|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$15,652.48
|
|
|
Service Code
|
CPT 37220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,980.47 |
| Max. Negotiated Rate |
$15,652.48 |
| Rate for Payer: Aetna Medicare |
$5,783.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,950.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,950.73
|
| Rate for Payer: BCBS Complete |
$3,129.49
|
| Rate for Payer: BCBS MAPPO |
$5,560.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,560.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,560.58
|
| Rate for Payer: Mclaren Medicaid |
$2,980.47
|
| Rate for Payer: Mclaren Medicare |
$5,560.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,838.61
|
| Rate for Payer: Meridian Medicaid |
$3,129.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,394.67
|
| Rate for Payer: PACE Medicare |
$5,282.55
|
| Rate for Payer: PACE SWMI |
$5,560.58
|
| Rate for Payer: PHP Medicare Advantage |
$5,560.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,980.47
|
| Rate for Payer: Priority Health Medicare |
$5,560.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,560.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15,652.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,560.58
|
| Rate for Payer: UHC Exchange |
$10,626.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,560.58
|
| Rate for Payer: UHCCP Medicaid |
$2,980.47
|
| Rate for Payer: VA VA |
$5,560.58
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$31,133.44
|
|
|
Service Code
|
CPT 37221
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$21,137.21
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED
|
Facility
|
OP
|
$49,296.87
|
|
|
Service Code
|
CPT 37229
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,386.88 |
| Max. Negotiated Rate |
$49,296.87 |
| Rate for Payer: Aetna Medicare |
$18,213.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,891.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,891.04
|
| Rate for Payer: BCBS Complete |
$9,856.22
|
| Rate for Payer: BCBS MAPPO |
$17,512.83
|
| Rate for Payer: BCN Medicare Advantage |
$17,512.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,512.83
|
| Rate for Payer: Mclaren Medicaid |
$9,386.88
|
| Rate for Payer: Mclaren Medicare |
$17,512.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,388.47
|
| Rate for Payer: Meridian Medicaid |
$9,856.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,139.75
|
| Rate for Payer: PACE Medicare |
$16,637.19
|
| Rate for Payer: PACE SWMI |
$17,512.83
|
| Rate for Payer: PHP Medicare Advantage |
$17,512.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,386.88
|
| Rate for Payer: Priority Health Medicare |
$17,512.83
|
| Rate for Payer: Railroad Medicare Medicare |
$17,512.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,296.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,512.83
|
| Rate for Payer: UHC Exchange |
$33,468.77
|
| Rate for Payer: UHC Medicare Advantage |
$17,512.83
|
| Rate for Payer: UHCCP Medicaid |
$9,386.88
|
| Rate for Payer: VA VA |
$17,512.83
|
|
|
REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY
|
Facility
|
OP
|
$31,133.44
|
|
|
Service Code
|
CPT 37228
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,928.28 |
| Max. Negotiated Rate |
$31,133.44 |
| Rate for Payer: Aetna Medicare |
$11,502.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,825.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,825.29
|
| Rate for Payer: BCBS Complete |
$6,224.70
|
| Rate for Payer: BCBS MAPPO |
$11,060.23
|
| Rate for Payer: BCN Medicare Advantage |
$11,060.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,060.23
|
| Rate for Payer: Mclaren Medicaid |
$5,928.28
|
| Rate for Payer: Mclaren Medicare |
$11,060.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,613.24
|
| Rate for Payer: Meridian Medicaid |
$6,224.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,719.26
|
| Rate for Payer: PACE Medicare |
$10,507.22
|
| Rate for Payer: PACE SWMI |
$11,060.23
|
| Rate for Payer: PHP Medicare Advantage |
$11,060.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,928.28
|
| Rate for Payer: Priority Health Medicare |
$11,060.23
|
| Rate for Payer: Railroad Medicare Medicare |
$11,060.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31,133.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,060.23
|
| Rate for Payer: UHC Exchange |
$21,137.21
|
| Rate for Payer: UHC Medicare Advantage |
$11,060.23
|
| Rate for Payer: UHCCP Medicaid |
$5,928.28
|
| Rate for Payer: VA VA |
$11,060.23
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, LAPAROSCOPIC APPROACH
|
Facility
|
OP
|
$20,301.09
|
|
|
Service Code
|
CPT 57426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,865.64 |
| Max. Negotiated Rate |
$20,301.09 |
| Rate for Payer: Aetna Medicare |
$7,500.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,015.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,015.01
|
| Rate for Payer: BCBS Complete |
$4,058.92
|
| Rate for Payer: BCBS MAPPO |
$7,212.01
|
| Rate for Payer: BCN Medicare Advantage |
$7,212.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,212.01
|
| Rate for Payer: Mclaren Medicaid |
$3,865.64
|
| Rate for Payer: Mclaren Medicare |
$7,212.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,572.61
|
| Rate for Payer: Meridian Medicaid |
$4,058.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,293.81
|
| Rate for Payer: PACE Medicare |
$6,851.41
|
| Rate for Payer: PACE SWMI |
$7,212.01
|
| Rate for Payer: PHP Medicare Advantage |
$7,212.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,865.64
|
| Rate for Payer: Priority Health Medicare |
$7,212.01
|
| Rate for Payer: Railroad Medicare Medicare |
$7,212.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,301.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,212.01
|
| Rate for Payer: UHC Exchange |
$13,782.87
|
| Rate for Payer: UHC Medicare Advantage |
$7,212.01
|
| Rate for Payer: UHCCP Medicaid |
$3,865.64
|
| Rate for Payer: VA VA |
$7,212.01
|
|
|
REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT; VAGINAL APPROACH
|
Facility
|
OP
|
$8,728.81
|
|
|
Service Code
|
CPT 57295
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,662.10 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$34,234.93
|
|
|
Service Code
|
CPT 63664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,518.85 |
| Max. Negotiated Rate |
$34,234.93 |
| Rate for Payer: Aetna Medicare |
$12,648.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,202.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,202.55
|
| Rate for Payer: BCBS Complete |
$6,844.80
|
| Rate for Payer: BCBS MAPPO |
$12,162.04
|
| Rate for Payer: BCN Medicare Advantage |
$12,162.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,162.04
|
| Rate for Payer: Mclaren Medicaid |
$6,518.85
|
| Rate for Payer: Mclaren Medicare |
$12,162.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,770.14
|
| Rate for Payer: Meridian Medicaid |
$6,844.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,986.35
|
| Rate for Payer: PACE Medicare |
$11,553.94
|
| Rate for Payer: PACE SWMI |
$12,162.04
|
| Rate for Payer: PHP Medicare Advantage |
$12,162.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,518.85
|
| Rate for Payer: Priority Health Medicare |
$12,162.04
|
| Rate for Payer: Railroad Medicare Medicare |
$12,162.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,234.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,162.04
|
| Rate for Payer: UHC Exchange |
$23,242.87
|
| Rate for Payer: UHC Medicare Advantage |
$12,162.04
|
| Rate for Payer: UHCCP Medicaid |
$6,518.85
|
| Rate for Payer: VA VA |
$12,162.04
|
|
|
REVISION, LOWER EXTREMITY ARTERIAL BYPASS, WITHOUT THROMBECTOMY, OPEN; WITH SEGMENTAL VEIN INTERPOSITION
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 35881
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITH GRAFT
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITHOUT GRAFT
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 66184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
|
REVISION OF COLOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 44340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 44312
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
REVISION OF PERI-IMPLANT CAPSULE, BREAST, INCLUDING CAPSULOTOMY, CAPSULORRHAPHY, AND/OR PARTIAL CAPSULECTOMY
|
Facility
|
OP
|
$10,512.58
|
|
|
Service Code
|
CPT 19370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,001.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
REVISION OF RECONSTRUCTED BREAST (EG, SIGNIFICANT REMOVAL OF TISSUE, RE-ADVANCEMENT AND/OR RE-INSET OF FLAPS IN AUTOLOGOUS RECONSTRUCTION OR SIGNIFICANT CAPSULAR REVISION COMBINED WITH SOFT TISSUE EXCISION IN IMPLANT-BASED RECONSTRUCTION)
|
Facility
|
OP
|
$17,903.47
|
|
|
Service Code
|
CPT 19380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,409.09 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$12,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: VA VA |
$6,360.25
|
|
|
REVISION OF STAPEDECTOMY OR STAPEDOTOMY
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 69662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
REVISION OF TOTAL ELBOW ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND ULNAR COMPONENT
|
Facility
|
OP
|
$50,486.50
|
|
|
Service Code
|
CPT 24371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,613.40 |
| Max. Negotiated Rate |
$50,486.50 |
| Rate for Payer: Aetna Medicare |
$18,652.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,419.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,419.31
|
| Rate for Payer: BCBS Complete |
$10,094.07
|
| Rate for Payer: BCBS MAPPO |
$17,935.45
|
| Rate for Payer: BCN Medicare Advantage |
$17,935.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,935.45
|
| Rate for Payer: Mclaren Medicaid |
$9,613.40
|
| Rate for Payer: Mclaren Medicare |
$17,935.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,832.22
|
| Rate for Payer: Meridian Medicaid |
$10,094.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,625.77
|
| Rate for Payer: PACE Medicare |
$17,038.68
|
| Rate for Payer: PACE SWMI |
$17,935.45
|
| Rate for Payer: PHP Medicare Advantage |
$17,935.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,613.40
|
| Rate for Payer: Priority Health Medicare |
$17,935.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17,935.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,486.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,935.45
|
| Rate for Payer: UHC Exchange |
$34,276.44
|
| Rate for Payer: UHC Medicare Advantage |
$17,935.45
|
| Rate for Payer: UHCCP Medicaid |
$9,613.40
|
| Rate for Payer: VA VA |
$17,935.45
|
|
|
REVISION OF TOTAL ELBOW ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR ULNAR COMPONENT
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 24370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID COMPONENT
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 23473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
REVISION OF TRACHEOSTOMY SCAR
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 31830
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36832
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
REVISION, OPEN, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY, AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$14,840.35
|
|
|
Service Code
|
CPT 36833
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,825.83 |
| Max. Negotiated Rate |
$14,840.35 |
| Rate for Payer: Aetna Medicare |
$5,482.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,590.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,590.09
|
| Rate for Payer: BCBS Complete |
$2,967.12
|
| Rate for Payer: BCBS MAPPO |
$5,272.07
|
| Rate for Payer: BCN Medicare Advantage |
$5,272.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,272.07
|
| Rate for Payer: Mclaren Medicaid |
$2,825.83
|
| Rate for Payer: Mclaren Medicare |
$5,272.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,535.67
|
| Rate for Payer: Meridian Medicaid |
$2,967.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,062.88
|
| Rate for Payer: PACE Medicare |
$5,008.47
|
| Rate for Payer: PACE SWMI |
$5,272.07
|
| Rate for Payer: PHP Medicare Advantage |
$5,272.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,825.83
|
| Rate for Payer: Priority Health Medicare |
$5,272.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,272.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,840.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,272.07
|
| Rate for Payer: UHC Exchange |
$10,075.45
|
| Rate for Payer: UHC Medicare Advantage |
$5,272.07
|
| Rate for Payer: UHCCP Medicaid |
$2,825.83
|
| Rate for Payer: VA VA |
$5,272.07
|
|
|
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER
|
Facility
|
OP
|
$34,234.93
|
|
|
Service Code
|
CPT 61888
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,518.85 |
| Max. Negotiated Rate |
$34,234.93 |
| Rate for Payer: Aetna Medicare |
$12,648.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,202.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,202.55
|
| Rate for Payer: BCBS Complete |
$6,844.80
|
| Rate for Payer: BCBS MAPPO |
$12,162.04
|
| Rate for Payer: BCN Medicare Advantage |
$12,162.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,162.04
|
| Rate for Payer: Mclaren Medicaid |
$6,518.85
|
| Rate for Payer: Mclaren Medicare |
$12,162.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,770.14
|
| Rate for Payer: Meridian Medicaid |
$6,844.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,986.35
|
| Rate for Payer: PACE Medicare |
$11,553.94
|
| Rate for Payer: PACE SWMI |
$12,162.04
|
| Rate for Payer: PHP Medicare Advantage |
$12,162.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,518.85
|
| Rate for Payer: Priority Health Medicare |
$12,162.04
|
| Rate for Payer: Railroad Medicare Medicare |
$12,162.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34,234.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,162.04
|
| Rate for Payer: UHC Exchange |
$23,242.87
|
| Rate for Payer: UHC Medicare Advantage |
$12,162.04
|
| Rate for Payer: UHCCP Medicaid |
$6,518.85
|
| Rate for Payer: VA VA |
$12,162.04
|
|
|
REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$9,441.17
|
|
|
Service Code
|
CPT 63688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,797.74 |
| Max. Negotiated Rate |
$9,441.17 |
| Rate for Payer: Aetna Medicare |
$3,488.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,192.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,192.50
|
| Rate for Payer: BCBS Complete |
$1,887.63
|
| Rate for Payer: BCBS MAPPO |
$3,354.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,354.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,354.00
|
| Rate for Payer: Mclaren Medicaid |
$1,797.74
|
| Rate for Payer: Mclaren Medicare |
$3,354.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,521.70
|
| Rate for Payer: Meridian Medicaid |
$1,887.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,857.10
|
| Rate for Payer: PACE Medicare |
$3,186.30
|
| Rate for Payer: PACE SWMI |
$3,354.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,354.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,797.74
|
| Rate for Payer: Priority Health Medicare |
$3,354.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,354.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,441.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,354.00
|
| Rate for Payer: UHC Exchange |
$6,409.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,354.00
|
| Rate for Payer: UHCCP Medicaid |
$1,797.74
|
| Rate for Payer: VA VA |
$3,354.00
|
|
|
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY
|
Facility
|
OP
|
$9,441.17
|
|
|
Service Code
|
CPT 64585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,797.74 |
| Max. Negotiated Rate |
$9,441.17 |
| Rate for Payer: Aetna Medicare |
$3,488.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,192.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,192.50
|
| Rate for Payer: BCBS Complete |
$1,887.63
|
| Rate for Payer: BCBS MAPPO |
$3,354.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,354.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,354.00
|
| Rate for Payer: Mclaren Medicaid |
$1,797.74
|
| Rate for Payer: Mclaren Medicare |
$3,354.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,521.70
|
| Rate for Payer: Meridian Medicaid |
$1,887.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,857.10
|
| Rate for Payer: PACE Medicare |
$3,186.30
|
| Rate for Payer: PACE SWMI |
$3,354.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,354.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,797.74
|
| Rate for Payer: Priority Health Medicare |
$3,354.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,354.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,441.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,354.00
|
| Rate for Payer: UHC Exchange |
$6,409.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,354.00
|
| Rate for Payer: UHCCP Medicaid |
$1,797.74
|
| Rate for Payer: VA VA |
$3,354.00
|
|
|
REVISION OR REMOVAL OF PERIPHERAL, SACRAL, OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, WITH DETACHABLE CONNECTION TO ELECTRODE ARRAY
|
Facility
|
OP
|
$9,441.17
|
|
|
Service Code
|
CPT 64595
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,797.74 |
| Max. Negotiated Rate |
$9,441.17 |
| Rate for Payer: Aetna Medicare |
$3,488.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,192.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,192.50
|
| Rate for Payer: BCBS Complete |
$1,887.63
|
| Rate for Payer: BCBS MAPPO |
$3,354.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,354.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,354.00
|
| Rate for Payer: Mclaren Medicaid |
$1,797.74
|
| Rate for Payer: Mclaren Medicare |
$3,354.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,521.70
|
| Rate for Payer: Meridian Medicaid |
$1,887.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,857.10
|
| Rate for Payer: PACE Medicare |
$3,186.30
|
| Rate for Payer: PACE SWMI |
$3,354.00
|
| Rate for Payer: PHP Medicare Advantage |
$3,354.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,797.74
|
| Rate for Payer: Priority Health Medicare |
$3,354.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,354.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,441.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,354.00
|
| Rate for Payer: UHC Exchange |
$6,409.83
|
| Rate for Payer: UHC Medicare Advantage |
$3,354.00
|
| Rate for Payer: UHCCP Medicaid |
$1,797.74
|
| Rate for Payer: VA VA |
$3,354.00
|
|
