|
PEPTAMEN INTENSE VHP CYCLIC FEED
|
Facility
|
IP
|
$70.30
|
|
|
Service Code
|
NDC 4390072395
|
| Hospital Charge Code |
300422
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.93 |
| Max. Negotiated Rate |
$63.27 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.24
|
| Rate for Payer: Cofinity Commercial |
$49.21
|
| Rate for Payer: Cofinity Commercial |
$60.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.24
|
| Rate for Payer: Healthscope Commercial |
$63.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.21
|
| Rate for Payer: Priority Health SBD |
$44.29
|
| Rate for Payer: UMR Bronson Commercial |
$30.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.72
|
|
|
PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$1,035.68
|
|
|
Service Code
|
HCPCS J2547
|
| Hospital Charge Code |
119324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$455.70 |
| Max. Negotiated Rate |
$932.11 |
| Rate for Payer: Aetna American Axle |
$673.19
|
| Rate for Payer: Aetna Commercial |
$880.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: Cash Price |
$828.54
|
| Rate for Payer: Cofinity Commercial |
$724.98
|
| Rate for Payer: Cofinity Commercial |
$890.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.54
|
| Rate for Payer: Healthscope Commercial |
$932.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$724.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$880.33
|
| Rate for Payer: PHP Commercial |
$880.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.98
|
| Rate for Payer: Priority Health SBD |
$652.48
|
| Rate for Payer: UMR Bronson Commercial |
$455.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.76
|
|
|
PERAMPANEL 2 MG TABLET
|
Facility
|
IP
|
$2,016.43
|
|
|
Service Code
|
NDC 62856-272-30
|
| Hospital Charge Code |
169250
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$887.23 |
| Max. Negotiated Rate |
$1,814.79 |
| Rate for Payer: Aetna American Axle |
$1,310.68
|
| Rate for Payer: Aetna Commercial |
$1,713.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.68
|
| Rate for Payer: Cash Price |
$1,613.14
|
| Rate for Payer: Cofinity Commercial |
$1,411.50
|
| Rate for Payer: Cofinity Commercial |
$1,734.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,613.14
|
| Rate for Payer: Healthscope Commercial |
$1,814.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,411.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,512.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,713.97
|
| Rate for Payer: PHP Commercial |
$1,713.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,411.50
|
| Rate for Payer: Priority Health SBD |
$1,270.35
|
| Rate for Payer: UMR Bronson Commercial |
$887.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,512.32
|
|
|
PERAMPANEL 4 MG TABLET
|
Facility
|
IP
|
$3,984.68
|
|
|
Service Code
|
NDC 62856-274-30
|
| Hospital Charge Code |
169251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,753.26 |
| Max. Negotiated Rate |
$3,586.21 |
| Rate for Payer: Aetna American Axle |
$2,590.04
|
| Rate for Payer: Aetna Commercial |
$3,386.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,590.04
|
| Rate for Payer: Cash Price |
$3,187.74
|
| Rate for Payer: Cofinity Commercial |
$2,789.28
|
| Rate for Payer: Cofinity Commercial |
$3,426.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,187.74
|
| Rate for Payer: Healthscope Commercial |
$3,586.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,789.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,988.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,386.98
|
| Rate for Payer: PHP Commercial |
$3,386.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,789.28
|
| Rate for Payer: Priority Health SBD |
$2,510.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,753.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,988.51
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$69,805.85
|
|
|
Service Code
|
MS-DRG 273
|
| Min. Negotiated Rate |
$29,015.63 |
| Max. Negotiated Rate |
$69,805.85 |
| Rate for Payer: Aetna Medicare |
$31,764.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,178.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,178.46
|
| Rate for Payer: BCBS MAPPO |
$30,542.77
|
| Rate for Payer: BCBS Trust/PPO |
$69,805.85
|
| Rate for Payer: BCN Medicare Advantage |
$30,542.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,542.77
|
| Rate for Payer: Mclaren Medicare |
$30,542.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32,069.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,124.19
|
| Rate for Payer: PACE Medicare |
$29,015.63
|
| Rate for Payer: PACE SWMI |
$30,542.77
|
| Rate for Payer: PHP Medicare Advantage |
$30,542.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,921.64
|
| Rate for Payer: Priority Health Medicare |
$30,542.77
|
| Rate for Payer: Priority Health Narrow Network |
$44,737.31
|
| Rate for Payer: Railroad Medicare Medicare |
$30,542.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59,444.84
|
| Rate for Payer: UHC Core |
$48,743.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$30,542.77
|
| Rate for Payer: UHC Exchange |
$38,751.77
|
| Rate for Payer: UHC Medicare Advantage |
$31,459.05
|
| Rate for Payer: VA VA |
$30,542.77
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$61,163.99
|
|
|
Service Code
|
MS-DRG 274
|
| Min. Negotiated Rate |
$24,211.77 |
| Max. Negotiated Rate |
$61,163.99 |
| Rate for Payer: Aetna Medicare |
$26,505.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,857.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,857.59
|
| Rate for Payer: BCBS MAPPO |
$25,486.07
|
| Rate for Payer: BCBS Trust/PPO |
$61,163.99
|
| Rate for Payer: BCN Medicare Advantage |
$25,486.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,486.07
|
| Rate for Payer: Mclaren Medicare |
$25,486.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26,760.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,308.98
|
| Rate for Payer: PACE Medicare |
$24,211.77
|
| Rate for Payer: PACE SWMI |
$25,486.07
|
| Rate for Payer: PHP Medicare Advantage |
$25,486.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46,505.22
|
| Rate for Payer: Priority Health Medicare |
$25,486.07
|
| Rate for Payer: Priority Health Narrow Network |
$37,204.18
|
| Rate for Payer: Railroad Medicare Medicare |
$25,486.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49,435.16
|
| Rate for Payer: UHC Core |
$40,535.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$25,486.07
|
| Rate for Payer: UHC Exchange |
$32,226.52
|
| Rate for Payer: UHC Medicare Advantage |
$26,250.65
|
| Rate for Payer: VA VA |
$25,486.07
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$62,345.05
|
|
|
Service Code
|
MS-DRG 321
|
| Min. Negotiated Rate |
$21,531.65 |
| Max. Negotiated Rate |
$62,345.05 |
| Rate for Payer: Aetna Medicare |
$23,571.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28,331.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28,331.11
|
| Rate for Payer: BCBS MAPPO |
$22,664.89
|
| Rate for Payer: BCBS Trust/PPO |
$62,345.05
|
| Rate for Payer: BCN Medicare Advantage |
$22,664.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22,664.89
|
| Rate for Payer: Mclaren Medicare |
$22,664.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,798.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26,064.62
|
| Rate for Payer: PACE Medicare |
$21,531.65
|
| Rate for Payer: PACE SWMI |
$22,664.89
|
| Rate for Payer: PHP Medicare Advantage |
$22,664.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41,251.72
|
| Rate for Payer: Priority Health Medicare |
$22,664.89
|
| Rate for Payer: Priority Health Narrow Network |
$33,001.38
|
| Rate for Payer: Railroad Medicare Medicare |
$22,664.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43,850.67
|
| Rate for Payer: UHC Core |
$35,956.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$22,664.89
|
| Rate for Payer: UHC Exchange |
$28,586.02
|
| Rate for Payer: UHC Medicare Advantage |
$23,344.84
|
| Rate for Payer: VA VA |
$22,664.89
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$43,279.68
|
|
|
Service Code
|
MS-DRG 322
|
| Min. Negotiated Rate |
$13,835.35 |
| Max. Negotiated Rate |
$43,279.68 |
| Rate for Payer: Aetna Medicare |
$15,146.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,204.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,204.41
|
| Rate for Payer: BCBS MAPPO |
$14,563.53
|
| Rate for Payer: BCBS Trust/PPO |
$43,279.68
|
| Rate for Payer: BCN Medicare Advantage |
$14,563.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,563.53
|
| Rate for Payer: Mclaren Medicare |
$14,563.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,291.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,748.06
|
| Rate for Payer: PACE Medicare |
$13,835.35
|
| Rate for Payer: PACE SWMI |
$14,563.53
|
| Rate for Payer: PHP Medicare Advantage |
$14,563.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,165.64
|
| Rate for Payer: Priority Health Medicare |
$14,563.53
|
| Rate for Payer: Priority Health Narrow Network |
$20,932.51
|
| Rate for Payer: Railroad Medicare Medicare |
$14,563.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27,814.14
|
| Rate for Payer: UHC Core |
$22,807.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,563.53
|
| Rate for Payer: UHC Exchange |
$18,131.89
|
| Rate for Payer: UHC Medicare Advantage |
$15,000.44
|
| Rate for Payer: VA VA |
$14,563.53
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$52,042.16
|
|
|
Service Code
|
MS-DRG 250
|
| Min. Negotiated Rate |
$17,696.32 |
| Max. Negotiated Rate |
$52,042.16 |
| Rate for Payer: Aetna Medicare |
$19,372.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23,284.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23,284.62
|
| Rate for Payer: BCBS MAPPO |
$18,627.70
|
| Rate for Payer: BCBS Trust/PPO |
$52,042.16
|
| Rate for Payer: BCN Medicare Advantage |
$18,627.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,627.70
|
| Rate for Payer: Mclaren Medicare |
$18,627.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,559.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,421.86
|
| Rate for Payer: PACE Medicare |
$17,696.32
|
| Rate for Payer: PACE SWMI |
$18,627.70
|
| Rate for Payer: PHP Medicare Advantage |
$18,627.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,733.79
|
| Rate for Payer: Priority Health Medicare |
$18,627.70
|
| Rate for Payer: Priority Health Narrow Network |
$26,987.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18,627.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,859.10
|
| Rate for Payer: UHC Core |
$29,403.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,627.70
|
| Rate for Payer: UHC Exchange |
$23,376.36
|
| Rate for Payer: UHC Medicare Advantage |
$19,186.53
|
| Rate for Payer: VA VA |
$18,627.70
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$33,441.67
|
|
|
Service Code
|
MS-DRG 251
|
| Min. Negotiated Rate |
$12,104.02 |
| Max. Negotiated Rate |
$33,441.67 |
| Rate for Payer: Aetna Medicare |
$13,250.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,926.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,926.34
|
| Rate for Payer: BCBS MAPPO |
$12,741.07
|
| Rate for Payer: BCBS Trust/PPO |
$33,441.67
|
| Rate for Payer: BCN Medicare Advantage |
$12,741.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,741.07
|
| Rate for Payer: Mclaren Medicare |
$12,741.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,378.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,652.23
|
| Rate for Payer: PACE Medicare |
$12,104.02
|
| Rate for Payer: PACE SWMI |
$12,741.07
|
| Rate for Payer: PHP Medicare Advantage |
$12,741.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22,771.89
|
| Rate for Payer: Priority Health Medicare |
$12,741.07
|
| Rate for Payer: Priority Health Narrow Network |
$18,217.51
|
| Rate for Payer: Railroad Medicare Medicare |
$12,741.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,206.57
|
| Rate for Payer: UHC Core |
$19,848.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,741.07
|
| Rate for Payer: UHC Exchange |
$15,780.13
|
| Rate for Payer: UHC Medicare Advantage |
$13,123.30
|
| Rate for Payer: VA VA |
$12,741.07
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
|
Facility
|
OP
|
$19,137.49
|
|
|
Service Code
|
CPT 64561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$296.66 |
| Max. Negotiated Rate |
$19,137.49 |
| Rate for Payer: Aetna Medicare |
$6,322.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,598.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,598.96
|
| Rate for Payer: BCBS Complete |
$3,491.88
|
| Rate for Payer: BCBS MAPPO |
$6,079.17
|
| Rate for Payer: BCBS Trust/PPO |
$7,707.23
|
| Rate for Payer: BCN Medicare Advantage |
$6,079.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,079.17
|
| Rate for Payer: Mclaren Medicaid |
$3,325.31
|
| Rate for Payer: Mclaren Medicare |
$6,079.17
|
| Rate for Payer: Meridian Medicaid |
$3,491.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,383.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,991.05
|
| Rate for Payer: PACE Medicare |
$5,775.21
|
| Rate for Payer: PACE SWMI |
$6,079.17
|
| Rate for Payer: PHP Medicare Advantage |
$6,079.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,325.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,137.49
|
| Rate for Payer: Priority Health Medicare |
$6,079.17
|
| Rate for Payer: Priority Health Narrow Network |
$15,309.99
|
| Rate for Payer: Railroad Medicare Medicare |
$6,079.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.33
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,079.17
|
| Rate for Payer: UHC Exchange |
$296.66
|
| Rate for Payer: UHC Medicare Advantage |
$6,261.55
|
| Rate for Payer: VA VA |
$6,079.17
|
|
|
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DISCECTOMY, FACETECTOMY AND/OR FORAMINOTOMY), ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (EG, FLUOROSCOPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 0275T
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,478.42 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; COMPLEX (EG, STONE[S] > 2 CM, BRANCHING STONES, STONES IN MULTIPLE LOCATIONS, URETER STONES, COMPLICATED ANATOMY)
|
Facility
|
OP
|
$25,778.15
|
|
|
Service Code
|
CPT 50081
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,094.97 |
| Max. Negotiated Rate |
$25,778.15 |
| Rate for Payer: Aetna Medicare |
$8,516.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,235.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,235.78
|
| Rate for Payer: BCBS Complete |
$4,703.54
|
| Rate for Payer: BCBS MAPPO |
$8,188.62
|
| Rate for Payer: BCBS Trust/PPO |
$7,702.81
|
| Rate for Payer: BCN Medicare Advantage |
$8,188.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,188.62
|
| Rate for Payer: Mclaren Medicaid |
$4,479.18
|
| Rate for Payer: Mclaren Medicare |
$8,188.62
|
| Rate for Payer: Meridian Medicaid |
$4,703.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,598.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,416.91
|
| Rate for Payer: PACE Medicare |
$7,779.19
|
| Rate for Payer: PACE SWMI |
$8,188.62
|
| Rate for Payer: PHP Medicare Advantage |
$8,188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,479.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,778.15
|
| Rate for Payer: Priority Health Medicare |
$8,188.62
|
| Rate for Payer: Priority Health Narrow Network |
$20,622.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,188.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.47
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,188.62
|
| Rate for Payer: UHC Exchange |
$1,094.97
|
| Rate for Payer: UHC Medicare Advantage |
$8,434.28
|
| Rate for Payer: VA VA |
$8,188.62
|
|
|
PERCUTANEOUS NEPHROLITHOTOMY OR PYELOLITHOTOMY, LITHOTRIPSY, STONE EXTRACTION, ANTEGRADE URETEROSCOPY, ANTEGRADE STENT PLACEMENT AND NEPHROSTOMY TUBE PLACEMENT, WHEN PERFORMED, INCLUDING IMAGING GUIDANCE; SIMPLE (EG, STONE[S] UP TO 2 CM IN SINGLE LOCATION OF KIDNEY OR RENAL PELVIS, NONBRANCHING STONES)
|
Facility
|
OP
|
$25,778.15
|
|
|
Service Code
|
CPT 50080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$680.75 |
| Max. Negotiated Rate |
$25,778.15 |
| Rate for Payer: Aetna Medicare |
$8,516.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,235.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,235.78
|
| Rate for Payer: BCBS Complete |
$4,703.54
|
| Rate for Payer: BCBS MAPPO |
$8,188.62
|
| Rate for Payer: BCBS Trust/PPO |
$6,461.50
|
| Rate for Payer: BCN Medicare Advantage |
$8,188.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,188.62
|
| Rate for Payer: Mclaren Medicaid |
$4,479.18
|
| Rate for Payer: Mclaren Medicare |
$8,188.62
|
| Rate for Payer: Meridian Medicaid |
$4,703.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,598.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,416.91
|
| Rate for Payer: PACE Medicare |
$7,779.19
|
| Rate for Payer: PACE SWMI |
$8,188.62
|
| Rate for Payer: PHP Medicare Advantage |
$8,188.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,479.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,778.15
|
| Rate for Payer: Priority Health Medicare |
$8,188.62
|
| Rate for Payer: Priority Health Narrow Network |
$20,622.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8,188.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.82
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$8,188.62
|
| Rate for Payer: UHC Exchange |
$680.75
|
| Rate for Payer: UHC Medicare Advantage |
$8,434.28
|
| Rate for Payer: VA VA |
$8,188.62
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB, WITH MANIPULATION, EACH JOINT
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26676
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$514.41 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$565.85
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$514.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), WITH MANIPULATION
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$485.60 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.16
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$485.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, EACH
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$428.95 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,905.90
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$471.84
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$428.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 25606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$670.60 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,923.96
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.66
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$670.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, OR SUPRACONDYLAR OR TRANSCONDYLAR, WITH OR WITHOUT INTERCONDYLAR EXTENSION, OR DISTAL FEMORAL EPIPHYSEAL SEPARATION
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 27509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$673.55 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,075.04
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$740.90
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$673.55
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, PHALANX OR PHALANGES, WITH MANIPULATION
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$276.03 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.63
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$276.03
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR LATERAL, WITH MANIPULATION
|
Facility
|
OP
|
$20,018.71
|
|
|
Service Code
|
CPT 24582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$816.31 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.94
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$816.31
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF INTERPHALANGEAL JOINT DISLOCATION, SINGLE, WITH MANIPULATION
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26776
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$454.16 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.58
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$454.16
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$485.92 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,432.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$534.51
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$485.92
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$9,057.42
|
|
|
Service Code
|
CPT 28476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$388.02 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.70
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$426.82
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$388.02
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: VA VA |
$2,877.15
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC BONE FRACTURE AND/OR DISLOCATION, FOR FRACTURE PATTERNS THAT DISRUPT THE PELVIC RING, UNILATERAL (INCLUDES IPSILATERAL ILIUM, SACROILIAC JOINT AND/OR SACRUM)
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
CPT 27216
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$878.85 |
| Max. Negotiated Rate |
$5,042.00 |
| Rate for Payer: BCBS Trust/PPO |
$3,204.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$966.74
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$878.85
|
|
