|
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL SCAPHOID [NAVICULAR]); WITHOUT MANIPULATION, EACH BONE
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 25630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$202.89
|
| Rate for Payer: BCN Commercial |
$202.89
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.55
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$279.59
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.11 |
| 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 |
$795.35
|
| Rate for Payer: BCN Commercial |
$795.35
|
| 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 |
$3,292.90
|
| 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) |
$426.92
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$388.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITH OR WITHOUT PERCUTANEOUS PINNING (EG, MALLET FINGER)
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 26432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$840.47 |
| 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 |
$1,444.32
|
| Rate for Payer: BCN Commercial |
$1,444.32
|
| 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 |
$3,292.90
|
| 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) |
$4,413.90
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$2,996.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 27788
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$462.96
|
| Rate for Payer: BCN Commercial |
$462.96
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.58
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$377.80
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 27786
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$261.20
|
| Rate for Payer: BCN Commercial |
$261.20
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.11
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$281.01
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPULATION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26750
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$197.17
|
| Rate for Payer: BCN Commercial |
$197.17
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.95
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$187.23
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB; WITHOUT MANIPULATION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$197.17
|
| Rate for Payer: BCN Commercial |
$197.17
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.95
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$187.23
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$501.11 |
| 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 |
$720.08
|
| Rate for Payer: BCN Commercial |
$720.08
|
| 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 |
$3,292.90
|
| 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) |
$551.22
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$501.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITH MANIPULATION
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 25605
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$501.11 |
| 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 |
$720.08
|
| Rate for Payer: BCN Commercial |
$720.08
|
| 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 |
$3,292.90
|
| 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) |
$551.22
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$501.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES OR SMITH TYPE) OR EPIPHYSEAL SEPARATION, INCLUDES CLOSED TREATMENT OF FRACTURE OF ULNAR STYLOID, WHEN PERFORMED; WITHOUT MANIPULATION
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 25600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$195.83
|
| Rate for Payer: BCN Commercial |
$195.83
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$348.04
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$316.40
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 27508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$196.22
|
| Rate for Payer: BCN Commercial |
$196.22
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$486.09
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 27502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$734.80 |
| 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 |
$1,083.23
|
| Rate for Payer: BCN Commercial |
$1,083.23
|
| 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 |
$3,292.90
|
| 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) |
$808.28
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$734.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG, PILON OR TIBIAL PLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKELETAL TRACTION AND/OR REQUIRING MANIPULATION
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 27825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$482.15 |
| 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 |
$996.29
|
| Rate for Payer: BCN Commercial |
$996.29
|
| 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 |
$3,292.90
|
| 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) |
$530.36
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$482.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER THAN GREAT TOE; WITHOUT MANIPULATION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 28510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.35 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$95.35
|
| Rate for Payer: BCN Commercial |
$95.35
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$116.47
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$4,928.37
|
|
|
Service Code
|
CPT 27252
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.67 |
| 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 |
$1,083.23
|
| Rate for Payer: BCN Commercial |
$1,083.23
|
| 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 |
$3,292.90
|
| 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) |
$801.54
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$728.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA
|
Facility
|
OP
|
$817.84
|
|
|
Service Code
|
CPT 26775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$139.47 |
| Max. Negotiated Rate |
$817.84 |
| Rate for Payer: Aetna Medicare |
$270.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$325.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$325.26
|
| Rate for Payer: BCBS Complete |
$146.45
|
| Rate for Payer: BCBS MAPPO |
$260.21
|
| Rate for Payer: BCBS Trust/PPO |
$157.92
|
| Rate for Payer: BCN Commercial |
$157.92
|
| Rate for Payer: BCN Medicare Advantage |
$260.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.21
|
| Rate for Payer: Mclaren Medicaid |
$139.47
|
| Rate for Payer: Mclaren Medicare |
$260.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.22
|
| Rate for Payer: Meridian Medicaid |
$146.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$299.24
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE Medicare |
$247.20
|
| Rate for Payer: PACE SWMI |
$260.21
|
| Rate for Payer: PHP Medicare Advantage |
$260.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$817.84
|
| Rate for Payer: Priority Health Medicare |
$260.21
|
| Rate for Payer: Priority Health Narrow Network |
$654.27
|
| Rate for Payer: Railroad Medicare Medicare |
$260.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.38
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.21
|
| Rate for Payer: UHC Exchange |
$348.53
|
| Rate for Payer: UHC Medicare Advantage |
$260.21
|
| Rate for Payer: UHCCP Medicaid |
$139.47
|
| Rate for Payer: VA VA |
$260.21
|
|
|
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 21453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.31 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,174.78
|
| Rate for Payer: BCN Commercial |
$3,174.78
|
| 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) |
$946.34
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$860.31
|
| 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
|
|
|
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH MANIPULATION, EACH BONE
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26605
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$353.51
|
| Rate for Payer: BCN Commercial |
$353.51
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.77
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$291.61
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUT MANIPULATION, EACH BONE
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$197.36
|
| Rate for Payer: BCN Commercial |
$197.36
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$309.02
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$280.93
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT MANIPULATION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 28470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$159.51
|
| Rate for Payer: BCN Commercial |
$159.51
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$218.59
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$198.72
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITHOUT STABILIZATION
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 21315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$57.57 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.88
|
| Rate for Payer: BCN Commercial |
$1,172.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.33
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$57.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
CLOSED TREATMENT OF NASAL BONE FRACTURE WITH MANIPULATION; WITH STABILIZATION
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 21320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.71 |
| 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 |
$2,644.84
|
| Rate for Payer: BCN Commercial |
$2,644.84
|
| 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) |
$100.88
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$91.71
|
| 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
|
|
|
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT STABILIZATION
|
Facility
|
OP
|
$9,986.81
|
|
|
Service Code
|
CPT 21337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$286.99 |
| 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 |
$1,464.71
|
| Rate for Payer: BCN Commercial |
$1,464.71
|
| 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) |
$315.69
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,177.50
|
| Rate for Payer: UHC Exchange |
$286.99
|
| 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
|
|
|
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26725
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$381.05
|
| Rate for Payer: BCN Commercial |
$381.05
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.37
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$300.34
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
|
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH
|
Facility
|
OP
|
$738.70
|
|
|
Service Code
|
CPT 26725
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$738.70 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$381.05
|
| Rate for Payer: BCN Commercial |
$381.05
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.37
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$300.34
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$125.98
|
| Rate for Payer: VA VA |
$235.03
|
|
