|
OPEN TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR ANATOMICAL NECK FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 23680
|
|
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 TALOTARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28585
|
|
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 TALUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28445
|
|
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 TARSAL BONE DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28555
|
|
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 TARSAL BONE FRACTURE (EXCEPT TALUS AND CALCANEUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28465
|
|
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 TARSOMETATARSAL JOINT DISLOCATION, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28615
|
|
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 TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE), WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 27758
|
|
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 TRANS-SCAPHOPERILUNAR TYPE OF FRACTURE DISLOCATION
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25685
|
|
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 TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITH FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27823
|
|
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 TRIMALLEOLAR ANKLE FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, MEDIAL AND/OR LATERAL MALLEOLUS; WITHOUT FIXATION OF POSTERIOR LIP
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27822
|
|
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 ULNAR FRACTURE, PROXIMAL END (EG, OLECRANON OR CORONOID PROCESS[ES]), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 24685
|
|
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 ULNAR SHAFT FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25545
|
|
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 ULNAR STYLOID FRACTURE
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25652
|
|
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
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$11.46
|
|
|
Service Code
|
NDC 09900001924
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$1,339.19
|
|
|
Service Code
|
NDC 62559015304
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$589.24 |
| Max. Negotiated Rate |
$1,205.27 |
| Rate for Payer: Aetna American Axle |
$870.47
|
| Rate for Payer: Aetna Commercial |
$1,138.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.47
|
| Rate for Payer: Cash Price |
$1,071.35
|
| Rate for Payer: Cofinity Commercial |
$1,151.70
|
| Rate for Payer: Cofinity Commercial |
$937.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.35
|
| Rate for Payer: Healthscope Commercial |
$1,205.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.31
|
| Rate for Payer: PHP Commercial |
$1,138.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.47
|
| Rate for Payer: Priority Health SBD |
$843.69
|
| Rate for Payer: UMR Bronson Commercial |
$589.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.39
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$1,339.19
|
|
|
Service Code
|
NDC 62559015304
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$495.50 |
| Max. Negotiated Rate |
$1,205.27 |
| Rate for Payer: Aetna American Axle |
$870.47
|
| Rate for Payer: Aetna Commercial |
$1,138.31
|
| Rate for Payer: Aetna Medicare |
$669.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.47
|
| Rate for Payer: BCBS Complete |
$535.68
|
| Rate for Payer: Cash Price |
$1,071.35
|
| Rate for Payer: Cofinity Commercial |
$1,151.70
|
| Rate for Payer: Cofinity Commercial |
$937.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$937.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,071.35
|
| Rate for Payer: Healthscope Commercial |
$1,205.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$937.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,004.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,138.31
|
| Rate for Payer: PHP Commercial |
$1,138.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$870.47
|
| Rate for Payer: Priority Health SBD |
$843.69
|
| Rate for Payer: UMR Bronson Commercial |
$495.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,004.39
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
IP
|
$2,240.26
|
|
|
Service Code
|
NDC 42799021701
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$985.71 |
| Max. Negotiated Rate |
$2,016.23 |
| Rate for Payer: Aetna American Axle |
$1,456.17
|
| Rate for Payer: Aetna Commercial |
$1,904.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.17
|
| Rate for Payer: Cash Price |
$1,792.21
|
| Rate for Payer: Cofinity Commercial |
$1,568.18
|
| Rate for Payer: Cofinity Commercial |
$1,926.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,568.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.21
|
| Rate for Payer: Healthscope Commercial |
$2,016.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.22
|
| Rate for Payer: PHP Commercial |
$1,904.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.17
|
| Rate for Payer: Priority Health SBD |
$1,411.36
|
| Rate for Payer: UMR Bronson Commercial |
$985.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.19
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$2,240.26
|
|
|
Service Code
|
NDC 42799021701
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$828.90 |
| Max. Negotiated Rate |
$2,016.23 |
| Rate for Payer: Aetna American Axle |
$1,456.17
|
| Rate for Payer: Aetna Commercial |
$1,904.22
|
| Rate for Payer: Aetna Medicare |
$1,120.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,456.17
|
| Rate for Payer: BCBS Complete |
$896.10
|
| Rate for Payer: Cash Price |
$1,792.21
|
| Rate for Payer: Cofinity Commercial |
$1,568.18
|
| Rate for Payer: Cofinity Commercial |
$1,926.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,568.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,792.21
|
| Rate for Payer: Healthscope Commercial |
$2,016.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,568.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,680.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,904.22
|
| Rate for Payer: PHP Commercial |
$1,904.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.17
|
| Rate for Payer: Priority Health SBD |
$1,411.36
|
| Rate for Payer: UMR Bronson Commercial |
$828.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,680.19
|
|
|
OPIUM TINCTURE 10 MG/ML (MORPHINE) ORAL
|
Facility
|
OP
|
$11.46
|
|
|
Service Code
|
NDC 09900001924
|
| Hospital Charge Code |
99405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$10.31 |
| Rate for Payer: Aetna American Axle |
$7.45
|
| Rate for Payer: Aetna Commercial |
$9.74
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.45
|
| Rate for Payer: BCBS Complete |
$4.58
|
| Rate for Payer: Cash Price |
$9.17
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.17
|
| Rate for Payer: Healthscope Commercial |
$10.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.74
|
| Rate for Payer: PHP Commercial |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.45
|
| Rate for Payer: Priority Health SBD |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.60
|
|
|
OPPONENSPLASTY; SUPERFICIALIS TENDON TRANSFER TYPE, EACH TENDON
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 26490
|
|
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
|
|
|
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION
|
Facility
|
OP
|
$6,404.71
|
|
|
Service Code
|
CPT 67412
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.56 |
| Max. Negotiated Rate |
$6,404.71 |
| Rate for Payer: Aetna Medicare |
$2,366.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,844.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,844.11
|
| Rate for Payer: BCBS Complete |
$1,280.53
|
| Rate for Payer: BCBS MAPPO |
$2,275.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,275.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,275.29
|
| Rate for Payer: Mclaren Medicaid |
$1,219.56
|
| Rate for Payer: Mclaren Medicare |
$2,275.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,389.05
|
| Rate for Payer: Meridian Medicaid |
$1,280.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,616.58
|
| Rate for Payer: PACE Medicare |
$2,161.53
|
| Rate for Payer: PACE SWMI |
$2,275.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,275.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,219.56
|
| Rate for Payer: Priority Health Medicare |
$2,275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,275.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,404.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,275.29
|
| Rate for Payer: UHC Exchange |
$4,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,275.29
|
| Rate for Payer: UHCCP Medicaid |
$1,219.56
|
| Rate for Payer: VA VA |
$2,275.29
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH
|
Facility
|
OP
|
$9,468.51
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.95 |
| Max. Negotiated Rate |
$9,468.51 |
| Rate for Payer: Aetna Medicare |
$3,498.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,204.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,204.64
|
| Rate for Payer: BCBS Complete |
$1,893.10
|
| Rate for Payer: BCBS MAPPO |
$3,363.71
|
| Rate for Payer: BCN Medicare Advantage |
$3,363.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,363.71
|
| Rate for Payer: Mclaren Medicaid |
$1,802.95
|
| Rate for Payer: Mclaren Medicare |
$3,363.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,531.90
|
| Rate for Payer: Meridian Medicaid |
$1,893.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,868.27
|
| Rate for Payer: PACE Medicare |
$3,195.52
|
| Rate for Payer: PACE SWMI |
$3,363.71
|
| Rate for Payer: PHP Medicare Advantage |
$3,363.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.95
|
| Rate for Payer: Priority Health Medicare |
$3,363.71
|
| Rate for Payer: Railroad Medicare Medicare |
$3,363.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,468.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,363.71
|
| Rate for Payer: UHC Exchange |
$6,428.39
|
| Rate for Payer: UHC Medicare Advantage |
$3,363.71
|
| Rate for Payer: UHCCP Medicaid |
$1,802.95
|
| Rate for Payer: VA VA |
$3,363.71
|
|
|
ORCHIOPEXY, INGUINAL OR SCROTAL APPROACH
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 54640
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
ORITAVANCIN 1,200 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$12,904.58
|
|
|
Service Code
|
HCPCS J2406
|
| Hospital Charge Code |
197251
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,678.02 |
| Max. Negotiated Rate |
$11,614.12 |
| Rate for Payer: Aetna American Axle |
$8,387.98
|
| Rate for Payer: Aetna Commercial |
$10,968.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,387.98
|
| Rate for Payer: Cash Price |
$10,323.66
|
| Rate for Payer: Cofinity Commercial |
$11,097.94
|
| Rate for Payer: Cofinity Commercial |
$9,033.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,033.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10,323.66
|
| Rate for Payer: Healthscope Commercial |
$11,614.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,033.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9,678.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,968.89
|
| Rate for Payer: PHP Commercial |
$10,968.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,387.98
|
| Rate for Payer: Priority Health SBD |
$8,129.89
|
| Rate for Payer: UMR Bronson Commercial |
$5,678.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9,678.43
|
|
