|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$1,417.59
|
|
|
Service Code
|
NDC 00378127093
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$524.51 |
| Max. Negotiated Rate |
$1,275.83 |
| Rate for Payer: Aetna American Axle |
$921.43
|
| Rate for Payer: Aetna Commercial |
$1,204.95
|
| Rate for Payer: Aetna Medicare |
$708.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.43
|
| Rate for Payer: BCBS Complete |
$567.04
|
| Rate for Payer: Cash Price |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,219.13
|
| Rate for Payer: Cofinity Commercial |
$992.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$992.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.07
|
| Rate for Payer: Healthscope Commercial |
$1,275.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,204.95
|
| Rate for Payer: PHP Commercial |
$1,204.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.43
|
| Rate for Payer: Priority Health SBD |
$893.08
|
| Rate for Payer: UMR Bronson Commercial |
$524.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.19
|
|
|
RASAGILINE 0.5 MG TABLET
|
Facility
|
OP
|
$295.93
|
|
|
Service Code
|
NDC 23155074603
|
| Hospital Charge Code |
76480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.54
|
| Rate for Payer: Aetna Medicare |
$147.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: BCBS Complete |
$118.37
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Commercial |
$207.15
|
| Rate for Payer: Cofinity Commercial |
$254.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.54
|
| Rate for Payer: PHP Commercial |
$251.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.35
|
| Rate for Payer: Priority Health SBD |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$109.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.95
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna American Axle |
$2,268.52
|
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna Medicare |
$384.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$462.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$462.46
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS MAPPO |
$369.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.11
|
| Rate for Payer: BCN Commercial |
$1,001.11
|
| Rate for Payer: BCN Medicare Advantage |
$369.97
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.97
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,443.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,617.52
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Mclaren Medicare |
$369.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.47
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: Nomi Health Commercial |
$1,109.91
|
| Rate for Payer: PACE Medicare |
$351.47
|
| Rate for Payer: PACE SWMI |
$369.97
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: PHP Medicare Advantage |
$369.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,068.58
|
| Rate for Payer: Priority Health Medicare |
$369.97
|
| Rate for Payer: Priority Health Narrow Network |
$854.86
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: Railroad Medicare Medicare |
$369.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.97
|
| Rate for Payer: UHC Exchange |
$707.05
|
| Rate for Payer: UHC Medicare Advantage |
$369.97
|
| Rate for Payer: UHCCP Medicaid |
$198.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,291.31
|
| Rate for Payer: VA VA |
$369.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,617.52
|
|
|
RASBURICASE 1.5 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,490.03
|
|
|
Service Code
|
HCPCS J2783
|
| Hospital Charge Code |
33591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,535.61 |
| Max. Negotiated Rate |
$3,141.03 |
| Rate for Payer: Aetna American Axle |
$2,268.52
|
| Rate for Payer: Aetna Commercial |
$2,966.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,268.52
|
| Rate for Payer: Cash Price |
$2,792.02
|
| Rate for Payer: Cofinity Commercial |
$2,443.02
|
| Rate for Payer: Cofinity Commercial |
$3,001.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,443.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,792.02
|
| Rate for Payer: Healthscope Commercial |
$3,141.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,443.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,617.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,966.53
|
| Rate for Payer: PHP Commercial |
$2,966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,268.52
|
| Rate for Payer: Priority Health SBD |
$2,198.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,535.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,617.52
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16,650.41
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,326.18 |
| Max. Negotiated Rate |
$14,985.37 |
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Cofinity Commercial |
$42,736.02
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,655.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$42,736.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Healthscope Commercial |
$54,946.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,893.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,822.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39,683.44
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: UMR Bronson Commercial |
$7,326.18
|
| Rate for Payer: UMR Bronson Commercial |
$26,862.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
|
|
RAVULIZUMAB-CWVZ 100 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16,650.41
|
|
|
Service Code
|
HCPCS J1303
|
| Hospital Charge Code |
195284
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.24 |
| Max. Negotiated Rate |
$14,985.37 |
| Rate for Payer: Aetna American Axle |
$10,822.77
|
| Rate for Payer: Aetna American Axle |
$39,683.44
|
| Rate for Payer: Aetna Commercial |
$51,893.73
|
| Rate for Payer: Aetna Commercial |
$14,152.85
|
| Rate for Payer: Aetna Medicare |
$229.41
|
| Rate for Payer: Aetna Medicare |
$229.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,822.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39,683.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.74
|
| Rate for Payer: BCBS Complete |
$124.15
|
| Rate for Payer: BCBS Complete |
$124.15
|
| Rate for Payer: BCBS MAPPO |
$220.59
|
| Rate for Payer: BCBS MAPPO |
$220.59
|
| Rate for Payer: BCBS Trust/PPO |
$595.20
|
| Rate for Payer: BCBS Trust/PPO |
$595.20
|
| Rate for Payer: BCN Commercial |
$595.20
|
| Rate for Payer: BCN Commercial |
$595.20
|
| Rate for Payer: BCN Medicare Advantage |
$220.59
|
| Rate for Payer: BCN Medicare Advantage |
$220.59
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cash Price |
$48,841.16
|
| Rate for Payer: Cash Price |
$13,320.33
|
| Rate for Payer: Cofinity Commercial |
$42,736.02
|
| Rate for Payer: Cofinity Commercial |
$11,655.29
|
| Rate for Payer: Cofinity Commercial |
$14,319.35
|
| Rate for Payer: Cofinity Commercial |
$52,504.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$11,655.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$42,736.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48,841.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.59
|
| Rate for Payer: Healthscope Commercial |
$14,985.37
|
| Rate for Payer: Healthscope Commercial |
$54,946.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$42,736.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11,655.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12,487.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45,788.59
|
| Rate for Payer: Mclaren Medicaid |
$118.24
|
| Rate for Payer: Mclaren Medicaid |
$118.24
|
| Rate for Payer: Mclaren Medicare |
$220.59
|
| Rate for Payer: Mclaren Medicare |
$220.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.62
|
| Rate for Payer: Meridian Medicaid |
$124.15
|
| Rate for Payer: Meridian Medicaid |
$124.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,152.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51,893.73
|
| Rate for Payer: Nomi Health Commercial |
$661.77
|
| Rate for Payer: Nomi Health Commercial |
$661.77
|
| Rate for Payer: PACE Medicare |
$209.56
|
| Rate for Payer: PACE Medicare |
$209.56
|
| Rate for Payer: PACE SWMI |
$220.59
|
| Rate for Payer: PACE SWMI |
$220.59
|
| Rate for Payer: PHP Commercial |
$14,152.85
|
| Rate for Payer: PHP Commercial |
$51,893.73
|
| Rate for Payer: PHP Medicare Advantage |
$220.59
|
| Rate for Payer: PHP Medicare Advantage |
$220.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,822.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39,683.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$635.34
|
| Rate for Payer: Priority Health Medicare |
$220.59
|
| Rate for Payer: Priority Health Medicare |
$220.59
|
| Rate for Payer: Priority Health Narrow Network |
$508.27
|
| Rate for Payer: Priority Health Narrow Network |
$508.27
|
| Rate for Payer: Priority Health SBD |
$10,489.76
|
| Rate for Payer: Priority Health SBD |
$38,462.41
|
| Rate for Payer: Railroad Medicare Medicare |
$220.59
|
| Rate for Payer: Railroad Medicare Medicare |
$220.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.59
|
| Rate for Payer: UHC Exchange |
$421.57
|
| Rate for Payer: UHC Exchange |
$421.57
|
| Rate for Payer: UHC Medicare Advantage |
$220.59
|
| Rate for Payer: UHC Medicare Advantage |
$220.59
|
| Rate for Payer: UHCCP Medicaid |
$118.24
|
| Rate for Payer: UHCCP Medicaid |
$118.24
|
| Rate for Payer: UMR Bronson Commercial |
$6,160.65
|
| Rate for Payer: UMR Bronson Commercial |
$22,589.04
|
| Rate for Payer: VA VA |
$220.59
|
| Rate for Payer: VA VA |
$220.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12,487.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45,788.59
|
|
|
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26437
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.78 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.06
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$632.78
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITH EXCISION OF ACCESSORY TARSAL NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 28238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$472.19 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,398.79
|
| Rate for Payer: BCN Commercial |
$4,398.79
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.41
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$472.19
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.55 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$348.55
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$686.69 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.36
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$686.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEAL JOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$797.38 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.10
|
| Rate for Payer: BCN Commercial |
$2,452.10
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$877.12
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$797.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
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
|
$21,998.64
|
|
|
Service Code
|
CPT 25337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$859.06 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$944.97
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$859.06
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 24344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.35 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,814.60
|
| Rate for Payer: BCN Commercial |
$4,814.60
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,177.38
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,070.35
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT, ELBOW, WITH TENDON GRAFT (INCLUDES HARVESTING OF GRAFT)
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 24346
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,070.35 |
| Max. Negotiated Rate |
$39,622.51 |
| Rate for Payer: Aetna Medicare |
$13,110.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,758.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,758.31
|
| Rate for Payer: BCBS Complete |
$7,095.02
|
| Rate for Payer: BCBS MAPPO |
$12,606.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,754.27
|
| Rate for Payer: BCN Commercial |
$7,754.27
|
| Rate for Payer: BCN Medicare Advantage |
$12,606.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,606.65
|
| Rate for Payer: Mclaren Medicaid |
$6,757.16
|
| Rate for Payer: Mclaren Medicare |
$12,606.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,236.98
|
| Rate for Payer: Meridian Medicaid |
$7,095.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,497.65
|
| Rate for Payer: Nomi Health Commercial |
$26,473.96
|
| Rate for Payer: PACE Medicare |
$11,976.32
|
| Rate for Payer: PACE SWMI |
$12,606.65
|
| Rate for Payer: PHP Medicare Advantage |
$12,606.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,757.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39,622.51
|
| Rate for Payer: Priority Health Medicare |
$12,606.65
|
| Rate for Payer: Priority Health Narrow Network |
$31,698.01
|
| Rate for Payer: Railroad Medicare Medicare |
$12,606.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,177.38
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$1,070.35
|
| Rate for Payer: UHC Medicare Advantage |
$12,606.65
|
| Rate for Payer: UHCCP Medicaid |
$6,757.16
|
| Rate for Payer: VA VA |
$12,606.65
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 2 PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21142
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,293.80 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,146.13
|
| Rate for Payer: BCN Commercial |
$5,146.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.18
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,293.80
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; 3 OR MORE PIECES, SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21143
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,334.01 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,347.03
|
| Rate for Payer: BCN Commercial |
$5,347.03
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,467.41
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,334.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENT MOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21141
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,260.02 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$4,908.60
|
| Rate for Payer: BCN Commercial |
$4,908.60
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,386.02
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,260.02
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSER TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.81 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.69
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$728.81
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$720.39 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,126.82
|
| Rate for Payer: BCN Commercial |
$4,126.82
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.43
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$720.39
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG, FOR STENOSIS DUE TO INJURY, INFECTION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69310
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,049.78 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,703.90
|
| Rate for Payer: BCN Commercial |
$3,703.90
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,154.76
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,049.78
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
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
|
$7,184.18
|
|
|
Service Code
|
CPT 67971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$671.88 |
| Max. Negotiated Rate |
$7,184.18 |
| Rate for Payer: Aetna Medicare |
$2,377.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,857.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,857.24
|
| Rate for Payer: BCBS Complete |
$1,286.44
|
| Rate for Payer: BCBS MAPPO |
$2,285.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.51
|
| Rate for Payer: BCN Commercial |
$1,644.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.79
|
| Rate for Payer: Mclaren Medicaid |
$1,225.18
|
| Rate for Payer: Mclaren Medicare |
$2,285.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.08
|
| Rate for Payer: Meridian Medicaid |
$1,286.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,628.66
|
| Rate for Payer: Nomi Health Commercial |
$4,800.16
|
| Rate for Payer: PACE Medicare |
$2,171.50
|
| Rate for Payer: PACE SWMI |
$2,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,225.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,184.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.79
|
| Rate for Payer: Priority Health Narrow Network |
$5,747.34
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.07
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$671.88
|
| Rate for Payer: UHC Medicare Advantage |
$2,285.79
|
| Rate for Payer: UHCCP Medicaid |
$1,225.18
|
| Rate for Payer: VA VA |
$2,285.79
|
|
|
RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEAL IMPLANT; PARTIAL
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$893.41 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$982.75
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$893.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL SPLIT; WITH INTERNAL RIGID FIXATION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21196
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,351.61 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,424.09
|
| Rate for Payer: BCN Commercial |
$5,424.09
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,486.77
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,351.61
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
RECONSTRUCTION OF NAIL BED WITH GRAFT
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 11762
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$178.75 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$223.20
|
| Rate for Payer: BCN Commercial |
$223.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.62
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$178.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
RECONSTRUCTION OF POLYDACTYLOUS DIGIT, SOFT TISSUE AND BONE
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26587
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,011.64 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,898.39
|
| Rate for Payer: BCN Commercial |
$1,898.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.80
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$1,011.64
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
