|
REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$38,117.56
|
|
|
Service Code
|
CPT 63664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$885.73 |
| Max. Negotiated Rate |
$38,117.56 |
| Rate for Payer: Aetna Medicare |
$12,592.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,135.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,135.40
|
| Rate for Payer: BCBS Complete |
$6,955.02
|
| Rate for Payer: BCBS MAPPO |
$12,108.32
|
| Rate for Payer: BCBS Trust/PPO |
$9,028.85
|
| Rate for Payer: BCN Medicare Advantage |
$12,108.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,108.32
|
| Rate for Payer: Mclaren Medicaid |
$6,623.25
|
| Rate for Payer: Mclaren Medicare |
$12,108.32
|
| Rate for Payer: Meridian Medicaid |
$6,955.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,713.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,924.57
|
| Rate for Payer: PACE Medicare |
$11,502.90
|
| Rate for Payer: PACE SWMI |
$12,108.32
|
| Rate for Payer: PHP Medicare Advantage |
$12,108.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,623.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,117.56
|
| Rate for Payer: Priority Health Medicare |
$12,108.32
|
| Rate for Payer: Priority Health Narrow Network |
$30,494.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12,108.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.30
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,108.32
|
| Rate for Payer: UHC Exchange |
$885.73
|
| Rate for Payer: UHC Medicare Advantage |
$12,471.57
|
| Rate for Payer: VA VA |
$12,108.32
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITH GRAFT
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$828.76 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,935.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$911.64
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$828.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITHOUT GRAFT
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$772.11 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,693.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.32
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Exchange |
$772.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 44340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$622.14 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$622.14
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$54,695.78
|
|
|
Service Code
|
MS-DRG 467
|
| Min. Negotiated Rate |
$26,009.00 |
| Max. Negotiated Rate |
$54,695.78 |
| Rate for Payer: Aetna Medicare |
$28,473.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34,222.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34,222.36
|
| Rate for Payer: BCBS MAPPO |
$27,377.89
|
| Rate for Payer: BCBS Trust/PPO |
$54,695.78
|
| Rate for Payer: BCN Medicare Advantage |
$27,377.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,377.89
|
| Rate for Payer: Mclaren Medicare |
$27,377.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,746.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,484.57
|
| Rate for Payer: PACE Medicare |
$26,009.00
|
| Rate for Payer: PACE SWMI |
$27,377.89
|
| Rate for Payer: PHP Medicare Advantage |
$27,377.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50,028.13
|
| Rate for Payer: Priority Health Medicare |
$27,377.89
|
| Rate for Payer: Priority Health Narrow Network |
$40,022.50
|
| Rate for Payer: Railroad Medicare Medicare |
$27,377.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53,180.02
|
| Rate for Payer: UHC Core |
$43,606.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$27,377.89
|
| Rate for Payer: UHC Exchange |
$34,667.77
|
| Rate for Payer: UHC Medicare Advantage |
$28,199.23
|
| Rate for Payer: VA VA |
$27,377.89
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$79,116.40
|
|
|
Service Code
|
MS-DRG 466
|
| Min. Negotiated Rate |
$38,456.46 |
| Max. Negotiated Rate |
$79,116.40 |
| Rate for Payer: Aetna Medicare |
$42,099.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50,600.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50,600.60
|
| Rate for Payer: BCBS MAPPO |
$40,480.48
|
| Rate for Payer: BCBS Trust/PPO |
$78,590.95
|
| Rate for Payer: BCN Medicare Advantage |
$40,480.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40,480.48
|
| Rate for Payer: Mclaren Medicare |
$40,480.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42,504.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46,552.55
|
| Rate for Payer: PACE Medicare |
$38,456.46
|
| Rate for Payer: PACE SWMI |
$40,480.48
|
| Rate for Payer: PHP Medicare Advantage |
$40,480.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74,427.30
|
| Rate for Payer: Priority Health Medicare |
$40,480.48
|
| Rate for Payer: Priority Health Narrow Network |
$59,541.84
|
| Rate for Payer: Railroad Medicare Medicare |
$40,480.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79,116.40
|
| Rate for Payer: UHC Core |
$64,873.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$40,480.48
|
| Rate for Payer: UHC Exchange |
$51,575.55
|
| Rate for Payer: UHC Medicare Advantage |
$41,694.89
|
| Rate for Payer: VA VA |
$40,480.48
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$47,948.64
|
|
|
Service Code
|
MS-DRG 468
|
| Min. Negotiated Rate |
$20,030.15 |
| Max. Negotiated Rate |
$47,948.64 |
| Rate for Payer: Aetna Medicare |
$21,927.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26,355.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26,355.46
|
| Rate for Payer: BCBS MAPPO |
$21,084.37
|
| Rate for Payer: BCBS Trust/PPO |
$47,948.64
|
| Rate for Payer: BCN Medicare Advantage |
$21,084.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,084.37
|
| Rate for Payer: Mclaren Medicare |
$21,084.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22,138.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24,247.03
|
| Rate for Payer: PACE Medicare |
$20,030.15
|
| Rate for Payer: PACE SWMI |
$21,084.37
|
| Rate for Payer: PHP Medicare Advantage |
$21,084.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,308.55
|
| Rate for Payer: Priority Health Medicare |
$21,084.37
|
| Rate for Payer: Priority Health Narrow Network |
$30,646.84
|
| Rate for Payer: Railroad Medicare Medicare |
$21,084.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40,722.08
|
| Rate for Payer: UHC Core |
$33,391.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$21,084.37
|
| Rate for Payer: UHC Exchange |
$26,546.50
|
| Rate for Payer: UHC Medicare Advantage |
$21,716.90
|
| Rate for Payer: VA VA |
$21,084.37
|
|
|
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,039.01
|
|
|
Service Code
|
CPT 44312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$588.74 |
| Max. Negotiated Rate |
$10,039.01 |
| Rate for Payer: Aetna Medicare |
$3,316.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,986.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,986.20
|
| Rate for Payer: BCBS Complete |
$1,831.74
|
| Rate for Payer: BCBS MAPPO |
$3,188.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.98
|
| Rate for Payer: BCN Medicare Advantage |
$3,188.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,188.96
|
| Rate for Payer: Mclaren Medicaid |
$1,744.36
|
| Rate for Payer: Mclaren Medicare |
$3,188.96
|
| Rate for Payer: Meridian Medicaid |
$1,831.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,348.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,667.30
|
| Rate for Payer: PACE Medicare |
$3,029.51
|
| Rate for Payer: PACE SWMI |
$3,188.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,188.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,744.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,039.01
|
| Rate for Payer: Priority Health Medicare |
$3,188.96
|
| Rate for Payer: Priority Health Narrow Network |
$8,031.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3,188.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.61
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,188.96
|
| Rate for Payer: UHC Exchange |
$588.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,284.63
|
| Rate for Payer: VA VA |
$3,188.96
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$10,666.11
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$663.07 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,270.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.38
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$663.07
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: VA VA |
$3,388.17
|
|
|
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
|
$18,247.50
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$796.01 |
| Max. Negotiated Rate |
$18,247.50 |
| Rate for Payer: Aetna Medicare |
$6,028.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.58
|
| Rate for Payer: BCBS Complete |
$3,329.49
|
| Rate for Payer: BCBS MAPPO |
$5,796.46
|
| Rate for Payer: BCBS Trust/PPO |
$4,957.30
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.46
|
| Rate for Payer: Mclaren Medicaid |
$3,170.66
|
| Rate for Payer: Mclaren Medicare |
$5,796.46
|
| Rate for Payer: Meridian Medicaid |
$3,329.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,086.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.93
|
| Rate for Payer: PACE Medicare |
$5,506.64
|
| Rate for Payer: PACE SWMI |
$5,796.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,170.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,247.50
|
| Rate for Payer: Priority Health Medicare |
$5,796.46
|
| Rate for Payer: Priority Health Narrow Network |
$14,598.00
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.61
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.46
|
| Rate for Payer: UHC Exchange |
$796.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,970.35
|
| Rate for Payer: VA VA |
$5,796.46
|
|
|
REVISION OF STAPEDECTOMY OR STAPEDOTOMY
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 69662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,142.12 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,531.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,256.33
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,142.12
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
|
REVISION OF TOTAL ELBOW ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND ULNAR COMPONENT
|
Facility
|
OP
|
$52,147.99
|
|
|
Service Code
|
CPT 24371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,737.73 |
| Max. Negotiated Rate |
$52,147.99 |
| Rate for Payer: Aetna Medicare |
$17,227.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,706.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,706.49
|
| Rate for Payer: BCBS Complete |
$9,515.05
|
| Rate for Payer: BCBS MAPPO |
$16,565.19
|
| Rate for Payer: BCBS Trust/PPO |
$16,078.76
|
| Rate for Payer: BCN Medicare Advantage |
$16,565.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,565.19
|
| Rate for Payer: Mclaren Medicaid |
$9,061.16
|
| Rate for Payer: Mclaren Medicare |
$16,565.19
|
| Rate for Payer: Meridian Medicaid |
$9,515.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17,393.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,049.97
|
| Rate for Payer: PACE Medicare |
$15,736.93
|
| Rate for Payer: PACE SWMI |
$16,565.19
|
| Rate for Payer: PHP Medicare Advantage |
$16,565.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,061.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52,147.99
|
| Rate for Payer: Priority Health Medicare |
$16,565.19
|
| Rate for Payer: Priority Health Narrow Network |
$41,718.39
|
| Rate for Payer: Railroad Medicare Medicare |
$16,565.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,911.50
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16,565.19
|
| Rate for Payer: UHC Exchange |
$1,737.73
|
| Rate for Payer: UHC Medicare Advantage |
$17,062.15
|
| Rate for Payer: VA VA |
$16,565.19
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,383.12 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$7,094.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,521.43
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,383.12
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,722.67 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: BCBS Trust/PPO |
$13,036.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,894.94
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,722.67
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID COMPONENT
|
Facility
|
OP
|
$18,265.12
|
|
|
Service Code
|
CPT 23474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,706.63 |
| Max. Negotiated Rate |
$18,265.12 |
| Rate for Payer: BCBS Trust/PPO |
$18,265.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,877.29
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Exchange |
$1,706.63
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$36,827.89
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,581.22 |
| Max. Negotiated Rate |
$36,827.89 |
| Rate for Payer: Aetna Medicare |
$12,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,623.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,623.31
|
| Rate for Payer: BCBS Complete |
$6,719.70
|
| Rate for Payer: BCBS MAPPO |
$11,698.65
|
| Rate for Payer: BCBS Trust/PPO |
$6,814.90
|
| Rate for Payer: BCN Medicare Advantage |
$11,698.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,698.65
|
| Rate for Payer: Mclaren Medicaid |
$6,399.16
|
| Rate for Payer: Mclaren Medicare |
$11,698.65
|
| Rate for Payer: Meridian Medicaid |
$6,719.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,283.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,453.45
|
| Rate for Payer: PACE Medicare |
$11,113.72
|
| Rate for Payer: PACE SWMI |
$11,698.65
|
| Rate for Payer: PHP Medicare Advantage |
$11,698.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,399.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36,827.89
|
| Rate for Payer: Priority Health Medicare |
$11,698.65
|
| Rate for Payer: Priority Health Narrow Network |
$29,462.31
|
| Rate for Payer: Railroad Medicare Medicare |
$11,698.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,739.34
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,698.65
|
| Rate for Payer: UHC Exchange |
$1,581.22
|
| Rate for Payer: UHC Medicare Advantage |
$12,049.61
|
| Rate for Payer: VA VA |
$11,698.65
|
|
|
REVISION OF TRACHEOSTOMY SCAR
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 31830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$365.10 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,629.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$401.61
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$365.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$727.90 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$5,526.61
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$800.69
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$727.90
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,377.24
|
|
|
Service Code
|
CPT 36833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$776.36 |
| Max. Negotiated Rate |
$15,377.24 |
| Rate for Payer: Aetna Medicare |
$5,080.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,105.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,105.86
|
| Rate for Payer: BCBS Complete |
$2,805.77
|
| Rate for Payer: BCBS MAPPO |
$4,884.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,674.03
|
| Rate for Payer: BCN Medicare Advantage |
$4,884.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,884.69
|
| Rate for Payer: Mclaren Medicaid |
$2,671.93
|
| Rate for Payer: Mclaren Medicare |
$4,884.69
|
| Rate for Payer: Meridian Medicaid |
$2,805.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,128.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,617.39
|
| Rate for Payer: PACE Medicare |
$4,640.46
|
| Rate for Payer: PACE SWMI |
$4,884.69
|
| Rate for Payer: PHP Medicare Advantage |
$4,884.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,671.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,377.24
|
| Rate for Payer: Priority Health Medicare |
$4,884.69
|
| Rate for Payer: Priority Health Narrow Network |
$12,301.79
|
| Rate for Payer: Railroad Medicare Medicare |
$4,884.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.00
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,884.69
|
| Rate for Payer: UHC Exchange |
$776.36
|
| Rate for Payer: UHC Medicare Advantage |
$5,031.23
|
| Rate for Payer: VA VA |
$4,884.69
|
|
|
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$38,117.56
|
|
|
Service Code
|
CPT 61888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$398.50 |
| Max. Negotiated Rate |
$38,117.56 |
| Rate for Payer: Aetna Medicare |
$12,592.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,135.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,135.40
|
| Rate for Payer: BCBS Complete |
$6,955.02
|
| Rate for Payer: BCBS MAPPO |
$12,108.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,939.77
|
| Rate for Payer: BCN Medicare Advantage |
$12,108.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,108.32
|
| Rate for Payer: Mclaren Medicaid |
$6,623.25
|
| Rate for Payer: Mclaren Medicare |
$12,108.32
|
| Rate for Payer: Meridian Medicaid |
$6,955.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,713.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,924.57
|
| Rate for Payer: PACE Medicare |
$11,502.90
|
| Rate for Payer: PACE SWMI |
$12,108.32
|
| Rate for Payer: PHP Medicare Advantage |
$12,108.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,623.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,117.56
|
| Rate for Payer: Priority Health Medicare |
$12,108.32
|
| Rate for Payer: Priority Health Narrow Network |
$30,494.05
|
| Rate for Payer: Railroad Medicare Medicare |
$12,108.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$438.35
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,108.32
|
| Rate for Payer: UHC Exchange |
$398.50
|
| Rate for Payer: UHC Medicare Advantage |
$12,471.57
|
| Rate for Payer: VA VA |
$12,108.32
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$9,521.05
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$297.64 |
| Max. Negotiated Rate |
$9,521.05 |
| Rate for Payer: Aetna Medicare |
$3,145.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,780.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,780.54
|
| Rate for Payer: BCBS Complete |
$1,737.23
|
| Rate for Payer: BCBS MAPPO |
$3,024.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,024.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,024.43
|
| Rate for Payer: Mclaren Medicaid |
$1,654.36
|
| Rate for Payer: Mclaren Medicare |
$3,024.43
|
| Rate for Payer: Meridian Medicaid |
$1,737.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,175.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,478.09
|
| Rate for Payer: PACE Medicare |
$2,873.21
|
| Rate for Payer: PACE SWMI |
$3,024.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,024.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,654.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,521.05
|
| Rate for Payer: Priority Health Medicare |
$3,024.43
|
| Rate for Payer: Priority Health Narrow Network |
$7,616.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,024.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.40
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,024.43
|
| Rate for Payer: UHC Exchange |
$297.64
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.16
|
| Rate for Payer: VA VA |
$3,024.43
|
|
|
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$9,521.05
|
|
|
Service Code
|
CPT 64585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$141.78 |
| Max. Negotiated Rate |
$9,521.05 |
| Rate for Payer: Aetna Medicare |
$3,145.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,780.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,780.54
|
| Rate for Payer: BCBS Complete |
$1,737.23
|
| Rate for Payer: BCBS MAPPO |
$3,024.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.05
|
| Rate for Payer: BCN Medicare Advantage |
$3,024.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,024.43
|
| Rate for Payer: Mclaren Medicaid |
$1,654.36
|
| Rate for Payer: Mclaren Medicare |
$3,024.43
|
| Rate for Payer: Meridian Medicaid |
$1,737.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,175.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,478.09
|
| Rate for Payer: PACE Medicare |
$2,873.21
|
| Rate for Payer: PACE SWMI |
$3,024.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,024.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,654.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,521.05
|
| Rate for Payer: Priority Health Medicare |
$3,024.43
|
| Rate for Payer: Priority Health Narrow Network |
$7,616.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,024.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.96
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,024.43
|
| Rate for Payer: UHC Exchange |
$141.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.16
|
| Rate for Payer: VA VA |
$3,024.43
|
|
|
REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$9,521.05
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$225.61 |
| Max. Negotiated Rate |
$9,521.05 |
| Rate for Payer: Aetna Medicare |
$3,145.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,780.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,780.54
|
| Rate for Payer: BCBS Complete |
$1,737.23
|
| Rate for Payer: BCBS MAPPO |
$3,024.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,518.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,024.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,024.43
|
| Rate for Payer: Mclaren Medicaid |
$1,654.36
|
| Rate for Payer: Mclaren Medicare |
$3,024.43
|
| Rate for Payer: Meridian Medicaid |
$1,737.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,175.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,478.09
|
| Rate for Payer: PACE Medicare |
$2,873.21
|
| Rate for Payer: PACE SWMI |
$3,024.43
|
| Rate for Payer: PHP Medicare Advantage |
$3,024.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,654.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,521.05
|
| Rate for Payer: Priority Health Medicare |
$3,024.43
|
| Rate for Payer: Priority Health Narrow Network |
$7,616.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3,024.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.17
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,024.43
|
| Rate for Payer: UHC Exchange |
$225.61
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.16
|
| Rate for Payer: VA VA |
$3,024.43
|
|
|
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MINOR PROCEDURE
|
Facility
|
OP
|
$6,538.91
|
|
|
Service Code
|
CPT 66250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$541.92 |
| Max. Negotiated Rate |
$6,538.91 |
| Rate for Payer: Aetna Medicare |
$2,160.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,596.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,596.41
|
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: BCBS MAPPO |
$2,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,371.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,077.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,077.13
|
| Rate for Payer: Mclaren Medicaid |
$1,136.19
|
| Rate for Payer: Mclaren Medicare |
$2,077.13
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,180.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,388.70
|
| Rate for Payer: PACE Medicare |
$1,973.27
|
| Rate for Payer: PACE SWMI |
$2,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,077.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.91
|
| Rate for Payer: Priority Health Medicare |
$2,077.13
|
| Rate for Payer: Priority Health Narrow Network |
$5,231.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2,077.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.11
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,077.13
|
| Rate for Payer: UHC Exchange |
$541.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,139.44
|
| Rate for Payer: VA VA |
$2,077.13
|
|
|
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
|
Facility
|
OP
|
$16,386.90
|
|
|
Service Code
|
CPT 30420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,434.20 |
| Max. Negotiated Rate |
$16,386.90 |
| Rate for Payer: Aetna Medicare |
$5,413.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,506.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,506.78
|
| Rate for Payer: BCBS Complete |
$2,989.99
|
| Rate for Payer: BCBS MAPPO |
$5,205.42
|
| Rate for Payer: BCBS Trust/PPO |
$5,938.83
|
| Rate for Payer: BCN Medicare Advantage |
$5,205.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,205.42
|
| Rate for Payer: Mclaren Medicaid |
$2,847.36
|
| Rate for Payer: Mclaren Medicare |
$5,205.42
|
| Rate for Payer: Meridian Medicaid |
$2,989.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,465.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,986.23
|
| Rate for Payer: PACE Medicare |
$4,945.15
|
| Rate for Payer: PACE SWMI |
$5,205.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,205.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,847.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,386.90
|
| Rate for Payer: Priority Health Medicare |
$5,205.42
|
| Rate for Payer: Priority Health Narrow Network |
$13,109.52
|
| Rate for Payer: Railroad Medicare Medicare |
$5,205.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.62
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,205.42
|
| Rate for Payer: UHC Exchange |
$1,434.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,361.58
|
| Rate for Payer: VA VA |
$5,205.42
|
|
