|
REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, REDUCIBLE
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 49613
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$413.99 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,616.01
|
| Rate for Payer: BCN Commercial |
$2,616.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.39
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$413.99
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
REPAIR OF BLEPHAROPTOSIS; (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$556.75 |
| 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 |
$1,593.11
|
| Rate for Payer: BCN Commercial |
$1,593.11
|
| 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) |
$612.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$556.75
|
| 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
|
|
|
REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH)
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$473.24 |
| 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 |
$1,738.00
|
| Rate for Payer: BCN Commercial |
$1,738.00
|
| 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) |
$520.56
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$473.24
|
| 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
|
|
|
REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE
|
Facility
|
OP
|
$4,783.71
|
|
|
Service Code
|
CPT 36576
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$175.58 |
| 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 |
$671.78
|
| Rate for Payer: BCN Commercial |
$671.78
|
| 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 |
$3,196.26
|
| 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) |
$193.14
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,522.03
|
| Rate for Payer: UHC Exchange |
$175.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,522.03
|
| Rate for Payer: UHCCP Medicaid |
$815.81
|
| Rate for Payer: VA VA |
$1,522.03
|
|
|
REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26540
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$664.74 |
| 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) |
$731.21
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$664.74
|
| 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 OF ECTROPION; EXTENSIVE (EG, TARSAL STRIP OPERATIONS)
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$425.98 |
| 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 |
$1,593.11
|
| Rate for Payer: BCN Commercial |
$1,593.11
|
| 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) |
$468.58
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$425.98
|
| 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
|
|
|
REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,201.47
|
|
|
Service Code
|
CPT 57268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.73 |
| Max. Negotiated Rate |
$15,201.47 |
| Rate for Payer: Aetna Medicare |
$5,030.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,145.13
|
| Rate for Payer: BCN Commercial |
$2,145.13
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: Nomi Health Commercial |
$10,156.92
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,201.47
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Priority Health Narrow Network |
$12,161.18
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.70
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$489.73
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
REPAIR OF ENTROPION; EXTENSIVE (EG, TARSAL STRIP OR CAPSULOPALPEBRAL FASCIA REPAIRS OPERATION)
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 67924
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$425.89 |
| 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 |
$1,593.11
|
| Rate for Payer: BCN Commercial |
$1,593.11
|
| 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) |
$468.48
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$425.89
|
| 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
|
|
|
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY (EG, BOUTONNIERE DEFORMITY); USING LOCAL TISSUE(S), INCLUDING LATERAL BAND(S), EACH FINGER
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$489.67 |
| 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 |
$2,372.99
|
| Rate for Payer: BCN Commercial |
$2,372.99
|
| 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) |
$538.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$489.67
|
| 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 OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY OR SECONDARY; WITHOUT GRAFT (EG, MALLET FINGER)
|
Facility
|
OP
|
$9,991.56
|
|
|
Service Code
|
CPT 26433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.67 |
| 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) |
$594.74
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$540.67
|
| 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 OF FIBULA NONUNION AND/OR MALUNION WITH INTERNAL FIXATION
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 27726
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$925.89 |
| 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) |
$1,018.48
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$925.89
|
| 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
|
|
|
REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT HOSPITALIZATION
|
Facility
|
OP
|
$7,184.18
|
|
|
Service Code
|
CPT 65272
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$329.47 |
| 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 |
$1,438.92
|
| Rate for Payer: BCN Commercial |
$1,438.92
|
| 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) |
$362.42
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,285.79
|
| Rate for Payer: UHC Exchange |
$329.47
|
| 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
|
|
|
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE
|
Facility
|
OP
|
$15,888.99
|
|
|
Service Code
|
CPT 65280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$626.31 |
| Max. Negotiated Rate |
$15,888.99 |
| Rate for Payer: Aetna Medicare |
$5,257.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,319.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,319.22
|
| Rate for Payer: BCBS Complete |
$2,845.17
|
| Rate for Payer: BCBS MAPPO |
$5,055.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,327.05
|
| Rate for Payer: BCN Commercial |
$2,327.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,055.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,055.38
|
| Rate for Payer: Mclaren Medicaid |
$2,709.68
|
| Rate for Payer: Mclaren Medicare |
$5,055.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,308.15
|
| Rate for Payer: Meridian Medicaid |
$2,845.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,813.69
|
| Rate for Payer: Nomi Health Commercial |
$10,616.30
|
| Rate for Payer: PACE Medicare |
$4,802.61
|
| Rate for Payer: PACE SWMI |
$5,055.38
|
| Rate for Payer: PHP Medicare Advantage |
$5,055.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,709.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,888.99
|
| Rate for Payer: Priority Health Medicare |
$5,055.38
|
| Rate for Payer: Priority Health Narrow Network |
$12,711.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,055.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$688.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,055.38
|
| Rate for Payer: UHC Exchange |
$626.31
|
| Rate for Payer: UHC Medicare Advantage |
$5,055.38
|
| Rate for Payer: UHCCP Medicaid |
$2,709.68
|
| Rate for Payer: VA VA |
$5,055.38
|
|
|
REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL TISSUE
|
Facility
|
OP
|
$15,888.99
|
|
|
Service Code
|
CPT 65285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,033.06 |
| Max. Negotiated Rate |
$15,888.99 |
| Rate for Payer: Aetna Medicare |
$5,257.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,319.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,319.22
|
| Rate for Payer: BCBS Complete |
$2,845.17
|
| Rate for Payer: BCBS MAPPO |
$5,055.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,724.13
|
| Rate for Payer: BCN Commercial |
$2,724.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,055.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,055.38
|
| Rate for Payer: Mclaren Medicaid |
$2,709.68
|
| Rate for Payer: Mclaren Medicare |
$5,055.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,308.15
|
| Rate for Payer: Meridian Medicaid |
$2,845.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,813.69
|
| Rate for Payer: Nomi Health Commercial |
$10,616.30
|
| Rate for Payer: PACE Medicare |
$4,802.61
|
| Rate for Payer: PACE SWMI |
$5,055.38
|
| Rate for Payer: PHP Medicare Advantage |
$5,055.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,709.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,888.99
|
| Rate for Payer: Priority Health Medicare |
$5,055.38
|
| Rate for Payer: Priority Health Narrow Network |
$12,711.19
|
| Rate for Payer: Railroad Medicare Medicare |
$5,055.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.37
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,055.38
|
| Rate for Payer: UHC Exchange |
$1,033.06
|
| Rate for Payer: UHC Medicare Advantage |
$5,055.38
|
| Rate for Payer: UHCCP Medicaid |
$2,709.68
|
| Rate for Payer: VA VA |
$5,055.38
|
|
|
REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$11,612.55
|
|
|
Service Code
|
CPT 65275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$430.31 |
| Max. Negotiated Rate |
$11,612.55 |
| Rate for Payer: Aetna Medicare |
$3,842.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,618.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,618.44
|
| Rate for Payer: BCBS Complete |
$2,079.41
|
| Rate for Payer: BCBS MAPPO |
$3,694.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,031.85
|
| Rate for Payer: BCN Commercial |
$2,031.85
|
| Rate for Payer: BCN Medicare Advantage |
$3,694.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,694.75
|
| Rate for Payer: Mclaren Medicaid |
$1,980.39
|
| Rate for Payer: Mclaren Medicare |
$3,694.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,879.49
|
| Rate for Payer: Meridian Medicaid |
$2,079.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,248.96
|
| Rate for Payer: Nomi Health Commercial |
$7,758.98
|
| Rate for Payer: PACE Medicare |
$3,510.01
|
| Rate for Payer: PACE SWMI |
$3,694.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,694.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,980.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,612.55
|
| Rate for Payer: Priority Health Medicare |
$3,694.75
|
| Rate for Payer: Priority Health Narrow Network |
$9,290.04
|
| Rate for Payer: Railroad Medicare Medicare |
$3,694.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.34
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,694.75
|
| Rate for Payer: UHC Exchange |
$430.31
|
| Rate for Payer: UHC Medicare Advantage |
$3,694.75
|
| Rate for Payer: UHCCP Medicaid |
$1,980.39
|
| Rate for Payer: VA VA |
$3,694.75
|
|
|
REPAIR OF LOW IMPERFORATE ANUS; WITH TRANSPOSITION OF ANOPERINEAL OR ANOVESTIBULAR FISTULA
|
Facility
|
OP
|
$4,040.60
|
|
|
Service Code
|
CPT 46716
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,201.19 |
| Max. Negotiated Rate |
$4,040.60 |
| Rate for Payer: BCBS Trust/PPO |
$4,040.60
|
| Rate for Payer: BCN Commercial |
$4,040.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.31
|
| Rate for Payer: UHC Core |
$1,879.00
|
| Rate for Payer: UHC Exchange |
$1,201.19
|
|
|
REPAIR OF NAIL BED
|
Facility
|
OP
|
$1,885.01
|
|
|
Service Code
|
CPT 11760
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$104.52 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$393.31
|
| Rate for Payer: BCN Commercial |
$393.31
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.97
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$104.52
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: VA VA |
$599.75
|
|
|
REPAIR OF NASAL VALVE COLLAPSE WITH LOW ENERGY, TEMPERATURE-CONTROLLED (IE, RADIOFREQUENCY) SUBCUTANEOUS/SUBMUCOSAL REMODELING
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$144.73 |
| 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) |
$159.20
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$144.73
|
| 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
|
|
|
REPAIR OF NASAL VALVE COLLAPSE WITH SUBCUTANEOUS/SUBMUCOSAL LATERAL WALL IMPLANT(S)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30468
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$162.53 |
| 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) |
$178.78
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$162.53
|
| 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
|
|
|
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 30465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$976.36 |
| 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 |
$4,206.04
|
| Rate for Payer: BCN Commercial |
$4,206.04
|
| 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) |
$1,074.00
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$976.36
|
| 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
|
|
|
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 24435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,046.40 |
| 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 |
$11,253.64
|
| Rate for Payer: BCN Commercial |
$11,253.64
|
| 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) |
$1,151.04
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$1,046.40
|
| 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
|
|
|
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$39,622.51
|
|
|
Service Code
|
CPT 24430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,022.57 |
| 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 |
$5,957.40
|
| Rate for Payer: BCN Commercial |
$5,957.40
|
| 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) |
$1,124.83
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,606.65
|
| Rate for Payer: UHC Exchange |
$1,022.57
|
| 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
|
|
|
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$938.81 |
| 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 |
$5,514.99
|
| Rate for Payer: BCN Commercial |
$5,514.99
|
| 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) |
$1,032.69
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$938.81
|
| 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
|
|
|
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,003.41 |
| 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 |
$5,330.44
|
| Rate for Payer: BCN Commercial |
$5,330.44
|
| 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) |
$1,103.75
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$1,003.41
|
| 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
|
|
|
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$21,998.64
|
|
|
Service Code
|
CPT 25400
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.93 |
| 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 |
$5,514.99
|
| Rate for Payer: BCN Commercial |
$5,514.99
|
| 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) |
$855.72
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$777.93
|
| 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
|
|
