|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$13,135.55
|
|
|
Service Code
|
APR-DRG 4443
|
| Min. Negotiated Rate |
$12,510.05 |
| Max. Negotiated Rate |
$13,135.55 |
| Rate for Payer: BCBS Complete |
$13,135.55
|
| Rate for Payer: Mclaren Medicaid |
$12,510.05
|
| Rate for Payer: Meridian Medicaid |
$13,135.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$12,510.05
|
| Rate for Payer: UHC Medicaid |
$12,510.05
|
| Rate for Payer: UHCCP Medicaid |
$12,510.05
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$7,511.48
|
|
|
Service Code
|
APR-DRG 4441
|
| Min. Negotiated Rate |
$7,153.79 |
| Max. Negotiated Rate |
$7,511.48 |
| Rate for Payer: BCBS Complete |
$7,511.48
|
| Rate for Payer: Mclaren Medicaid |
$7,153.79
|
| Rate for Payer: Meridian Medicaid |
$7,511.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,153.79
|
| Rate for Payer: UHC Medicaid |
$7,153.79
|
| Rate for Payer: UHCCP Medicaid |
$7,153.79
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$22,349.81
|
|
|
Service Code
|
APR-DRG 4444
|
| Min. Negotiated Rate |
$21,285.53 |
| Max. Negotiated Rate |
$22,349.81 |
| Rate for Payer: BCBS Complete |
$22,349.81
|
| Rate for Payer: Mclaren Medicaid |
$21,285.53
|
| Rate for Payer: Meridian Medicaid |
$22,349.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,285.53
|
| Rate for Payer: UHC Medicaid |
$21,285.53
|
| Rate for Payer: UHCCP Medicaid |
$21,285.53
|
|
|
RENAL DIALYSIS ACCESS PROCEDURES
|
Facility
|
IP
|
$10,947.30
|
|
|
Service Code
|
APR-DRG 4442
|
| Min. Negotiated Rate |
$10,426.00 |
| Max. Negotiated Rate |
$10,947.30 |
| Rate for Payer: BCBS Complete |
$10,947.30
|
| Rate for Payer: Mclaren Medicaid |
$10,426.00
|
| Rate for Payer: Meridian Medicaid |
$10,947.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,426.00
|
| Rate for Payer: UHC Medicaid |
$10,426.00
|
| Rate for Payer: UHCCP Medicaid |
$10,426.00
|
|
|
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH ENDOPYELOTOMY (INCLUDES CYSTOSCOPY, URETEROSCOPY, DILATION OF URETER AND URETERAL PELVIC JUNCTION, INCISION OF URETERAL PELVIC JUNCTION AND INSERTION OF ENDOPYELOTOMY STENT)
|
Facility
|
OP
|
$17,277.20
|
|
|
Service Code
|
CPT 50575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,794.14 |
| Max. Negotiated Rate |
$17,277.20 |
| Rate for Payer: Aetna Medicare |
$5,556.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,678.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,678.15
|
| Rate for Payer: BCBS Complete |
$2,934.11
|
| Rate for Payer: BCBS MAPPO |
$5,342.52
|
| Rate for Payer: BCBS Trust/PPO |
$3,820.33
|
| Rate for Payer: BCN Commercial |
$3,820.33
|
| Rate for Payer: BCN Medicare Advantage |
$5,342.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,342.52
|
| Rate for Payer: Mclaren Medicaid |
$5,342.52
|
| Rate for Payer: Mclaren Medicare |
$5,342.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,609.65
|
| Rate for Payer: Meridian Medicaid |
$5,609.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,143.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,876.77
|
| Rate for Payer: Nomi Health Commercial |
$16,027.56
|
| Rate for Payer: PACE Medicare |
$5,075.39
|
| Rate for Payer: PACE SWMI |
$5,342.52
|
| Rate for Payer: PHP Medicare Advantage |
$5,342.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,794.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,277.20
|
| Rate for Payer: Priority Health Medicare |
$5,342.52
|
| Rate for Payer: Priority Health Tiered Network |
$13,821.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,342.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,342.52
|
| Rate for Payer: UHC Medicaid |
$2,794.14
|
| Rate for Payer: UHCCP Medicaid |
$2,794.14
|
| Rate for Payer: VA VA |
$5,342.52
|
|
|
RENAL FAILURE WITH CC
|
Facility
|
IP
|
$16,218.05
|
|
|
Service Code
|
MSDRG 683
|
| Min. Negotiated Rate |
$7,521.16 |
| Max. Negotiated Rate |
$16,218.05 |
| Rate for Payer: Aetna Medicare |
$8,233.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,896.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,896.26
|
| Rate for Payer: BCBS MAPPO |
$7,917.01
|
| Rate for Payer: BCBS Trust/PPO |
$16,218.05
|
| Rate for Payer: BCN Commercial |
$16,218.05
|
| Rate for Payer: BCN Medicare Advantage |
$7,917.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,917.01
|
| Rate for Payer: Mclaren Medicare |
$7,917.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,312.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,104.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,708.71
|
| Rate for Payer: Nomi Health Commercial |
$11,297.82
|
| Rate for Payer: PACE Medicare |
$7,521.16
|
| Rate for Payer: PACE SWMI |
$7,917.01
|
| Rate for Payer: PHP Medicare Advantage |
$7,917.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,119.77
|
| Rate for Payer: Priority Health Medicare |
$7,917.01
|
| Rate for Payer: Priority Health Tiered Network |
$11,295.81
|
| Rate for Payer: Railroad Medicare Medicare |
$7,917.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,275.54
|
| Rate for Payer: UHC Core |
$11,943.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,917.01
|
| Rate for Payer: UHC Exchange |
$9,753.78
|
| Rate for Payer: VA VA |
$7,917.01
|
|
|
RENAL FAILURE WITH MCC
|
Facility
|
IP
|
$29,776.10
|
|
|
Service Code
|
MSDRG 682
|
| Min. Negotiated Rate |
$12,329.22 |
| Max. Negotiated Rate |
$29,776.10 |
| Rate for Payer: Aetna Medicare |
$13,497.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,222.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,222.66
|
| Rate for Payer: BCBS MAPPO |
$12,978.13
|
| Rate for Payer: BCBS Trust/PPO |
$29,776.10
|
| Rate for Payer: BCN Commercial |
$29,776.10
|
| Rate for Payer: BCN Medicare Advantage |
$12,978.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,978.13
|
| Rate for Payer: Mclaren Medicare |
$12,978.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,627.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,924.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,275.94
|
| Rate for Payer: Nomi Health Commercial |
$19,104.90
|
| Rate for Payer: PACE Medicare |
$12,329.22
|
| Rate for Payer: PACE SWMI |
$12,978.13
|
| Rate for Payer: PHP Medicare Advantage |
$12,978.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,876.89
|
| Rate for Payer: Priority Health Medicare |
$12,978.13
|
| Rate for Payer: Priority Health Tiered Network |
$19,101.51
|
| Rate for Payer: Railroad Medicare Medicare |
$12,978.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,140.30
|
| Rate for Payer: UHC Core |
$20,196.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,978.13
|
| Rate for Payer: UHC Exchange |
$16,493.90
|
| Rate for Payer: VA VA |
$12,978.13
|
|
|
RENAL FAILURE WITHOUT CC/MCC
|
Facility
|
IP
|
$12,234.91
|
|
|
Service Code
|
MSDRG 684
|
| Min. Negotiated Rate |
$5,332.44 |
| Max. Negotiated Rate |
$12,234.91 |
| Rate for Payer: Aetna Medicare |
$5,837.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,016.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,016.38
|
| Rate for Payer: BCBS MAPPO |
$5,613.10
|
| Rate for Payer: BCBS Trust/PPO |
$12,234.91
|
| Rate for Payer: BCN Commercial |
$12,234.91
|
| Rate for Payer: BCN Medicare Advantage |
$5,613.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,613.10
|
| Rate for Payer: Mclaren Medicare |
$5,613.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,893.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,455.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,174.41
|
| Rate for Payer: Nomi Health Commercial |
$7,743.87
|
| Rate for Payer: PACE Medicare |
$5,332.44
|
| Rate for Payer: PACE SWMI |
$5,613.10
|
| Rate for Payer: PHP Medicare Advantage |
$5,613.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,678.12
|
| Rate for Payer: Priority Health Medicare |
$5,613.10
|
| Rate for Payer: Priority Health Tiered Network |
$7,742.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,613.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,784.89
|
| Rate for Payer: UHC Core |
$8,186.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,613.10
|
| Rate for Payer: UHC Exchange |
$6,685.54
|
| Rate for Payer: VA VA |
$5,613.10
|
|
|
REPAGLINIDE 1 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 57237015801
|
| Hospital Charge Code |
22586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.41
|
| Rate for Payer: UHC Core |
$151.82
|
| Rate for Payer: UHC Exchange |
$114.52
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
REPAGLINIDE 1 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 57237015801
|
| Hospital Charge Code |
22586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
REPAIR CHOANAL ATRESIA; INTRANASAL
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 30540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,835.44
|
| Rate for Payer: BCN Commercial |
$3,835.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$2,381.49
|
|
|
Service Code
|
CPT 13152
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,636.56
|
| Rate for Payer: BCN Commercial |
$1,636.56
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 13131
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$505.51
|
| Rate for Payer: BCN Commercial |
$505.51
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 13132
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,143.34
|
| Rate for Payer: BCN Commercial |
$1,143.34
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
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
|
$776.94
|
|
|
Service Code
|
CPT 13133
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$776.94 |
| Max. Negotiated Rate |
$776.94 |
| Rate for Payer: BCBS Trust/PPO |
$776.94
|
| Rate for Payer: BCN Commercial |
$776.94
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$1,309.90
|
|
|
Service Code
|
CPT 13121
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$211.84 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Mclaren Medicaid |
$405.05
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,684.94
|
|
|
Service Code
|
CPT 13122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,684.94 |
| Max. Negotiated Rate |
$1,684.94 |
| Rate for Payer: BCBS Trust/PPO |
$1,684.94
|
| Rate for Payer: BCN Commercial |
$1,684.94
|
|
|
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
|
Facility
|
OP
|
$2,381.49
|
|
|
Service Code
|
CPT 13101
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$385.14 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: VA VA |
$736.41
|
|
|
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$526.62
|
|
|
Service Code
|
CPT 13102
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$526.62 |
| Max. Negotiated Rate |
$526.62 |
| Rate for Payer: BCBS Trust/PPO |
$526.62
|
| Rate for Payer: BCN Commercial |
$526.62
|
|
|
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26418
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,040.59
|
| Rate for Payer: BCN Commercial |
$3,040.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$5,181.40
|
|
|
Service Code
|
CPT 26410
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$837.96 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Mclaren Medicaid |
$1,602.21
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACH TENDON
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 27658
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,293.43
|
| Rate for Payer: BCN Commercial |
$2,293.43
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
REPAIR INCOMPLETE CIRCUMCISION
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54163
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,118.46
|
| Rate for Payer: BCN Commercial |
$3,118.46
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$2,082.87
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 49525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,191.89
|
| Rate for Payer: BCN Commercial |
$3,191.89
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 49553
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,191.89
|
| Rate for Payer: BCN Commercial |
$3,191.89
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
