|
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$6,013.44
|
|
|
Service Code
|
CPT 63661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$320.36 |
| Max. Negotiated Rate |
$6,013.44 |
| Rate for Payer: Aetna Medicare |
$1,989.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,391.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,391.60
|
| Rate for Payer: BCBS Complete |
$1,076.79
|
| Rate for Payer: BCBS MAPPO |
$1,913.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,638.28
|
| Rate for Payer: BCN Commercial |
$1,638.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,913.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,913.28
|
| Rate for Payer: Mclaren Medicaid |
$1,025.52
|
| Rate for Payer: Mclaren Medicare |
$1,913.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,008.94
|
| Rate for Payer: Meridian Medicaid |
$1,076.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,200.27
|
| Rate for Payer: Nomi Health Commercial |
$5,739.84
|
| Rate for Payer: PACE Medicare |
$1,817.62
|
| Rate for Payer: PACE SWMI |
$1,913.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,913.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,025.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,013.44
|
| Rate for Payer: Priority Health Medicare |
$1,913.28
|
| Rate for Payer: Priority Health Narrow Network |
$4,810.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,913.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,913.28
|
| Rate for Payer: UHC Exchange |
$320.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,913.28
|
| Rate for Payer: UHCCP Medicaid |
$1,025.52
|
| Rate for Payer: VA VA |
$1,913.28
|
|
|
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$10,590.19
|
|
|
Service Code
|
CPT 63662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$841.05 |
| Max. Negotiated Rate |
$10,590.19 |
| Rate for Payer: UHC Dual Complete DSNP |
$3,369.47
|
| Rate for Payer: Aetna Medicare |
$3,504.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,211.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,211.84
|
| Rate for Payer: BCBS Complete |
$1,896.34
|
| Rate for Payer: BCBS MAPPO |
$3,369.47
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.44
|
| Rate for Payer: BCN Commercial |
$2,264.44
|
| Rate for Payer: BCN Medicare Advantage |
$3,369.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,369.47
|
| Rate for Payer: Mclaren Medicaid |
$1,806.04
|
| Rate for Payer: Mclaren Medicare |
$3,369.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,537.94
|
| Rate for Payer: Meridian Medicaid |
$1,896.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,874.89
|
| Rate for Payer: Nomi Health Commercial |
$7,075.89
|
| Rate for Payer: PACE Medicare |
$3,201.00
|
| Rate for Payer: PACE SWMI |
$3,369.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,369.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,806.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,590.19
|
| Rate for Payer: Priority Health Medicare |
$3,369.47
|
| Rate for Payer: Priority Health Narrow Network |
$8,472.15
|
| Rate for Payer: Railroad Medicare Medicare |
$3,369.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.16
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$841.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,369.47
|
| Rate for Payer: UHCCP Medicaid |
$1,806.04
|
| Rate for Payer: VA VA |
$3,369.47
|
|
|
REMOVAL OF SUTURES OR STAPLES NOT REQUIRING ANESTHESIA (LIST SEPARATELY IN ADDITION TO E/M CODE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 15853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$36.99
|
| Rate for Payer: BCN Commercial |
$36.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.58
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$10.53
|
|
|
REMOVAL OF SUTURES OR STAPLES REQUIRING ANESTHESIA (IE, GENERAL ANESTHESIA, MODERATE SEDATION)
|
Facility
|
OP
|
$5,632.99
|
|
|
Service Code
|
CPT 15851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$62.40 |
| 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 |
$87.84
|
| Rate for Payer: BCN Commercial |
$87.84
|
| 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) |
$68.64
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Exchange |
$62.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$960.64
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
REMOVAL OF SYNTHETIC ROD AND INSERTION OF FLEXOR TENDON GRAFT, HAND OR FINGER (INCLUDES OBTAINING GRAFT), EACH ROD
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 26392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.85 |
| 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) |
$1,050.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$954.85
|
| 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
|
|
|
REMOVAL OF TISSUE EXPANDER WITHOUT INSERTION OF IMPLANT
|
Facility
|
OP
|
$8,813.49
|
|
|
Service Code
|
CPT 11971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$529.47 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,816.04
|
| Rate for Payer: BCN Commercial |
$3,816.04
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Nomi Health Commercial |
$8,412.54
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$529.47
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
REMOVAL OF TOTAL OR NEAR TOTAL NON-INFECTED MESH OR OTHER PROSTHESIS AT THE TIME OF INITIAL OR RECURRENT ANTERIOR ABDOMINAL HERNIA REPAIR OR PARASTOMAL HERNIA REPAIR, ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 49623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.11 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$639.78
|
| Rate for Payer: BCN Commercial |
$639.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.42
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$193.11
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION
|
Facility
|
OP
|
$4,783.71
|
|
|
Service Code
|
CPT 36590
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$181.31 |
| Max. Negotiated Rate |
$4,783.71 |
| Rate for Payer: Aetna Medicare |
$1,582.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,902.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,902.54
|
| Rate for Payer: BCBS Complete |
$856.60
|
| Rate for Payer: BCBS MAPPO |
$1,522.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.51
|
| Rate for Payer: BCN Commercial |
$1,183.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,522.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,522.03
|
| Rate for Payer: Mclaren Medicaid |
$815.81
|
| Rate for Payer: Mclaren Medicare |
$1,522.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,598.13
|
| Rate for Payer: Meridian Medicaid |
$856.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,750.33
|
| Rate for Payer: Nomi Health Commercial |
$4,566.09
|
| Rate for Payer: PACE Medicare |
$1,445.93
|
| Rate for Payer: PACE SWMI |
$1,522.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,522.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$815.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,783.71
|
| Rate for Payer: Priority Health Medicare |
$1,522.03
|
| Rate for Payer: Priority Health Narrow Network |
$3,826.97
|
| Rate for Payer: Railroad Medicare Medicare |
$1,522.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.44
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$181.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$1,903.90
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$852.26
|
| Rate for Payer: BCN Commercial |
$852.26
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Nomi Health Commercial |
$1,817.28
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.76
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$129.78
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP
|
Facility
|
OP
|
$1,903.90
|
|
|
Service Code
|
CPT 36589
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.78 |
| Max. Negotiated Rate |
$1,903.90 |
| Rate for Payer: Aetna Medicare |
$629.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCBS Trust/PPO |
$852.26
|
| Rate for Payer: BCN Commercial |
$852.26
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: Nomi Health Commercial |
$1,817.28
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,903.90
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,523.12
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.76
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$129.78
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
REMOVAL OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 49422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.09 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,459.21
|
| Rate for Payer: BCN Commercial |
$2,459.21
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$9,251.58
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.70
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$216.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
CPT 67005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$444.91 |
| Max. Negotiated Rate |
$7,023.35 |
| Rate for Payer: Aetna Medicare |
$2,323.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,793.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,793.26
|
| Rate for Payer: BCBS Complete |
$1,257.64
|
| Rate for Payer: BCBS MAPPO |
$2,234.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,776.49
|
| Rate for Payer: BCN Commercial |
$1,776.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,234.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,234.61
|
| Rate for Payer: Mclaren Medicaid |
$1,197.75
|
| Rate for Payer: Mclaren Medicare |
$2,234.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,346.34
|
| Rate for Payer: Meridian Medicaid |
$1,257.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,569.80
|
| Rate for Payer: Nomi Health Commercial |
$4,692.68
|
| Rate for Payer: PACE Medicare |
$2,122.88
|
| Rate for Payer: PACE SWMI |
$2,234.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,197.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,023.35
|
| Rate for Payer: Priority Health Medicare |
$2,234.61
|
| Rate for Payer: Priority Health Narrow Network |
$5,618.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,234.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.40
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,234.61
|
| Rate for Payer: UHC Exchange |
$444.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,234.61
|
| Rate for Payer: UHCCP Medicaid |
$1,197.75
|
| Rate for Payer: VA VA |
$2,234.61
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH MECHANICAL VITRECTOMY
|
Facility
|
OP
|
$7,023.35
|
|
|
Service Code
|
CPT 67010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$509.73 |
| Max. Negotiated Rate |
$7,023.35 |
| Rate for Payer: Aetna Medicare |
$2,323.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,793.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,793.26
|
| Rate for Payer: BCBS Complete |
$1,257.64
|
| Rate for Payer: BCBS MAPPO |
$2,234.61
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.29
|
| Rate for Payer: BCN Commercial |
$2,030.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,234.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,234.61
|
| Rate for Payer: Mclaren Medicaid |
$1,197.75
|
| Rate for Payer: Mclaren Medicare |
$2,234.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,346.34
|
| Rate for Payer: Meridian Medicaid |
$1,257.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,569.80
|
| Rate for Payer: Nomi Health Commercial |
$4,692.68
|
| Rate for Payer: PACE Medicare |
$2,122.88
|
| Rate for Payer: PACE SWMI |
$2,234.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,197.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,023.35
|
| Rate for Payer: Priority Health Medicare |
$2,234.61
|
| Rate for Payer: Priority Health Narrow Network |
$5,618.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,234.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$560.70
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,234.61
|
| Rate for Payer: UHC Exchange |
$509.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,234.61
|
| Rate for Payer: UHCCP Medicaid |
$1,197.75
|
| Rate for Payer: VA VA |
$2,234.61
|
|
|
REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARING DEVICE IN TEMPORAL BONE
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 69711
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$799.24 |
| Max. Negotiated Rate |
$9,986.81 |
| Rate for Payer: Aetna Medicare |
$3,304.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,971.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,971.88
|
| Rate for Payer: BCBS Complete |
$1,788.30
|
| Rate for Payer: BCBS MAPPO |
$3,177.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,793.85
|
| Rate for Payer: BCN Commercial |
$2,793.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,177.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,177.50
|
| Rate for Payer: Mclaren Medicaid |
$1,703.14
|
| Rate for Payer: Mclaren Medicare |
$3,177.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,336.38
|
| Rate for Payer: Meridian Medicaid |
$1,788.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,654.12
|
| Rate for Payer: Nomi Health Commercial |
$6,672.75
|
| Rate for Payer: PACE Medicare |
$3,018.62
|
| Rate for Payer: PACE SWMI |
$3,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,177.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,986.81
|
| Rate for Payer: Priority Health Medicare |
$3,177.50
|
| Rate for Payer: Priority Health Narrow Network |
$7,989.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,177.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.16
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$799.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,177.50
|
| Rate for Payer: UHCCP Medicaid |
$1,703.14
|
| Rate for Payer: VA VA |
$3,177.50
|
|
|
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC)
|
Facility
|
OP
|
$9,791.14
|
|
|
Service Code
|
CPT 57287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$3,942.94
|
| Rate for Payer: BCN Commercial |
$3,942.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,115.24
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Nomi Health Commercial |
$9,345.72
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.94
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Exchange |
$715.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,669.77
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 20694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$329.99 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,863.98
|
| Rate for Payer: BCN Commercial |
$3,863.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Nomi Health Commercial |
$4,704.15
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$362.99
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$329.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Facility
|
OP
|
$1,228.82
|
|
|
Service Code
|
CPT 11983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$100.36 |
| Max. Negotiated Rate |
$1,228.82 |
| Rate for Payer: Aetna Medicare |
$406.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$423.48
|
| Rate for Payer: BCN Commercial |
$423.48
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Nomi Health Commercial |
$1,172.91
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,228.82
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$983.06
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.40
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$100.36
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
REPAGLINIDE 1 MG TABLET
|
Facility
|
OP
|
$213.85
|
|
|
Service Code
|
NDC 57237015801
|
| Hospital Charge Code |
22586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.12 |
| Max. Negotiated Rate |
$192.46 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna Medicare |
$106.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: BCBS Complete |
$85.54
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$149.70
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.00
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UMR Bronson Commercial |
$79.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
REPAGLINIDE 1 MG TABLET
|
Facility
|
IP
|
$213.85
|
|
|
Service Code
|
NDC 57237015801
|
| Hospital Charge Code |
22586
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$192.46 |
| Rate for Payer: Aetna American Axle |
$139.00
|
| Rate for Payer: Aetna Commercial |
$181.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.00
|
| Rate for Payer: Cash Price |
$171.08
|
| Rate for Payer: Cofinity Commercial |
$149.70
|
| Rate for Payer: Cofinity Commercial |
$183.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$149.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.08
|
| Rate for Payer: Healthscope Commercial |
$192.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$160.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.77
|
| Rate for Payer: PHP Commercial |
$181.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.00
|
| Rate for Payer: Priority Health SBD |
$134.73
|
| Rate for Payer: UMR Bronson Commercial |
$94.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$160.39
|
|
|
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA; EXTREMITIES
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 35190
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$732.59 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,665.22
|
| Rate for Payer: BCN Commercial |
$3,665.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$805.85
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$732.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
|
REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE, INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26548
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$762.50 |
| 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) |
$838.75
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$762.50
|
| 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
|
|
|
REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 35207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.36 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,787.58
|
| Rate for Payer: BCN Commercial |
$2,787.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.20
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$728.36
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
|
Facility
|
OP
|
$2,166.65
|
|
|
Service Code
|
CPT 35226
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$369.50 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$503.53
|
| Rate for Payer: BCN Commercial |
$503.53
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$883.15
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$802.86
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
|
Facility
|
OP
|
$9,692.51
|
|
|
Service Code
|
CPT 35206
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$765.38 |
| Max. Negotiated Rate |
$9,692.51 |
| Rate for Payer: Aetna Medicare |
$3,207.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,854.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,854.82
|
| Rate for Payer: BCBS Complete |
$1,735.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,204.75
|
| Rate for Payer: BCN Commercial |
$2,204.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.86
|
| Rate for Payer: Mclaren Medicaid |
$1,652.95
|
| Rate for Payer: Mclaren Medicare |
$3,083.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,238.05
|
| Rate for Payer: Meridian Medicaid |
$1,735.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,546.44
|
| Rate for Payer: Nomi Health Commercial |
$6,476.11
|
| Rate for Payer: PACE Medicare |
$2,929.67
|
| Rate for Payer: PACE SWMI |
$3,083.86
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,652.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,692.51
|
| Rate for Payer: Priority Health Medicare |
$3,083.86
|
| Rate for Payer: Priority Health Narrow Network |
$7,754.01
|
| Rate for Payer: Railroad Medicare Medicare |
$3,083.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.92
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.86
|
| Rate for Payer: UHC Exchange |
$765.38
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.86
|
| Rate for Payer: UHCCP Medicaid |
$1,652.95
|
| Rate for Payer: VA VA |
$3,083.86
|
|
|
REPAIR BLOOD VESSEL WITH VEIN GRAFT; UPPER EXTREMITY
|
Facility
|
OP
|
$16,646.50
|
|
|
Service Code
|
CPT 35236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$967.17 |
| Max. Negotiated Rate |
$16,646.50 |
| Rate for Payer: Aetna Medicare |
$5,508.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,620.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,620.50
|
| Rate for Payer: BCBS Complete |
$2,980.81
|
| Rate for Payer: BCBS MAPPO |
$5,296.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,665.22
|
| Rate for Payer: BCN Commercial |
$3,665.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,296.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,296.40
|
| Rate for Payer: Mclaren Medicaid |
$2,838.87
|
| Rate for Payer: Mclaren Medicare |
$5,296.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,561.22
|
| Rate for Payer: Meridian Medicaid |
$2,980.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,090.86
|
| Rate for Payer: Nomi Health Commercial |
$11,122.44
|
| Rate for Payer: PACE Medicare |
$5,031.58
|
| Rate for Payer: PACE SWMI |
$5,296.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,296.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,838.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,646.50
|
| Rate for Payer: Priority Health Medicare |
$5,296.40
|
| Rate for Payer: Priority Health Narrow Network |
$13,317.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,296.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.89
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,296.40
|
| Rate for Payer: UHC Exchange |
$967.17
|
| Rate for Payer: UHC Medicare Advantage |
$5,296.40
|
| Rate for Payer: UHCCP Medicaid |
$2,838.87
|
| Rate for Payer: VA VA |
$5,296.40
|
|
