|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.96 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna American Axle |
$339.71
|
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.71
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$365.84
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health SBD |
$329.26
|
| Rate for Payer: UMR Bronson Commercial |
$229.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$53.96
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna American Axle |
$35.07
|
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.07
|
| Rate for Payer: Cash Price |
$43.17
|
| Rate for Payer: Cofinity Commercial |
$37.77
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.17
|
| Rate for Payer: Healthscope Commercial |
$48.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.87
|
| Rate for Payer: PHP Commercial |
$45.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health SBD |
$33.99
|
| Rate for Payer: UMR Bronson Commercial |
$23.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.47
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$298.37
|
|
|
Service Code
|
NDC 60219126601
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$268.53 |
| Rate for Payer: Aetna American Axle |
$193.94
|
| Rate for Payer: Aetna Commercial |
$253.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.94
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.86
|
| Rate for Payer: Cofinity Commercial |
$256.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$208.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.61
|
| Rate for Payer: PHP Commercial |
$253.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.94
|
| Rate for Payer: Priority Health SBD |
$187.97
|
| Rate for Payer: UMR Bronson Commercial |
$131.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$963.48
|
|
|
Service Code
|
NDC 68094005061
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.49 |
| Max. Negotiated Rate |
$867.13 |
| Rate for Payer: Aetna American Axle |
$626.26
|
| Rate for Payer: Aetna Commercial |
$818.96
|
| Rate for Payer: Aetna Medicare |
$481.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.26
|
| Rate for Payer: BCBS Complete |
$385.39
|
| Rate for Payer: Cash Price |
$770.78
|
| Rate for Payer: Cofinity Commercial |
$674.44
|
| Rate for Payer: Cofinity Commercial |
$828.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.78
|
| Rate for Payer: Healthscope Commercial |
$867.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.96
|
| Rate for Payer: PHP Commercial |
$818.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.26
|
| Rate for Payer: Priority Health SBD |
$606.99
|
| Rate for Payer: UMR Bronson Commercial |
$356.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.61
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$522.63
|
|
|
Service Code
|
NDC 00004080085
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.37 |
| Max. Negotiated Rate |
$470.37 |
| Rate for Payer: Aetna American Axle |
$339.71
|
| Rate for Payer: Aetna Commercial |
$444.24
|
| Rate for Payer: Aetna Medicare |
$261.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.71
|
| Rate for Payer: BCBS Complete |
$209.05
|
| Rate for Payer: Cash Price |
$418.10
|
| Rate for Payer: Cofinity Commercial |
$365.84
|
| Rate for Payer: Cofinity Commercial |
$449.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.10
|
| Rate for Payer: Healthscope Commercial |
$470.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.24
|
| Rate for Payer: PHP Commercial |
$444.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.71
|
| Rate for Payer: Priority Health SBD |
$329.26
|
| Rate for Payer: UMR Bronson Commercial |
$193.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.97
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$275.25
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.84 |
| Max. Negotiated Rate |
$247.72 |
| Rate for Payer: Aetna American Axle |
$178.91
|
| Rate for Payer: Aetna Commercial |
$233.96
|
| Rate for Payer: Aetna Medicare |
$137.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.91
|
| Rate for Payer: BCBS Complete |
$110.10
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cofinity Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.20
|
| Rate for Payer: Healthscope Commercial |
$247.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.96
|
| Rate for Payer: PHP Commercial |
$233.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.91
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| Rate for Payer: UMR Bronson Commercial |
$101.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.44
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$963.48
|
|
|
Service Code
|
NDC 68094005061
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.93 |
| Max. Negotiated Rate |
$867.13 |
| Rate for Payer: Aetna American Axle |
$626.26
|
| Rate for Payer: Aetna Commercial |
$818.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.26
|
| Rate for Payer: Cash Price |
$770.78
|
| Rate for Payer: Cofinity Commercial |
$674.44
|
| Rate for Payer: Cofinity Commercial |
$828.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$674.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$770.78
|
| Rate for Payer: Healthscope Commercial |
$867.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$674.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$722.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$818.96
|
| Rate for Payer: PHP Commercial |
$818.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.26
|
| Rate for Payer: Priority Health SBD |
$606.99
|
| Rate for Payer: UMR Bronson Commercial |
$423.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$722.61
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$9.64
|
|
|
Service Code
|
NDC 68094005059
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna American Axle |
$6.27
|
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna Medicare |
$4.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.27
|
| Rate for Payer: BCBS Complete |
$3.86
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Cofinity Commercial |
$8.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: PHP Commercial |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.27
|
| Rate for Payer: Priority Health SBD |
$6.07
|
| Rate for Payer: UMR Bronson Commercial |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.23
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 68094005059
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna American Axle |
$6.27
|
| Rate for Payer: Aetna Commercial |
$8.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.27
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Cofinity Commercial |
$8.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: PHP Commercial |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.27
|
| Rate for Payer: Priority Health SBD |
$6.07
|
| Rate for Payer: UMR Bronson Commercial |
$4.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.23
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
IP
|
$275.25
|
|
|
Service Code
|
NDC 62332041510
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.11 |
| Max. Negotiated Rate |
$247.72 |
| Rate for Payer: Aetna American Axle |
$178.91
|
| Rate for Payer: Aetna Commercial |
$233.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.91
|
| Rate for Payer: Cash Price |
$220.20
|
| Rate for Payer: Cofinity Commercial |
$192.68
|
| Rate for Payer: Cofinity Commercial |
$236.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.20
|
| Rate for Payer: Healthscope Commercial |
$247.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.96
|
| Rate for Payer: PHP Commercial |
$233.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.91
|
| Rate for Payer: Priority Health SBD |
$173.41
|
| Rate for Payer: UMR Bronson Commercial |
$121.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.44
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$276.21
|
|
|
Service Code
|
NDC 70710101002
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$248.59 |
| Rate for Payer: Aetna American Axle |
$179.54
|
| Rate for Payer: Aetna Commercial |
$234.78
|
| Rate for Payer: Aetna Medicare |
$138.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.54
|
| Rate for Payer: BCBS Complete |
$110.48
|
| Rate for Payer: Cash Price |
$220.97
|
| Rate for Payer: Cofinity Commercial |
$193.35
|
| Rate for Payer: Cofinity Commercial |
$237.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$193.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.97
|
| Rate for Payer: Healthscope Commercial |
$248.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$193.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.78
|
| Rate for Payer: PHP Commercial |
$234.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.54
|
| Rate for Payer: Priority Health SBD |
$174.01
|
| Rate for Payer: UMR Bronson Commercial |
$102.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.16
|
|
|
OSELTAMIVIR 75 MG CAPSULE
|
Facility
|
OP
|
$53.96
|
|
|
Service Code
|
NDC 68180067711
|
| Hospital Charge Code |
26546
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Aetna American Axle |
$35.07
|
| Rate for Payer: Aetna Commercial |
$45.87
|
| Rate for Payer: Aetna Medicare |
$26.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.07
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: Cash Price |
$43.17
|
| Rate for Payer: Cofinity Commercial |
$37.77
|
| Rate for Payer: Cofinity Commercial |
$46.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.17
|
| Rate for Payer: Healthscope Commercial |
$48.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.87
|
| Rate for Payer: PHP Commercial |
$45.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.07
|
| Rate for Payer: Priority Health SBD |
$33.99
|
| Rate for Payer: UMR Bronson Commercial |
$19.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.47
|
|
|
OSTECTOMY, CALCANEUS;
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28118
|
|
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
|
|
|
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTAR FASCIAL RELEASE
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28119
|
|
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
|
|
|
OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITH PARTIAL PROXIMAL PHALANGECTOMY, EXCLUDING FIRST METATARSAL (EG, CLAYTON TYPE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28114
|
|
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
|
|
|
OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28113
|
|
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
|
|
|
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND, THIRD OR FOURTH)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28112
|
|
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
|
|
|
OSTECTOMY, EXCISION OF TARSAL COALITION
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28116
|
|
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
|
|
|
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28110
|
|
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
|
|
|
OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD
|
Facility
|
OP
|
$8,907.47
|
|
|
Service Code
|
CPT 28288
|
|
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
|
|
|
OSTEOPLASTY, FACIAL BONES; REDUCTION
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 21209
|
|
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
|
|
|
OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 25390
|
|
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
|
|
|
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE), WITH OR WITHOUT INTERNAL FIXATION
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 28300
|
|
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
|
|
|
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION;
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 23480
|
|
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
|
|
|
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITH BONE GRAFT FOR NONUNION OR MALUNION (INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION)
|
Facility
|
OP
|
$35,323.48
|
|
|
Service Code
|
CPT 23485
|
|
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
|
|
