|
RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, OR TENODESIS) WITH OR WITHOUT OPEN REDUCTION OF DISTAL RADIOULNAR JOINT
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 24344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 24346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21142
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 3 OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21143
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; UP TO TWO-THIRDS OF EYELID, 1 STAGE OR FIRST STAGE
|
Facility
|
OP
|
$6,404.71
|
|
|
Service Code
|
CPT 67971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.56 |
| Max. Negotiated Rate |
$6,404.71 |
| Rate for Payer: Aetna Medicare |
$2,366.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,844.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,844.11
|
| Rate for Payer: BCBS Complete |
$1,280.53
|
| Rate for Payer: BCBS MAPPO |
$2,275.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,275.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,275.29
|
| Rate for Payer: Mclaren Medicaid |
$1,219.56
|
| Rate for Payer: Mclaren Medicare |
$2,275.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,389.05
|
| Rate for Payer: Meridian Medicaid |
$1,280.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,616.58
|
| Rate for Payer: PACE Medicare |
$2,161.53
|
| Rate for Payer: PACE SWMI |
$2,275.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,275.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,219.56
|
| Rate for Payer: Priority Health Medicare |
$2,275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,275.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,404.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,275.29
|
| Rate for Payer: UHC Exchange |
$4,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,275.29
|
| Rate for Payer: UHCCP Medicaid |
$1,219.56
|
| Rate for Payer: VA VA |
$2,275.29
|
|
|
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
RECONSTRUCTION OF NAIL BED WITH GRAFT
|
Facility
|
OP
|
$5,021.81
|
|
|
Service Code
|
CPT 11762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$956.23 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26587
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH LOCAL TISSUES (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 26500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTION, TOE(S); POLYDACTYLY
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECONSTRUCTIVE REPAIR OF PECTUS EXCAVATUM OR CARINATUM; MINIMALLY INVASIVE APPROACH (NUSS PROCEDURE), WITH THORACOSCOPY
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 21743
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RECTAL SENSATION, TONE, AND COMPLIANCE TEST (IE, RESPONSE TO GRADED BALLOON DISTENTION)
|
Facility
|
OP
|
$854.89
|
|
|
Service Code
|
CPT 91120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$162.78 |
| Max. Negotiated Rate |
$854.89 |
| Rate for Payer: Aetna Medicare |
$315.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$379.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$379.62
|
| Rate for Payer: BCBS Complete |
$170.92
|
| Rate for Payer: BCBS MAPPO |
$303.70
|
| Rate for Payer: BCN Medicare Advantage |
$303.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.70
|
| Rate for Payer: Mclaren Medicaid |
$162.78
|
| Rate for Payer: Mclaren Medicare |
$303.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.88
|
| Rate for Payer: Meridian Medicaid |
$170.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.25
|
| Rate for Payer: PACE Medicare |
$288.51
|
| Rate for Payer: PACE SWMI |
$303.70
|
| Rate for Payer: PHP Medicare Advantage |
$303.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.78
|
| Rate for Payer: Priority Health Medicare |
$303.70
|
| Rate for Payer: Railroad Medicare Medicare |
$303.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.70
|
| Rate for Payer: UHC Exchange |
$580.40
|
| Rate for Payer: UHC Medicare Advantage |
$303.70
|
| Rate for Payer: UHCCP Medicaid |
$162.78
|
| Rate for Payer: VA VA |
$303.70
|
|
|
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 54600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$38.14
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$34.33 |
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$85.51
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna American Axle |
$553.16
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Medicare |
$16.78
|
| Rate for Payer: Aetna Medicare |
$65.78
|
| Rate for Payer: Aetna Medicare |
$31.04
|
| Rate for Payer: Aetna Medicare |
$425.50
|
| Rate for Payer: Aetna Medicare |
$19.07
|
| Rate for Payer: Aetna Medicare |
$13.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Complete |
$15.26
|
| Rate for Payer: BCBS Complete |
$10.88
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Complete |
$24.83
|
| Rate for Payer: BCBS Complete |
$52.62
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$118.39
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: UMR Bronson Commercial |
$314.87
|
| Rate for Payer: UMR Bronson Commercial |
$48.67
|
| Rate for Payer: UMR Bronson Commercial |
$10.06
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$14.11
|
| Rate for Payer: UMR Bronson Commercial |
$22.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
|
|
REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$131.55
|
|
|
Service Code
|
HCPCS J2785
|
| Hospital Charge Code |
91408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.88 |
| Max. Negotiated Rate |
$118.39 |
| Rate for Payer: Aetna American Axle |
$85.51
|
| Rate for Payer: Aetna American Axle |
$40.35
|
| Rate for Payer: Aetna American Axle |
$24.79
|
| Rate for Payer: Aetna American Axle |
$17.67
|
| Rate for Payer: Aetna American Axle |
$21.81
|
| Rate for Payer: Aetna American Axle |
$553.16
|
| Rate for Payer: Aetna Commercial |
$111.82
|
| Rate for Payer: Aetna Commercial |
$23.11
|
| Rate for Payer: Aetna Commercial |
$32.42
|
| Rate for Payer: Aetna Commercial |
$723.36
|
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.35
|
| Rate for Payer: Cash Price |
$49.66
|
| Rate for Payer: Cash Price |
$30.51
|
| Rate for Payer: Cash Price |
$105.24
|
| Rate for Payer: Cash Price |
$26.85
|
| Rate for Payer: Cash Price |
$21.75
|
| Rate for Payer: Cash Price |
$680.81
|
| Rate for Payer: Cofinity Commercial |
$53.39
|
| Rate for Payer: Cofinity Commercial |
$113.13
|
| Rate for Payer: Cofinity Commercial |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$23.49
|
| Rate for Payer: Cofinity Commercial |
$19.03
|
| Rate for Payer: Cofinity Commercial |
$23.38
|
| Rate for Payer: Cofinity Commercial |
$28.86
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Commercial |
$731.87
|
| Rate for Payer: Cofinity Commercial |
$595.71
|
| Rate for Payer: Cofinity Commercial |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.81
|
| Rate for Payer: Healthscope Commercial |
$34.33
|
| Rate for Payer: Healthscope Commercial |
$765.91
|
| Rate for Payer: Healthscope Commercial |
$55.87
|
| Rate for Payer: Healthscope Commercial |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$30.20
|
| Rate for Payer: Healthscope Commercial |
$118.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$595.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$111.82
|
| Rate for Payer: PHP Commercial |
$23.11
|
| Rate for Payer: PHP Commercial |
$32.42
|
| Rate for Payer: PHP Commercial |
$52.77
|
| Rate for Payer: PHP Commercial |
$28.53
|
| Rate for Payer: PHP Commercial |
$723.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.16
|
| Rate for Payer: Priority Health SBD |
$39.11
|
| Rate for Payer: Priority Health SBD |
$24.03
|
| Rate for Payer: Priority Health SBD |
$82.88
|
| Rate for Payer: Priority Health SBD |
$17.13
|
| Rate for Payer: Priority Health SBD |
$21.14
|
| Rate for Payer: Priority Health SBD |
$536.14
|
| Rate for Payer: UMR Bronson Commercial |
$374.44
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$14.77
|
| Rate for Payer: UMR Bronson Commercial |
$27.32
|
| Rate for Payer: UMR Bronson Commercial |
$16.78
|
| Rate for Payer: UMR Bronson Commercial |
$57.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.66
|
|
|
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL, WITH OR WITHOUT TENDON GRAFT
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 24342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
RELEASE, INTRINSIC MUSCLES OF HAND, EACH MUSCLE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVE DECOMPRESSION)
|
Facility
|
OP
|
$5,360.98
|
|
|
Service Code
|
CPT 28035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,020.81 |
| Max. Negotiated Rate |
$5,360.98 |
| Rate for Payer: Aetna Medicare |
$1,980.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,380.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,380.62
|
| Rate for Payer: BCBS Complete |
$1,071.85
|
| Rate for Payer: BCBS MAPPO |
$1,904.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,904.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,904.50
|
| Rate for Payer: Mclaren Medicaid |
$1,020.81
|
| Rate for Payer: Mclaren Medicare |
$1,904.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,999.72
|
| Rate for Payer: Meridian Medicaid |
$1,071.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,190.18
|
| Rate for Payer: PACE Medicare |
$1,809.28
|
| Rate for Payer: PACE SWMI |
$1,904.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,904.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,020.81
|
| Rate for Payer: Priority Health Medicare |
$1,904.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1,904.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,360.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,904.50
|
| Rate for Payer: UHC Exchange |
$3,639.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,904.50
|
| Rate for Payer: UHCCP Medicaid |
$1,020.81
|
| Rate for Payer: VA VA |
$1,904.50
|
|
