|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 65862018830
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
ONDANSETRON HCL 8 MG TABLET
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 65862018830
|
| Hospital Charge Code |
10779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$6.51
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.91
|
| Rate for Payer: PHP Commercial |
$7.91
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.86
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.83
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION (CODE)
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
163708
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$6.51
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$7.91
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$5.86
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$9.72 |
| Rate for Payer: Aetna American Axle |
$7.02
|
| Rate for Payer: Aetna American Axle |
$11.38
|
| Rate for Payer: Aetna American Axle |
$11.24
|
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna American Axle |
$10.03
|
| Rate for Payer: Aetna American Axle |
$6.34
|
| Rate for Payer: Aetna American Axle |
$6.79
|
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna Commercial |
$13.12
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Commercial |
$8.29
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Aetna Medicare |
$5.40
|
| Rate for Payer: Aetna Medicare |
$4.55
|
| Rate for Payer: Aetna Medicare |
$8.75
|
| Rate for Payer: Aetna Medicare |
$4.65
|
| Rate for Payer: Aetna Medicare |
$7.71
|
| Rate for Payer: Aetna Medicare |
$4.88
|
| Rate for Payer: Aetna Medicare |
$8.64
|
| Rate for Payer: Aetna Medicare |
$5.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.24
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS Complete |
$3.90
|
| Rate for Payer: BCBS Complete |
$4.28
|
| Rate for Payer: BCBS Complete |
$6.92
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS Complete |
$3.64
|
| Rate for Payer: BCBS Complete |
$7.00
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$6.51
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$13.27
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$12.25
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$13.89
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.88
|
| Rate for Payer: PHP Commercial |
$8.29
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$14.88
|
| Rate for Payer: PHP Commercial |
$7.91
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$13.12
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: Priority Health SBD |
$11.03
|
| Rate for Payer: Priority Health SBD |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$5.86
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$6.74
|
| Rate for Payer: UMR Bronson Commercial |
$6.40
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$6.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.61
|
| Rate for Payer: UMR Bronson Commercial |
$3.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$3.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.83
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
105614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna American Axle |
$7.54
|
| Rate for Payer: Aetna American Axle |
$6.34
|
| Rate for Payer: Aetna American Axle |
$7.02
|
| Rate for Payer: Aetna American Axle |
$6.04
|
| Rate for Payer: Aetna American Axle |
$11.24
|
| Rate for Payer: Aetna American Axle |
$5.92
|
| Rate for Payer: Aetna American Axle |
$11.38
|
| Rate for Payer: Aetna American Axle |
$6.79
|
| Rate for Payer: Aetna American Axle |
$6.96
|
| Rate for Payer: Aetna Commercial |
$8.29
|
| Rate for Payer: Aetna Commercial |
$9.10
|
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Commercial |
$9.18
|
| Rate for Payer: Aetna Commercial |
$7.91
|
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Aetna Commercial |
$14.70
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Commercial |
$7.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.24
|
| Rate for Payer: Cash Price |
$7.28
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$7.44
|
| Rate for Payer: Cash Price |
$8.36
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.56
|
| Rate for Payer: Cash Price |
$14.00
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$7.32
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$7.49
|
| Rate for Payer: Cofinity Commercial |
$9.20
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$8.99
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$6.83
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$6.51
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$7.83
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Cofinity Commercial |
$12.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Healthscope Commercial |
$9.72
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Commercial |
$15.56
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$9.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.88
|
| Rate for Payer: PHP Commercial |
$14.70
|
| Rate for Payer: PHP Commercial |
$7.91
|
| Rate for Payer: PHP Commercial |
$8.29
|
| Rate for Payer: PHP Commercial |
$14.88
|
| Rate for Payer: PHP Commercial |
$7.74
|
| Rate for Payer: PHP Commercial |
$9.18
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$8.88
|
| Rate for Payer: PHP Commercial |
$9.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.34
|
| Rate for Payer: Priority Health SBD |
$6.58
|
| Rate for Payer: Priority Health SBD |
$10.89
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: Priority Health SBD |
$6.14
|
| Rate for Payer: Priority Health SBD |
$5.73
|
| Rate for Payer: Priority Health SBD |
$6.80
|
| Rate for Payer: Priority Health SBD |
$6.74
|
| Rate for Payer: Priority Health SBD |
$11.03
|
| Rate for Payer: Priority Health SBD |
$5.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.09
|
| Rate for Payer: UMR Bronson Commercial |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.75
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
| Rate for Payer: UMR Bronson Commercial |
$4.00
|
| Rate for Payer: UMR Bronson Commercial |
$5.10
|
| Rate for Payer: UMR Bronson Commercial |
$7.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.83
|
|
|
OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY, PULSE GENERATOR, AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY
|
Facility
|
OP
|
$83,659.62
|
|
|
Service Code
|
CPT 64582
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,930.07 |
| Max. Negotiated Rate |
$83,659.62 |
| Rate for Payer: Aetna Medicare |
$30,909.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37,150.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37,150.35
|
| Rate for Payer: BCBS Complete |
$16,726.57
|
| Rate for Payer: BCBS MAPPO |
$29,720.28
|
| Rate for Payer: BCN Medicare Advantage |
$29,720.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29,720.28
|
| Rate for Payer: Mclaren Medicaid |
$15,930.07
|
| Rate for Payer: Mclaren Medicare |
$29,720.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31,206.29
|
| Rate for Payer: Meridian Medicaid |
$16,726.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34,178.32
|
| Rate for Payer: PACE Medicare |
$28,234.27
|
| Rate for Payer: PACE SWMI |
$29,720.28
|
| Rate for Payer: PHP Medicare Advantage |
$29,720.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,930.07
|
| Rate for Payer: Priority Health Medicare |
$29,720.28
|
| Rate for Payer: Railroad Medicare Medicare |
$29,720.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83,659.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$29,720.28
|
| Rate for Payer: UHC Exchange |
$56,798.43
|
| Rate for Payer: UHC Medicare Advantage |
$29,720.28
|
| Rate for Payer: UHCCP Medicaid |
$15,930.07
|
| Rate for Payer: VA VA |
$29,720.28
|
|
|
OPEN IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT)
|
Facility
|
OP
|
$18,017.25
|
|
|
Service Code
|
CPT 64581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,430.76 |
| Max. Negotiated Rate |
$18,017.25 |
| Rate for Payer: Aetna Medicare |
$6,656.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,000.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,000.84
|
| Rate for Payer: BCBS Complete |
$3,602.30
|
| Rate for Payer: BCBS MAPPO |
$6,400.67
|
| Rate for Payer: BCN Medicare Advantage |
$6,400.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,400.67
|
| Rate for Payer: Mclaren Medicaid |
$3,430.76
|
| Rate for Payer: Mclaren Medicare |
$6,400.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,720.70
|
| Rate for Payer: Meridian Medicaid |
$3,602.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,360.77
|
| Rate for Payer: PACE Medicare |
$6,080.64
|
| Rate for Payer: PACE SWMI |
$6,400.67
|
| Rate for Payer: PHP Medicare Advantage |
$6,400.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,430.76
|
| Rate for Payer: Priority Health Medicare |
$6,400.67
|
| Rate for Payer: Railroad Medicare Medicare |
$6,400.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,017.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,400.67
|
| Rate for Payer: UHC Exchange |
$12,232.32
|
| Rate for Payer: UHC Medicare Advantage |
$6,400.67
|
| Rate for Payer: UHCCP Medicaid |
$3,430.76
|
| Rate for Payer: VA VA |
$6,400.67
|
|
|
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC;
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR CHRONIC; WITH FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF ACUTE OR CHRONIC ELBOW DISLOCATION
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 24615
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF ACUTE SHOULDER DISLOCATION
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF ARTICULAR FRACTURE, INVOLVING METACARPOPHALANGEAL OR INTERPHALANGEAL JOINT, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED;
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF CALCANEAL FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED; WITH PRIMARY ILIAC OR OTHER AUTOGENOUS BONE GRAFT (INCLUDES OBTAINING GRAFT)
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 28420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,726.13 |
| Max. Negotiated Rate |
$35,323.48 |
| Rate for Payer: Aetna Medicare |
$13,050.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,685.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,685.94
|
| Rate for Payer: BCBS Complete |
$7,062.44
|
| Rate for Payer: BCBS MAPPO |
$12,548.75
|
| Rate for Payer: BCN Medicare Advantage |
$12,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,548.75
|
| Rate for Payer: Mclaren Medicaid |
$6,726.13
|
| Rate for Payer: Mclaren Medicare |
$12,548.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,176.19
|
| Rate for Payer: Meridian Medicaid |
$7,062.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,431.06
|
| Rate for Payer: PACE Medicare |
$11,921.31
|
| Rate for Payer: PACE SWMI |
$12,548.75
|
| Rate for Payer: PHP Medicare Advantage |
$12,548.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,726.13
|
| Rate for Payer: Priority Health Medicare |
$12,548.75
|
| Rate for Payer: Railroad Medicare Medicare |
$12,548.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,323.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,548.75
|
| Rate for Payer: UHC Exchange |
$23,981.92
|
| Rate for Payer: UHC Medicare Advantage |
$12,548.75
|
| Rate for Payer: UHCCP Medicaid |
$6,726.13
|
| Rate for Payer: VA VA |
$12,548.75
|
|
|
OPEN TREATMENT OF CARPAL BONE FRACTURE (OTHER THAN CARPAL SCAPHOID [NAVICULAR]), EACH BONE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 25645
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OPEN TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; COMPLEX, MULTIPLE, OR DELAYED REDUCTION
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OPEN TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB; INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH JOINT
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OPEN TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION, THUMB (BENNETT FRACTURE), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,696.12 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23515
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Exchange |
$13,314.90
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,734.39
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE FORAMINA) FRACTURE(S) OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD; WITH INTERNAL FIXATION AND MULTIPLE SURGICAL APPROACHES
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21365
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BY MULTIPLE SURGICAL APPROACHES INCLUDING INTERNAL FIXATION, INTERDENTAL FIXATION, AND/OR WIRING OF DENTURES OR SPLINTS
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLIES APPROACH)
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Exchange |
$11,025.94
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,092.41
|
| Rate for Payer: VA VA |
$5,769.42
|
|
