|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); COMBINED DISTAL FEMUR, PROXIMAL TIBIA AND FIBULA
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,044.01 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$3,044.01
|
| Rate for Payer: BCN Commercial |
$3,044.01
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYSIODESIS); DISTAL FEMUR
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 27475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,939.04 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,939.04
|
| Rate for Payer: BCN Commercial |
$2,939.04
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$147.43
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$132.69 |
| Rate for Payer: Aetna American Axle |
$95.83
|
| Rate for Payer: Aetna American Axle |
$132.13
|
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna Commercial |
$172.79
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna Commercial |
$125.32
|
| Rate for Payer: Aetna Medicare |
$101.64
|
| Rate for Payer: Aetna Medicare |
$73.72
|
| Rate for Payer: Aetna Medicare |
$89.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.83
|
| Rate for Payer: BCBS Complete |
$81.31
|
| Rate for Payer: BCBS Complete |
$71.84
|
| Rate for Payer: BCBS Complete |
$58.97
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$23.93
|
| Rate for Payer: BCN Commercial |
$23.93
|
| Rate for Payer: BCN Commercial |
$23.93
|
| Rate for Payer: BCN Commercial |
$23.93
|
| Rate for Payer: Cash Price |
$162.62
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cash Price |
$162.62
|
| Rate for Payer: Cofinity Advantage |
$103.20
|
| Rate for Payer: Cofinity Advantage |
$142.30
|
| Rate for Payer: Cofinity Advantage |
$125.72
|
| Rate for Payer: Cofinity Commercial |
$126.79
|
| Rate for Payer: Cofinity Commercial |
$174.82
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.62
|
| Rate for Payer: Healthscope Commercial |
$182.95
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Healthscope Commercial |
$132.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.70
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: PHP Commercial |
$172.79
|
| Rate for Payer: PHP Commercial |
$125.32
|
| Rate for Payer: Priority Health SBD |
$92.88
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: Priority Health SBD |
$128.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.19
|
| Rate for Payer: UHC Core |
$12.19
|
| Rate for Payer: UHC Core |
$12.19
|
| Rate for Payer: UHC Core |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.19
|
| Rate for Payer: UHC Exchange |
$12.19
|
| Rate for Payer: UMR Bronson Commercial |
$66.45
|
| Rate for Payer: UMR Bronson Commercial |
$54.55
|
| Rate for Payer: UMR Bronson Commercial |
$75.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
|
|
ARSENIC TRIOXIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$179.60
|
|
|
Service Code
|
HCPCS J9017
|
| Hospital Charge Code |
29071
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$161.64 |
| Rate for Payer: Aetna American Axle |
$116.74
|
| Rate for Payer: Aetna Commercial |
$152.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: Cash Price |
$143.68
|
| Rate for Payer: Cofinity Advantage |
$125.72
|
| Rate for Payer: Cofinity Commercial |
$154.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.68
|
| Rate for Payer: Healthscope Commercial |
$161.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.70
|
| Rate for Payer: PHP Commercial |
$152.66
|
| Rate for Payer: Priority Health SBD |
$113.15
|
| Rate for Payer: UMR Bronson Commercial |
$79.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.70
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET
|
Facility
|
OP
|
$463.81
|
|
|
Service Code
|
NDC 00078056845
|
| Hospital Charge Code |
96948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.61 |
| Max. Negotiated Rate |
$417.43 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna Medicare |
$231.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: BCBS Complete |
$185.52
|
| Rate for Payer: Cash Price |
$371.05
|
| Rate for Payer: Cofinity Advantage |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$417.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$371.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.86
|
| Rate for Payer: PHP Commercial |
$394.24
|
| Rate for Payer: Priority Health SBD |
$292.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.48
|
| Rate for Payer: UHC Core |
$241.65
|
| Rate for Payer: UHC Exchange |
$182.28
|
| Rate for Payer: UMR Bronson Commercial |
$171.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
ARTEMETHER-LUMEFANTRINE 20 MG-120 MG TABLET
|
Facility
|
IP
|
$463.81
|
|
|
Service Code
|
NDC 00078056845
|
| Hospital Charge Code |
96948
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.08 |
| Max. Negotiated Rate |
$417.43 |
| Rate for Payer: Aetna American Axle |
$301.48
|
| Rate for Payer: Aetna Commercial |
$394.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.48
|
| Rate for Payer: Cash Price |
$371.05
|
| Rate for Payer: Cofinity Advantage |
$324.67
|
| Rate for Payer: Cofinity Commercial |
$398.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$371.05
|
| Rate for Payer: Healthscope Commercial |
$417.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.86
|
| Rate for Payer: PHP Commercial |
$394.24
|
| Rate for Payer: Priority Health SBD |
$292.20
|
| Rate for Payer: UMR Bronson Commercial |
$204.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.86
|
|
|
ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING, MONITORING OR TRANSFUSION (SEPARATE PROCEDURE); PERCUTANEOUS
|
Facility
|
OP
|
$653.57
|
|
|
Service Code
|
CPT 36620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$653.57 |
| Max. Negotiated Rate |
$653.57 |
| Rate for Payer: BCBS Trust/PPO |
$653.57
|
| Rate for Payer: BCN Commercial |
$653.57
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM BASILIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 36819
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$6,958.83
|
| Rate for Payer: BCN Commercial |
$6,958.83
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION
|
Facility
|
OP
|
$17,930.33
|
|
|
Service Code
|
CPT 36818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,899.76 |
| Max. Negotiated Rate |
$17,930.33 |
| Rate for Payer: Aetna Medicare |
$5,766.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,930.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,930.60
|
| Rate for Payer: BCBS Complete |
$3,045.03
|
| Rate for Payer: BCBS MAPPO |
$5,544.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,990.20
|
| Rate for Payer: BCN Commercial |
$3,990.20
|
| Rate for Payer: BCN Medicare Advantage |
$5,544.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,544.48
|
| Rate for Payer: Mclaren Medicaid |
$5,544.48
|
| Rate for Payer: Mclaren Medicare |
$5,544.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,821.70
|
| Rate for Payer: Meridian Medicaid |
$5,821.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,376.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,098.93
|
| Rate for Payer: Nomi Health Commercial |
$16,633.44
|
| Rate for Payer: PACE Medicare |
$5,267.26
|
| Rate for Payer: PACE SWMI |
$5,544.48
|
| Rate for Payer: PHP Medicare Advantage |
$5,544.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,899.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17,930.33
|
| Rate for Payer: Priority Health Medicare |
$5,544.48
|
| Rate for Payer: Priority Health Tiered Network |
$14,344.26
|
| Rate for Payer: Railroad Medicare Medicare |
$5,544.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,544.48
|
| Rate for Payer: UHC Medicaid |
$2,899.76
|
| Rate for Payer: UHCCP Medicaid |
$2,899.76
|
| Rate for Payer: VA VA |
$5,544.48
|
|
|
ARTERIOVENOUS ANASTOMOSIS, OPEN; DIRECT, ANY SITE (EG, CIMINO TYPE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,174.29
|
|
|
Service Code
|
CPT 36821
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,645.43 |
| Max. Negotiated Rate |
$10,174.29 |
| Rate for Payer: Aetna Medicare |
$3,271.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,932.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,932.66
|
| Rate for Payer: BCBS Complete |
$1,727.85
|
| Rate for Payer: BCBS MAPPO |
$3,146.13
|
| Rate for Payer: BCBS Trust/PPO |
$5,431.25
|
| Rate for Payer: BCN Commercial |
$5,431.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,146.13
|
| Rate for Payer: Mclaren Medicaid |
$3,146.13
|
| Rate for Payer: Mclaren Medicare |
$3,146.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,303.44
|
| Rate for Payer: Meridian Medicaid |
$3,303.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,618.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,460.74
|
| Rate for Payer: Nomi Health Commercial |
$9,438.39
|
| Rate for Payer: PACE Medicare |
$2,988.82
|
| Rate for Payer: PACE SWMI |
$3,146.13
|
| Rate for Payer: PHP Medicare Advantage |
$3,146.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,174.29
|
| Rate for Payer: Priority Health Medicare |
$3,146.13
|
| Rate for Payer: Priority Health Tiered Network |
$8,139.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3,146.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,146.13
|
| Rate for Payer: UHC Medicaid |
$1,645.43
|
| Rate for Payer: UHCCP Medicaid |
$1,645.43
|
| Rate for Payer: VA VA |
$3,146.13
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20610
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITHOUT ULTRASOUND GUIDANCE
|
Facility
|
OP
|
$989.08
|
|
|
Service Code
|
CPT 20600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$989.08 |
| Rate for Payer: Aetna Medicare |
$318.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$368.41
|
| Rate for Payer: BCN Commercial |
$368.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$321.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Nomi Health Commercial |
$917.55
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$989.08
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Tiered Network |
$791.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
ARTHRODESIS, ANKLE, OPEN
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 27870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$10,388.89
|
| Rate for Payer: BCN Commercial |
$10,388.89
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 22551
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$35,600.94
|
| Rate for Payer: BCN Commercial |
$35,600.94
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$41,481.86
|
|
|
Service Code
|
CPT 22552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$41,481.86 |
| Max. Negotiated Rate |
$41,481.86 |
| Rate for Payer: BCBS Trust/PPO |
$41,481.86
|
| Rate for Payer: BCN Commercial |
$41,481.86
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); CERVICAL BELOW C2
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 22554
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$17,303.32
|
| Rate for Payer: BCN Commercial |
$17,303.32
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$1,573.28
|
|
|
Service Code
|
CPT 22585
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,573.28 |
| Max. Negotiated Rate |
$1,573.28 |
| Rate for Payer: BCBS Trust/PPO |
$1,573.28
|
| Rate for Payer: BCN Commercial |
$1,573.28
|
|
|
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR
|
Facility
|
OP
|
$87,433.44
|
|
|
Service Code
|
CPT 22558
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,140.06 |
| Max. Negotiated Rate |
$87,433.44 |
| Rate for Payer: Aetna Medicare |
$28,117.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,795.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,795.56
|
| Rate for Payer: BCBS Complete |
$14,848.42
|
| Rate for Payer: BCBS MAPPO |
$27,036.45
|
| Rate for Payer: BCBS Trust/PPO |
$30,165.67
|
| Rate for Payer: BCN Commercial |
$30,165.67
|
| Rate for Payer: BCN Medicare Advantage |
$27,036.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,036.45
|
| Rate for Payer: Mclaren Medicaid |
$27,036.45
|
| Rate for Payer: Mclaren Medicare |
$27,036.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,388.27
|
| Rate for Payer: Meridian Medicaid |
$28,388.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,091.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,740.10
|
| Rate for Payer: Nomi Health Commercial |
$81,109.35
|
| Rate for Payer: PACE Medicare |
$25,684.63
|
| Rate for Payer: PACE SWMI |
$27,036.45
|
| Rate for Payer: PHP Medicare Advantage |
$27,036.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,140.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87,433.44
|
| Rate for Payer: Priority Health Medicare |
$27,036.45
|
| Rate for Payer: Priority Health Tiered Network |
$69,946.75
|
| Rate for Payer: Railroad Medicare Medicare |
$27,036.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,036.45
|
| Rate for Payer: UHC Medicaid |
$14,140.06
|
| Rate for Payer: UHCCP Medicaid |
$14,140.06
|
| Rate for Payer: VA VA |
$27,036.45
|
|
|
ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE, LUMBAR;
|
Facility
|
OP
|
$87,433.44
|
|
|
Service Code
|
CPT 22633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,140.06 |
| Max. Negotiated Rate |
$87,433.44 |
| Rate for Payer: Aetna Medicare |
$28,117.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,795.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,795.56
|
| Rate for Payer: BCBS Complete |
$14,848.42
|
| Rate for Payer: BCBS MAPPO |
$27,036.45
|
| Rate for Payer: BCBS Trust/PPO |
$23,533.41
|
| Rate for Payer: BCN Commercial |
$23,533.41
|
| Rate for Payer: BCN Medicare Advantage |
$27,036.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,036.45
|
| Rate for Payer: Mclaren Medicaid |
$27,036.45
|
| Rate for Payer: Mclaren Medicare |
$27,036.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28,388.27
|
| Rate for Payer: Meridian Medicaid |
$28,388.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,091.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$29,740.10
|
| Rate for Payer: Nomi Health Commercial |
$81,109.35
|
| Rate for Payer: PACE Medicare |
$25,684.63
|
| Rate for Payer: PACE SWMI |
$27,036.45
|
| Rate for Payer: PHP Medicare Advantage |
$27,036.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,140.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$87,433.44
|
| Rate for Payer: Priority Health Medicare |
$27,036.45
|
| Rate for Payer: Priority Health Tiered Network |
$69,946.75
|
| Rate for Payer: Railroad Medicare Medicare |
$27,036.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27,036.45
|
| Rate for Payer: UHC Medicaid |
$14,140.06
|
| Rate for Payer: UHCCP Medicaid |
$14,140.06
|
| Rate for Payer: VA VA |
$27,036.45
|
|
|
ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE, LUMBAR; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$2,223.66
|
|
|
Service Code
|
CPT 22634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,223.66 |
| Max. Negotiated Rate |
$2,223.66 |
| Rate for Payer: BCBS Trust/PPO |
$2,223.66
|
| Rate for Payer: BCN Commercial |
$2,223.66
|
|
|
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28755
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$4,985.59
|
| Rate for Payer: BCN Commercial |
$4,985.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$23,381.57
|
|
|
Service Code
|
CPT 28750
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,781.35 |
| Max. Negotiated Rate |
$23,381.57 |
| Rate for Payer: Aetna Medicare |
$7,519.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,037.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,037.65
|
| Rate for Payer: BCBS Complete |
$3,970.78
|
| Rate for Payer: BCBS MAPPO |
$7,230.12
|
| Rate for Payer: BCBS Trust/PPO |
$7,096.04
|
| Rate for Payer: BCN Commercial |
$7,096.04
|
| Rate for Payer: BCN Medicare Advantage |
$7,230.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,230.12
|
| Rate for Payer: Mclaren Medicaid |
$7,230.12
|
| Rate for Payer: Mclaren Medicare |
$7,230.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,591.63
|
| Rate for Payer: Meridian Medicaid |
$7,591.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,314.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,953.13
|
| Rate for Payer: Nomi Health Commercial |
$21,690.36
|
| Rate for Payer: PACE Medicare |
$6,868.61
|
| Rate for Payer: PACE SWMI |
$7,230.12
|
| Rate for Payer: PHP Medicare Advantage |
$7,230.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,781.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23,381.57
|
| Rate for Payer: Priority Health Medicare |
$7,230.12
|
| Rate for Payer: Priority Health Tiered Network |
$18,705.26
|
| Rate for Payer: Railroad Medicare Medicare |
$7,230.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,230.12
|
| Rate for Payer: UHC Medicaid |
$3,781.35
|
| Rate for Payer: UHCCP Medicaid |
$3,781.35
|
| Rate for Payer: VA VA |
$7,230.12
|
|
|
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION;
|
Facility
|
OP
|
$10,543.31
|
|
|
Service Code
|
CPT 26860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,705.10 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$4,456.00
|
| Rate for Payer: BCN Commercial |
$4,456.00
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Mclaren Medicaid |
$3,260.23
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNAL FIXATION; EACH ADDITIONAL INTERPHALANGEAL JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$456.42
|
|
|
Service Code
|
CPT 26861
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.42 |
| Max. Negotiated Rate |
$456.42 |
| Rate for Payer: BCBS Trust/PPO |
$456.42
|
| Rate for Payer: BCN Commercial |
$456.42
|
|
