|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$123.70
|
|
|
Service Code
|
NDC 50102091101
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$111.33 |
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.40
|
| Rate for Payer: Cash Price |
$98.96
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Cofinity Commercial |
$106.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.96
|
| Rate for Payer: Healthscope Commercial |
$111.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.14
|
| Rate for Payer: PHP Commercial |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.40
|
| Rate for Payer: Priority Health SBD |
$77.93
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.49 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.66
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.40
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.66
|
| Rate for Payer: Priority Health SBD |
$68.49
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.48 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna Medicare |
$54.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.66
|
| Rate for Payer: BCBS Complete |
$43.48
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.40
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.66
|
| Rate for Payer: Priority Health SBD |
$68.49
|
|
|
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 58579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$81.58
|
| Rate for Payer: BCN Commercial |
$81.58
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$110.97
|
| Rate for Payer: VA VA |
$197.10
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,314.15 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,314.15
|
| Rate for Payer: BCN Commercial |
$2,314.15
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 51999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 49659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 58679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, RENAL
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 50549
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 55559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 43659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, URETER
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 50949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 58578
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.84 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,250.84
|
| Rate for Payer: BCN Commercial |
$2,250.84
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$7,322.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 22999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.11 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$107.11
|
| Rate for Payer: BCN Commercial |
$107.11
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$132.32
|
| Rate for Payer: VA VA |
$235.03
|
|
|
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$3,362.00
|
|
|
Service Code
|
CPT 49999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.10 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Medicare |
$955.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,148.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,148.25
|
| Rate for Payer: BCBS Complete |
$516.99
|
| Rate for Payer: BCBS MAPPO |
$918.60
|
| Rate for Payer: BCBS Trust/PPO |
$375.10
|
| Rate for Payer: BCN Commercial |
$375.10
|
| Rate for Payer: BCN Medicare Advantage |
$918.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.60
|
| Rate for Payer: Mclaren Medicaid |
$492.37
|
| Rate for Payer: Mclaren Medicare |
$918.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.53
|
| Rate for Payer: Meridian Medicaid |
$516.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,056.39
|
| Rate for Payer: Nomi Health Commercial |
$1,929.06
|
| Rate for Payer: PACE Medicare |
$872.67
|
| Rate for Payer: PACE SWMI |
$918.60
|
| Rate for Payer: PHP Medicare Advantage |
$918.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,887.15
|
| Rate for Payer: Priority Health Medicare |
$918.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,309.72
|
| Rate for Payer: Railroad Medicare Medicare |
$918.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,585.77
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.60
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$918.60
|
| Rate for Payer: UHCCP Medicaid |
$517.17
|
| Rate for Payer: VA VA |
$918.60
|
|
|
UNLISTED PROCEDURE, ANUS
|
Facility
|
OP
|
$2,807.55
|
|
|
Service Code
|
CPT 46999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$2,807.55 |
| Rate for Payer: Aetna Medicare |
$929.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$357.88
|
| Rate for Payer: BCN Commercial |
$357.88
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Nomi Health Commercial |
$1,875.89
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,807.55
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,246.04
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,514.49
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$502.92
|
| Rate for Payer: VA VA |
$893.28
|
|
|
UNLISTED PROCEDURE, ARTHROSCOPY
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 29999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$125.98 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$334.15
|
| Rate for Payer: BCN Commercial |
$334.15
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$132.32
|
| Rate for Payer: VA VA |
$235.03
|
|
|
UNLISTED PROCEDURE, BREAST
|
Facility
|
OP
|
$11,792.02
|
|
|
Service Code
|
CPT 19499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,339.79 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.79
|
| Rate for Payer: BCN Commercial |
$1,339.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,561.08
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,112.29
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
UNLISTED PROCEDURE, EXTERNAL EAR
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 69399
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$236.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$284.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$284.40
|
| Rate for Payer: BCBS Complete |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$227.52
|
| Rate for Payer: BCBS Trust/PPO |
$94.93
|
| Rate for Payer: BCN Commercial |
$94.93
|
| Rate for Payer: BCN Medicare Advantage |
$227.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.52
|
| Rate for Payer: Mclaren Medicaid |
$121.95
|
| Rate for Payer: Mclaren Medicare |
$227.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.90
|
| Rate for Payer: Meridian Medicaid |
$128.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.65
|
| Rate for Payer: Nomi Health Commercial |
$477.79
|
| Rate for Payer: PACE Medicare |
$216.14
|
| Rate for Payer: PACE SWMI |
$227.52
|
| Rate for Payer: PHP Medicare Advantage |
$227.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.11
|
| Rate for Payer: Priority Health Medicare |
$227.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.09
|
| Rate for Payer: Railroad Medicare Medicare |
$227.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.45
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.52
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$227.52
|
| Rate for Payer: UHCCP Medicaid |
$128.09
|
| Rate for Payer: VA VA |
$227.52
|
|
|
UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 58999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.58 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$81.58
|
| Rate for Payer: BCN Commercial |
$81.58
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.82
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$110.97
|
| Rate for Payer: VA VA |
$197.10
|
|
|
UNLISTED PROCEDURE, FEMUR OR KNEE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 27599
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.11 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$107.11
|
| Rate for Payer: BCN Commercial |
$107.11
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$132.32
|
| Rate for Payer: VA VA |
$235.03
|
|
|
UNLISTED PROCEDURE, FOREARM OR WRIST
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 25999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$107.11 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$244.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$293.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$293.79
|
| Rate for Payer: BCBS Complete |
$132.27
|
| Rate for Payer: BCBS MAPPO |
$235.03
|
| Rate for Payer: BCBS Trust/PPO |
$107.11
|
| Rate for Payer: BCN Commercial |
$107.11
|
| Rate for Payer: BCN Medicare Advantage |
$235.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.03
|
| Rate for Payer: Mclaren Medicaid |
$125.98
|
| Rate for Payer: Mclaren Medicare |
$235.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$246.78
|
| Rate for Payer: Meridian Medicaid |
$132.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$270.28
|
| Rate for Payer: Nomi Health Commercial |
$493.56
|
| Rate for Payer: PACE Medicare |
$223.28
|
| Rate for Payer: PACE SWMI |
$235.03
|
| Rate for Payer: PHP Medicare Advantage |
$235.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$738.70
|
| Rate for Payer: Priority Health Medicare |
$235.03
|
| Rate for Payer: Priority Health Narrow Network |
$590.96
|
| Rate for Payer: Railroad Medicare Medicare |
$235.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.59
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.03
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$235.03
|
| Rate for Payer: UHCCP Medicaid |
$132.32
|
| Rate for Payer: VA VA |
$235.03
|
|
