|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC VASCULAR TERRITORY, WITH TRANSLUMINAL STENT PLACEMENT, INCLUDING TRANSLUMINAL ANGIOPLASTY WHEN PERFORMED, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE STENT PLACEMENT AND ANGIOPLASTY WHEN PERFORMED, WITHIN THE SAME ARTERY, UNILATERAL; STRAIGHTFORWARD LESION, INITIAL VESSEL
|
Facility
|
OP
|
$37,198.61
|
|
|
Service Code
|
CPT 37258
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL AND PERONEAL VASCULAR TERRITORY, WITH TRANSLUMINAL ANGIOPLASTY, INCLUDING ALL MANEUVERS NECESSARY FOR ACCESSING AND SELECTIVELY CATHETERIZING THE ARTERY AND CROSSING THE LESION, INCLUDING ALL IMAGING GUIDANCE AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME ARTERY, UNILATERAL; STRAIGHTFORWARD LESION, INITIAL VESSEL
|
Facility
|
OP
|
$37,198.61
|
|
|
Service Code
|
CPT 37280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,015.90 |
| Max. Negotiated Rate |
$37,198.61 |
| Rate for Payer: Aetna Medicare |
$11,962.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,378.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,378.35
|
| Rate for Payer: BCBS Complete |
$6,317.27
|
| Rate for Payer: BCBS MAPPO |
$11,502.68
|
| Rate for Payer: BCN Medicare Advantage |
$11,502.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,502.68
|
| Rate for Payer: Mclaren Medicaid |
$11,502.68
|
| Rate for Payer: Mclaren Medicare |
$11,502.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,077.81
|
| Rate for Payer: Meridian Medicaid |
$12,077.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,228.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,652.95
|
| Rate for Payer: Nomi Health Commercial |
$34,508.04
|
| Rate for Payer: PACE Medicare |
$10,927.55
|
| Rate for Payer: PACE SWMI |
$11,502.68
|
| Rate for Payer: PHP Medicare Advantage |
$11,502.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,015.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$37,198.61
|
| Rate for Payer: Priority Health Medicare |
$11,502.68
|
| Rate for Payer: Priority Health Tiered Network |
$29,758.89
|
| Rate for Payer: Railroad Medicare Medicare |
$11,502.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,502.68
|
| Rate for Payer: UHC Medicaid |
$6,015.90
|
| Rate for Payer: UHCCP Medicaid |
$6,015.90
|
| Rate for Payer: VA VA |
$11,502.68
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$5,133.27
|
|
|
Service Code
|
CPT 37232
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,133.27 |
| Max. Negotiated Rate |
$5,133.27 |
| Rate for Payer: BCBS Trust/PPO |
$5,133.27
|
| Rate for Payer: BCN Commercial |
$5,133.27
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$8,334.63
|
|
|
Service Code
|
CPT 37228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,334.63 |
| Max. Negotiated Rate |
$8,334.63 |
| Rate for Payer: BCBS Trust/PPO |
$8,334.63
|
| Rate for Payer: BCN Commercial |
$8,334.63
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, LAPAROSCOPIC APPROACH
|
Facility
|
OP
|
$23,894.64
|
|
|
Service Code
|
CPT 57426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,864.33 |
| Max. Negotiated Rate |
$23,894.64 |
| Rate for Payer: Aetna Medicare |
$7,684.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,235.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,235.96
|
| Rate for Payer: BCBS Complete |
$4,057.91
|
| Rate for Payer: BCBS MAPPO |
$7,388.77
|
| Rate for Payer: BCBS Trust/PPO |
$4,896.06
|
| Rate for Payer: BCN Commercial |
$4,896.06
|
| Rate for Payer: BCN Medicare Advantage |
$7,388.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,388.77
|
| Rate for Payer: Mclaren Medicaid |
$7,388.77
|
| Rate for Payer: Mclaren Medicare |
$7,388.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,758.21
|
| Rate for Payer: Meridian Medicaid |
$7,758.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,497.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,127.65
|
| Rate for Payer: Nomi Health Commercial |
$22,166.31
|
| Rate for Payer: PACE Medicare |
$7,019.33
|
| Rate for Payer: PACE SWMI |
$7,388.77
|
| Rate for Payer: PHP Medicare Advantage |
$7,388.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,864.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,894.64
|
| Rate for Payer: Priority Health Medicare |
$7,388.77
|
| Rate for Payer: Priority Health Tiered Network |
$19,115.71
|
| Rate for Payer: Railroad Medicare Medicare |
$7,388.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,388.77
|
| Rate for Payer: UHC Medicaid |
$3,864.33
|
| Rate for Payer: UHCCP Medicaid |
$3,864.33
|
| Rate for Payer: VA VA |
$7,388.77
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$10,430.93
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,686.93 |
| Max. Negotiated Rate |
$10,430.93 |
| Rate for Payer: Aetna Medicare |
$3,354.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,031.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,031.86
|
| Rate for Payer: BCBS Complete |
$1,771.44
|
| Rate for Payer: BCBS MAPPO |
$3,225.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,340.72
|
| Rate for Payer: BCN Commercial |
$2,340.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,225.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,225.49
|
| Rate for Payer: Mclaren Medicaid |
$3,225.49
|
| Rate for Payer: Mclaren Medicare |
$3,225.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,386.76
|
| Rate for Payer: Meridian Medicaid |
$3,386.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,709.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,548.04
|
| Rate for Payer: Nomi Health Commercial |
$9,676.47
|
| Rate for Payer: PACE Medicare |
$3,064.22
|
| Rate for Payer: PACE SWMI |
$3,225.49
|
| Rate for Payer: PHP Medicare Advantage |
$3,225.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,686.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,430.93
|
| Rate for Payer: Priority Health Medicare |
$3,225.49
|
| Rate for Payer: Priority Health Tiered Network |
$8,344.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,225.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,225.49
|
| Rate for Payer: UHC Medicaid |
$1,686.93
|
| Rate for Payer: UHCCP Medicaid |
$1,686.93
|
| Rate for Payer: VA VA |
$3,225.49
|
|
|
REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$35,904.89
|
|
|
Service Code
|
CPT 63664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,806.68 |
| Max. Negotiated Rate |
$35,904.89 |
| Rate for Payer: Aetna Medicare |
$11,546.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,878.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,878.29
|
| Rate for Payer: BCBS Complete |
$6,097.56
|
| Rate for Payer: BCBS MAPPO |
$11,102.63
|
| Rate for Payer: BCBS Trust/PPO |
$11,440.14
|
| Rate for Payer: BCN Commercial |
$11,440.14
|
| Rate for Payer: BCN Medicare Advantage |
$11,102.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,102.63
|
| Rate for Payer: Mclaren Medicaid |
$11,102.63
|
| Rate for Payer: Mclaren Medicare |
$11,102.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,657.76
|
| Rate for Payer: Meridian Medicaid |
$11,657.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,768.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,212.89
|
| Rate for Payer: Nomi Health Commercial |
$33,307.89
|
| Rate for Payer: PACE Medicare |
$10,547.50
|
| Rate for Payer: PACE SWMI |
$11,102.63
|
| Rate for Payer: PHP Medicare Advantage |
$11,102.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,806.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,904.89
|
| Rate for Payer: Priority Health Medicare |
$11,102.63
|
| Rate for Payer: Priority Health Tiered Network |
$28,723.91
|
| Rate for Payer: Railroad Medicare Medicare |
$11,102.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,102.63
|
| Rate for Payer: UHC Medicaid |
$5,806.68
|
| Rate for Payer: UHCCP Medicaid |
$5,806.68
|
| Rate for Payer: VA VA |
$11,102.63
|
|
|
REVISION OF COLOSTOMY; COMPLICATED (RECONSTRUCTION IN-DEPTH) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 44345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,652.46
|
| Rate for Payer: BCN Commercial |
$4,652.46
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH CC
|
Facility
|
IP
|
$59,749.85
|
|
|
Service Code
|
MSDRG 467
|
| Min. Negotiated Rate |
$28,580.61 |
| Max. Negotiated Rate |
$59,749.85 |
| Rate for Payer: Aetna Medicare |
$31,288.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,606.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,606.06
|
| Rate for Payer: BCBS MAPPO |
$30,084.85
|
| Rate for Payer: BCBS Trust/PPO |
$59,749.85
|
| Rate for Payer: BCN Commercial |
$59,749.85
|
| Rate for Payer: BCN Medicare Advantage |
$30,084.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,084.85
|
| Rate for Payer: Mclaren Medicare |
$30,084.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,589.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,597.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,093.33
|
| Rate for Payer: Nomi Health Commercial |
$45,493.14
|
| Rate for Payer: PACE Medicare |
$28,580.61
|
| Rate for Payer: PACE SWMI |
$30,084.85
|
| Rate for Payer: PHP Medicare Advantage |
$30,084.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,856.34
|
| Rate for Payer: Priority Health Medicare |
$30,084.85
|
| Rate for Payer: Priority Health Tiered Network |
$45,485.06
|
| Rate for Payer: Railroad Medicare Medicare |
$30,084.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57,483.58
|
| Rate for Payer: UHC Core |
$48,092.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,084.85
|
| Rate for Payer: UHC Exchange |
$39,275.74
|
| Rate for Payer: VA VA |
$30,084.85
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITH MCC
|
Facility
|
IP
|
$85,853.00
|
|
|
Service Code
|
MSDRG 466
|
| Min. Negotiated Rate |
$41,917.91 |
| Max. Negotiated Rate |
$85,853.00 |
| Rate for Payer: Aetna Medicare |
$45,889.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,155.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,155.15
|
| Rate for Payer: BCBS MAPPO |
$44,124.12
|
| Rate for Payer: BCBS Trust/PPO |
$85,853.00
|
| Rate for Payer: BCN Commercial |
$85,853.00
|
| Rate for Payer: BCN Medicare Advantage |
$44,124.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,124.12
|
| Rate for Payer: Mclaren Medicare |
$44,124.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46,330.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,742.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$48,536.53
|
| Rate for Payer: Nomi Health Commercial |
$67,149.66
|
| Rate for Payer: PACE Medicare |
$41,917.91
|
| Rate for Payer: PACE SWMI |
$44,124.12
|
| Rate for Payer: PHP Medicare Advantage |
$44,124.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$83,922.19
|
| Rate for Payer: Priority Health Medicare |
$44,124.12
|
| Rate for Payer: Priority Health Tiered Network |
$67,137.74
|
| Rate for Payer: Railroad Medicare Medicare |
$44,124.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84,848.02
|
| Rate for Payer: UHC Core |
$70,986.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44,124.12
|
| Rate for Payer: UHC Exchange |
$57,972.54
|
| Rate for Payer: VA VA |
$44,124.12
|
|
|
REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC
|
Facility
|
IP
|
$52,379.25
|
|
|
Service Code
|
MSDRG 468
|
| Min. Negotiated Rate |
$22,394.97 |
| Max. Negotiated Rate |
$52,379.25 |
| Rate for Payer: Aetna Medicare |
$24,516.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,467.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,467.06
|
| Rate for Payer: BCBS MAPPO |
$23,573.65
|
| Rate for Payer: BCBS Trust/PPO |
$52,379.25
|
| Rate for Payer: BCN Commercial |
$52,379.25
|
| Rate for Payer: BCN Medicare Advantage |
$23,573.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,573.65
|
| Rate for Payer: Mclaren Medicare |
$23,573.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24,752.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,109.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$25,931.01
|
| Rate for Payer: Nomi Health Commercial |
$35,449.20
|
| Rate for Payer: PACE Medicare |
$22,394.97
|
| Rate for Payer: PACE SWMI |
$23,573.65
|
| Rate for Payer: PHP Medicare Advantage |
$23,573.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,303.64
|
| Rate for Payer: Priority Health Medicare |
$23,573.65
|
| Rate for Payer: Priority Health Tiered Network |
$35,442.91
|
| Rate for Payer: Railroad Medicare Medicare |
$23,573.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44,792.40
|
| Rate for Payer: UHC Core |
$37,474.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23,573.65
|
| Rate for Payer: UHC Exchange |
$30,604.48
|
| Rate for Payer: VA VA |
$23,573.65
|
|
|
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 44312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,546.78
|
| Rate for Payer: BCN Commercial |
$2,546.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
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
|
$21,396.49
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,460.32 |
| Max. Negotiated Rate |
$21,396.49 |
| Rate for Payer: Aetna Medicare |
$6,880.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,270.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,270.36
|
| Rate for Payer: BCBS Complete |
$3,633.67
|
| Rate for Payer: BCBS MAPPO |
$6,616.29
|
| Rate for Payer: BCBS Trust/PPO |
$6,281.22
|
| Rate for Payer: BCN Commercial |
$6,281.22
|
| Rate for Payer: BCN Medicare Advantage |
$6,616.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,616.29
|
| Rate for Payer: Mclaren Medicaid |
$6,616.29
|
| Rate for Payer: Mclaren Medicare |
$6,616.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,947.10
|
| Rate for Payer: Meridian Medicaid |
$6,947.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,608.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,277.92
|
| Rate for Payer: Nomi Health Commercial |
$19,848.87
|
| Rate for Payer: PACE Medicare |
$6,285.48
|
| Rate for Payer: PACE SWMI |
$6,616.29
|
| Rate for Payer: PHP Medicare Advantage |
$6,616.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,460.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,396.49
|
| Rate for Payer: Priority Health Medicare |
$6,616.29
|
| Rate for Payer: Priority Health Tiered Network |
$17,117.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,616.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,616.29
|
| Rate for Payer: UHC Medicaid |
$3,460.32
|
| Rate for Payer: UHCCP Medicaid |
$3,460.32
|
| Rate for Payer: VA VA |
$6,616.29
|
|
|
REVISION OF TOTAL ELBOW ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND ULNAR COMPONENT
|
Facility
|
OP
|
$56,498.90
|
|
|
Service Code
|
CPT 24371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,137.21 |
| Max. Negotiated Rate |
$56,498.90 |
| Rate for Payer: Aetna Medicare |
$18,169.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,838.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,838.46
|
| Rate for Payer: BCBS Complete |
$9,594.95
|
| Rate for Payer: BCBS MAPPO |
$17,470.77
|
| Rate for Payer: BCBS Trust/PPO |
$20,372.85
|
| Rate for Payer: BCN Commercial |
$20,372.85
|
| Rate for Payer: BCN Medicare Advantage |
$17,470.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,470.77
|
| Rate for Payer: Mclaren Medicaid |
$17,470.77
|
| Rate for Payer: Mclaren Medicare |
$17,470.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,344.31
|
| Rate for Payer: Meridian Medicaid |
$18,344.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,091.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,217.85
|
| Rate for Payer: Nomi Health Commercial |
$52,412.31
|
| Rate for Payer: PACE Medicare |
$16,597.23
|
| Rate for Payer: PACE SWMI |
$17,470.77
|
| Rate for Payer: PHP Medicare Advantage |
$17,470.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,137.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,498.90
|
| Rate for Payer: Priority Health Medicare |
$17,470.77
|
| Rate for Payer: Priority Health Tiered Network |
$45,199.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17,470.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,470.77
|
| Rate for Payer: UHC Medicaid |
$9,137.21
|
| Rate for Payer: UHCCP Medicaid |
$9,137.21
|
| Rate for Payer: VA VA |
$17,470.77
|
|
|
REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27137
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,488.72 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$6,488.72
|
| Rate for Payer: BCN Commercial |
$6,488.72
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27134
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$13,866.77
|
| Rate for Payer: BCN Commercial |
$13,866.77
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT ALLOGRAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27138
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$6,742.11
|
| Rate for Payer: BCN Commercial |
$6,742.11
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,989.11
|
| Rate for Payer: BCN Commercial |
$8,989.11
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT
|
Facility
|
OP
|
$56,498.90
|
|
|
Service Code
|
CPT 27487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,137.21 |
| Max. Negotiated Rate |
$56,498.90 |
| Rate for Payer: Aetna Medicare |
$18,169.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,838.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,838.46
|
| Rate for Payer: BCBS Complete |
$9,594.95
|
| Rate for Payer: BCBS MAPPO |
$17,470.77
|
| Rate for Payer: BCBS Trust/PPO |
$16,518.57
|
| Rate for Payer: BCN Commercial |
$16,518.57
|
| Rate for Payer: BCN Medicare Advantage |
$17,470.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,470.77
|
| Rate for Payer: Mclaren Medicaid |
$17,470.77
|
| Rate for Payer: Mclaren Medicare |
$17,470.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,344.31
|
| Rate for Payer: Meridian Medicaid |
$18,344.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,091.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,217.85
|
| Rate for Payer: Nomi Health Commercial |
$52,412.31
|
| Rate for Payer: PACE Medicare |
$16,597.23
|
| Rate for Payer: PACE SWMI |
$17,470.77
|
| Rate for Payer: PHP Medicare Advantage |
$17,470.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,137.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$56,498.90
|
| Rate for Payer: Priority Health Medicare |
$17,470.77
|
| Rate for Payer: Priority Health Tiered Network |
$45,199.12
|
| Rate for Payer: Railroad Medicare Medicare |
$17,470.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,470.77
|
| Rate for Payer: UHC Medicaid |
$9,137.21
|
| Rate for Payer: UHCCP Medicaid |
$9,137.21
|
| Rate for Payer: VA VA |
$17,470.77
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID COMPONENT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 23474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$23,143.10
|
| Rate for Payer: BCN Commercial |
$23,143.10
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$8,634.93
|
| Rate for Payer: BCN Commercial |
$8,634.93
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$7,002.57
|
| Rate for Payer: BCN Commercial |
$7,002.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$11,265.44
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,821.89 |
| Max. Negotiated Rate |
$11,265.44 |
| Rate for Payer: Aetna Medicare |
$3,622.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,354.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,354.41
|
| Rate for Payer: BCBS Complete |
$1,913.15
|
| Rate for Payer: BCBS MAPPO |
$3,483.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.66
|
| Rate for Payer: BCN Commercial |
$2,735.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,483.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,483.53
|
| Rate for Payer: Mclaren Medicaid |
$3,483.53
|
| Rate for Payer: Mclaren Medicare |
$3,483.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,657.71
|
| Rate for Payer: Meridian Medicaid |
$3,657.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,006.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,831.88
|
| Rate for Payer: Nomi Health Commercial |
$10,450.59
|
| Rate for Payer: PACE Medicare |
$3,309.35
|
| Rate for Payer: PACE SWMI |
$3,483.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,483.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,821.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,265.44
|
| Rate for Payer: Priority Health Medicare |
$3,483.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,012.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,483.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,483.53
|
| Rate for Payer: UHC Medicaid |
$1,821.89
|
| Rate for Payer: UHCCP Medicaid |
$1,821.89
|
| Rate for Payer: VA VA |
$3,483.53
|
|
|
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$11,265.44
|
|
|
Service Code
|
CPT 64585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,821.89 |
| Max. Negotiated Rate |
$11,265.44 |
| Rate for Payer: Aetna Medicare |
$3,622.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,354.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,354.41
|
| Rate for Payer: BCBS Complete |
$1,913.15
|
| Rate for Payer: BCBS MAPPO |
$3,483.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.66
|
| Rate for Payer: BCN Commercial |
$2,735.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,483.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,483.53
|
| Rate for Payer: Mclaren Medicaid |
$3,483.53
|
| Rate for Payer: Mclaren Medicare |
$3,483.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,657.71
|
| Rate for Payer: Meridian Medicaid |
$3,657.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,006.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,831.88
|
| Rate for Payer: Nomi Health Commercial |
$10,450.59
|
| Rate for Payer: PACE Medicare |
$3,309.35
|
| Rate for Payer: PACE SWMI |
$3,483.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,483.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,821.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,265.44
|
| Rate for Payer: Priority Health Medicare |
$3,483.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,012.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,483.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,483.53
|
| Rate for Payer: UHC Medicaid |
$1,821.89
|
| Rate for Payer: UHCCP Medicaid |
$1,821.89
|
| Rate for Payer: VA VA |
$3,483.53
|
|
|
REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$11,265.44
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,821.89 |
| Max. Negotiated Rate |
$11,265.44 |
| Rate for Payer: Aetna Medicare |
$3,622.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,354.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,354.41
|
| Rate for Payer: BCBS Complete |
$1,913.15
|
| Rate for Payer: BCBS MAPPO |
$3,483.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,191.61
|
| Rate for Payer: BCN Commercial |
$3,191.61
|
| Rate for Payer: BCN Medicare Advantage |
$3,483.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,483.53
|
| Rate for Payer: Mclaren Medicaid |
$3,483.53
|
| Rate for Payer: Mclaren Medicare |
$3,483.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,657.71
|
| Rate for Payer: Meridian Medicaid |
$3,657.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,006.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,831.88
|
| Rate for Payer: Nomi Health Commercial |
$10,450.59
|
| Rate for Payer: PACE Medicare |
$3,309.35
|
| Rate for Payer: PACE SWMI |
$3,483.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,483.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,821.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,265.44
|
| Rate for Payer: Priority Health Medicare |
$3,483.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,012.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,483.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,483.53
|
| Rate for Payer: UHC Medicaid |
$1,821.89
|
| Rate for Payer: UHCCP Medicaid |
$1,821.89
|
| Rate for Payer: VA VA |
$3,483.53
|
|
