for Payer: Mclaren Medicare |
$15,818.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,609.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,191.69
|
| Rate for Payer: PACE Medicare |
$15,027.92
|
| Rate for Payer: PACE SWMI |
$15,818.86
|
| Rate for Payer: PHP Medicare Advantage |
$15,818.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,538.06
|
| Rate for Payer: Priority Health Medicare |
$15,818.86
|
| Rate for Payer: Priority Health Narrow Network |
$24,430.45
|
| Rate for Payer: Railroad Medicare Medicare |
$15,818.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32,462.04
|
| Rate for Payer: UHC Core |
$19,919.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,818.86
|
| Rate for Payer: UHC Exchange |
$21,334.20
|
| Rate for Payer: UHC Medicare Advantage |
$16,293.43
|
| Rate for Payer: VA VA |
$15,818.86
|
|
|
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,833.39
|
|
|
Service Code
|
MS-DRG 816
|
| Min. Negotiated Rate |
$5,327.06 |
| Max. Negotiated Rate |
$10,833.39 |
| Rate for Payer: Aetna Medicare |
$5,831.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,009.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,009.29
|
| Rate for Payer: BCBS MAPPO |
$5,607.43
|
| Rate for Payer: BCBS Trust/PPO |
$10,722.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,607.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,607.43
|
| Rate for Payer: Mclaren Medicare |
$5,607.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,887.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,448.54
|
| Rate for Payer: PACE Medicare |
$5,327.06
|
| Rate for Payer: PACE SWMI |
$5,607.43
|
| Rate for Payer: PHP Medicare Advantage |
$5,607.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,191.31
|
| Rate for Payer: Priority Health Medicare |
$5,607.43
|
| Rate for Payer: Priority Health Narrow Network |
$8,153.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5,607.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,833.39
|
| Rate for Payer: UHC Core |
$6,647.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,607.43
|
| Rate for Payer: UHC Exchange |
$7,119.76
|
| Rate for Payer: UHC Medicare Advantage |
$5,775.65
|
| Rate for Payer: VA VA |
$5,607.43
|
|
|
RETRIEVAL (REMOVAL) OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGING GUIDANCE (ULTRASOUND AND FLUOROSCOPY), WHEN PERFORMED
|
Facility
|
OP
|
$8,913.25
|
|
|
Service Code
|
CPT 37193
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$330.39 |
| Max. Negotiated Rate |
$8,913.25 |
| Rate for Payer: Aetna Medicare |
$2,949.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,545.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,545.25
|
| Rate for Payer: BCBS Complete |
$1,629.11
|
| Rate for Payer: BCBS MAPPO |
$2,836.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,836.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,836.20
|
| Rate for Payer: Mclaren Medicaid |
$1,551.40
|
| Rate for Payer: Mclaren Medicare |
$2,836.20
|
| Rate for Payer: Meridian Medicaid |
$1,629.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,978.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,261.63
|
| Rate for Payer: PACE Medicare |
$2,694.39
|
| Rate for Payer: PACE SWMI |
$2,836.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,836.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,551.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,913.25
|
| Rate for Payer: Priority Health Medicare |
$2,836.20
|
| Rate for Payer: Priority Health Narrow Network |
$7,130.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,836.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.43
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,836.20
|
| Rate for Payer: UHC Exchange |
$330.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,921.29
|
| Rate for Payer: VA VA |
$2,836.20
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 37225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$570.08 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$6,207.78
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.09
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$570.08
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$15,432.16
|
|
|
Service Code
|
CPT 37224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$423.71 |
| Max. Negotiated Rate |
$15,432.16 |
| Rate for Payer: Aetna Medicare |
$5,289.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,357.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,357.20
|
| Rate for Payer: BCBS Complete |
$2,921.26
|
| Rate for Payer: BCBS MAPPO |
$5,085.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: BCN Medicare Advantage |
$5,085.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,085.76
|
| Rate for Payer: Mclaren Medicaid |
$2,781.91
|
| Rate for Payer: Mclaren Medicare |
$5,085.76
|
| Rate for Payer: Meridian Medicaid |
$2,921.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,340.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,848.62
|
| Rate for Payer: PACE Medicare |
$4,831.47
|
| Rate for Payer: PACE SWMI |
$5,085.76
|
| Rate for Payer: PHP Medicare Advantage |
$5,085.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,781.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,432.16
|
| Rate for Payer: Priority Health Medicare |
$5,085.76
|
| Rate for Payer: Priority Health Narrow Network |
$12,345.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5,085.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.08
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,085.76
|
| Rate for Payer: UHC Exchange |
$423.71
|
| Rate for Payer: UHC Medicare Advantage |
$5,238.33
|
| Rate for Payer: VA VA |
$5,085.76
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 37226
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$494.11 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$5,377.04
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.52
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$494.11
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
CPT 37223
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.70 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: BCBS Trust/PPO |
$5,082.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.87
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Exchange |
$201.70
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 37221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$469.55 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,767.59
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.50
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$469.55
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$31,275.01
|
|
|
Service Code
|
CPT 37228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.07 |
| Max. Negotiated Rate |
$31,275.01 |
| Rate for Payer: Aetna Medicare |
$10,180.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,235.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,235.94
|
| Rate for Payer: BCBS Complete |
$5,622.66
|
| Rate for Payer: BCBS MAPPO |
$9,788.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,845.00
|
| Rate for Payer: BCN Medicare Advantage |
$9,788.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,788.75
|
| Rate for Payer: Mclaren Medicaid |
$5,354.45
|
| Rate for Payer: Mclaren Medicare |
$9,788.75
|
| Rate for Payer: Meridian Medicaid |
$5,622.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,278.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,257.06
|
| Rate for Payer: PACE Medicare |
$9,299.31
|
| Rate for Payer: PACE SWMI |
$9,788.75
|
| Rate for Payer: PHP Medicare Advantage |
$9,788.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,354.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31,275.01
|
| Rate for Payer: Priority Health Medicare |
$9,788.75
|
| Rate for Payer: Priority Health Narrow Network |
$25,020.01
|
| Rate for Payer: Railroad Medicare Medicare |
$9,788.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.58
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,788.75
|
| Rate for Payer: UHC Exchange |
$515.07
|
| Rate for Payer: UHC Medicare Advantage |
$10,082.41
|
| Rate for Payer: VA VA |
$9,788.75
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$51,507.72
|
|
|
Service Code
|
CPT 37231
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$699.09 |
| Max. Negotiated Rate |
$51,507.72 |
| Rate for Payer: Aetna Medicare |
$16,226.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,503.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,503.28
|
| Rate for Payer: BCBS Complete |
$8,962.14
|
| Rate for Payer: BCBS MAPPO |
$15,602.62
|
| Rate for Payer: BCBS Trust/PPO |
$9,837.16
|
| Rate for Payer: BCN Medicare Advantage |
$15,602.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,602.62
|
| Rate for Payer: Mclaren Medicaid |
$8,534.63
|
| Rate for Payer: Mclaren Medicare |
$15,602.62
|
| Rate for Payer: Meridian Medicaid |
$8,962.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,382.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,943.01
|
| Rate for Payer: PACE Medicare |
$14,822.49
|
| Rate for Payer: PACE SWMI |
$15,602.62
|
| Rate for Payer: PHP Medicare Advantage |
$15,602.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,534.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51,507.72
|
| Rate for Payer: Priority Health Medicare |
$15,602.62
|
| Rate for Payer: Priority Health Narrow Network |
$41,206.18
|
| Rate for Payer: Railroad Medicare Medicare |
$15,602.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.00
|
| Rate for Payer: UHC Core |
$11,194.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,602.62
|
| Rate for Payer: UHC Exchange |
$699.09
|
| Rate for Payer: UHC Medicare Advantage |
$16,070.70
|
| Rate for Payer: VA VA |
$15,602.62
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$4,155.00
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$496.40 |
| Max. Negotiated Rate |
$4,155.00 |
| Rate for Payer: Aetna Medicare |
$2,893.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,477.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,477.26
|
| Rate for Payer: BCBS Complete |
$1,597.87
|
| Rate for Payer: BCBS MAPPO |
$2,781.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,079.84
|
| Rate for Payer: BCN Medicare Advantage |
$2,781.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,781.81
|
| Rate for Payer: Mclaren Medicaid |
$1,521.65
|
| Rate for Payer: Mclaren Medicare |
$2,781.81
|
| Rate for Payer: Meridian Medicaid |
$1,597.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,920.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,199.08
|
| Rate for Payer: PACE Medicare |
$2,642.72
|
| Rate for Payer: PACE SWMI |
$2,781.81
|
| Rate for Payer: PHP Medicare Advantage |
$2,781.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,521.65
|
| Rate for Payer: Priority Health Medicare |
$2,781.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,781.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.04
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,781.81
|
| Rate for Payer: UHC Exchange |
$496.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,865.26
|
| Rate for Payer: VA VA |
$2,781.81
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$53,180.02
|
|
|
Service Code
|
MS-DRG 467
|
| Min. Negotiated Rate |
$24,320.32 |
| Max. Negotiated Rate |
$53,180.02 |
| Rate for Payer: Aetna Medicare |
$26,624.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32,000.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32,000.42
|
| Rate for Payer: BCBS MAPPO |
$25,600.34
|
| Rate for Payer: BCBS Trust/PPO |
$47,795.96
|
| Rate for Payer: BCN Medicare Advantage |
$25,600.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,600.34
|
| Rate for Payer: Mclaren Medicare |
$25,600.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,880.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,440.39
|
| Rate for Payer: PACE Medicare |
$24,320.32
|
| Rate for Payer: PACE SWMI |
$25,600.34
|
| Rate for Payer: PHP Medicare Advantage |
$25,600.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,028.13
|
| Rate for Payer: Priority Health Medicare |
$25,600.34
|
| Rate for Payer: Priority Health Narrow Network |
$40,022.50
|
| Rate for Payer: Railroad Medicare Medicare |
$25,600.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,180.02
|
| Rate for Payer: UHC Core |
$32,631.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,600.34
|
| Rate for Payer: UHC Exchange |
$34,950.16
|
| Rate for Payer: UHC Medicare Advantage |
$26,368.35
|
| Rate for Payer: VA VA |
$25,600.34
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$79,116.40
|
|
|
Service Code
|
MS-DRG 466
|
| Min. Negotiated Rate |
$35,953.27 |
| Max. Negotiated Rate |
$79,116.40 |
| Rate for Payer: Aetna Medicare |
$39,359.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,306.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,306.94
|
| Rate for Payer: BCBS MAPPO |
$37,845.55
|
| Rate for Payer: BCBS Trust/PPO |
$68,676.77
|
| Rate for Payer: BCN Medicare Advantage |
$37,845.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37,845.55
|
| Rate for Payer: Mclaren Medicare |
$37,845.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39,737.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43,522.38
|
| Rate for Payer: PACE Medicare |
$35,953.27
|
| Rate for Payer: PACE SWMI |
$37,845.55
|
| Rate for Payer: PHP Medicare Advantage |
$37,845.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74,427.30
|
| Rate for Payer: Priority Health Medicare |
$37,845.55
|
| Rate for Payer: Priority Health Narrow Network |
$59,541.84
|
| Rate for Payer: Railroad Medicare Medicare |
$37,845.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79,116.40
|
| Rate for Payer: UHC Core |
$48,546.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$37,845.55
|
| Rate for Payer: UHC Exchange |
$51,995.67
|
| Rate for Payer: UHC Medicare Advantage |
$38,980.92
|
| Rate for Payer: VA VA |
$37,845.55
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$41,899.97
|
|
|
Service Code
|
MS-DRG 468
|
| Min. Negotiated Rate |
$18,732.69 |
| Max. Negotiated Rate |
$41,899.97 |
| Rate for Payer: Aetna Medicare |
$20,507.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,648.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,648.28
|
| Rate for Payer: BCBS MAPPO |
$19,718.62
|
| Rate for Payer: BCBS Trust/PPO |
$41,899.97
|
| Rate for Payer: BCN Medicare Advantage |
$19,718.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,718.62
|
| Rate for Payer: Mclaren Medicare |
$19,718.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20,704.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,676.41
|
| Rate for Payer: PACE Medicare |
$18,732.69
|
| Rate for Payer: PACE SWMI |
$19,718.62
|
| Rate for Payer: PHP Medicare Advantage |
$19,718.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,308.55
|
| Rate for Payer: Priority Health Medicare |
$19,718.62
|
| Rate for Payer: Priority Health Narrow Network |
$30,646.84
|
| Rate for Payer: Railroad Medicare Medicare |
$19,718.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,722.08
|
| Rate for Payer: UHC Core |
$24,987.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$19,718.62
|
| Rate for Payer: UHC Exchange |
$26,762.74
|
| Rate for Payer: UHC Medicare Advantage |
$20,310.18
|
| Rate for Payer: VA VA |
$19,718.62
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$10,308.37
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.07 |
| Max. Negotiated Rate |
$10,308.37 |
| Rate for Payer: Aetna Medicare |
$3,527.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,239.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,239.58
|
| Rate for Payer: BCBS Complete |
$1,948.17
|
| Rate for Payer: BCBS MAPPO |
$3,391.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.96
|
| Rate for Payer: BCN Medicare Advantage |
$3,391.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,391.66
|
| Rate for Payer: Mclaren Medicaid |
$1,855.24
|
| Rate for Payer: Mclaren Medicare |
$3,391.66
|
| Rate for Payer: Meridian Medicaid |
$1,948.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,561.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,900.41
|
| Rate for Payer: PACE Medicare |
$3,222.08
|
| Rate for Payer: PACE SWMI |
$3,391.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,391.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,855.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,308.37
|
| Rate for Payer: Priority Health Medicare |
$3,391.66
|
| Rate for Payer: Priority Health Narrow Network |
$8,246.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,391.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.38
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,391.66
|
| Rate for Payer: UHC Exchange |
$663.07
|
| Rate for Payer: UHC Medicare Advantage |
$3,493.41
|
| Rate for Payer: VA VA |
$3,391.66
|
|
|
REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)
|
Facility
|
OP
|
$17,231.52
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.01 |
| Max. Negotiated Rate |
$17,231.52 |
| Rate for Payer: Aetna Medicare |
$6,034.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,253.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,253.02
|
| Rate for Payer: BCBS Complete |
$3,332.91
|
| Rate for Payer: BCBS MAPPO |
$5,802.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,897.71
|
| Rate for Payer: BCN Medicare Advantage |
$5,802.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,802.42
|
| Rate for Payer: Mclaren Medicaid |
$3,173.92
|
| Rate for Payer: Mclaren Medicare |
$5,802.42
|
| Rate for Payer: Meridian Medicaid |
$3,332.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,092.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,672.78
|
| Rate for Payer: PACE Medicare |
$5,512.30
|
| Rate for Payer: PACE SWMI |
$5,802.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,802.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,173.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,231.52
|
| Rate for Payer: Priority Health Medicare |
$5,802.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,785.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,802.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.61
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,802.42
|
| Rate for Payer: UHC Exchange |
$796.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,976.49
|
| Rate for Payer: VA VA |
$5,802.42
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT
|
Facility
|
OP
|
$8,819.00
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,383.12 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: BCBS Trust/PPO |
$4,146.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,521.43
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$1,383.12
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$8,819.00
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,722.67 |
| Max. Negotiated Rate |
$8,819.00 |
| Rate for Payer: BCBS Trust/PPO |
$7,620.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,894.94
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Exchange |
$1,722.67
|
|
