|
UNLISTED PROCEDURE, LEG OR ANKLE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 27899
|
|
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, MALE GENITAL SYSTEM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 55899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$115.81
|
| Rate for Payer: BCN Commercial |
$115.81
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.76
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
UNLISTED PROCEDURE, NERVOUS SYSTEM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 64999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.82 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$123.82
|
| Rate for Payer: BCN Commercial |
$123.82
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.13
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 27299
|
|
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, PHARYNX, ADENOIDS, OR TONSILS
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 42999
|
|
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, RECTUM
|
Facility
|
OP
|
$2,807.55
|
|
|
Service Code
|
CPT 45999
|
|
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, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 17999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.08 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$202.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$243.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$243.35
|
| Rate for Payer: BCBS Complete |
$109.57
|
| Rate for Payer: BCBS MAPPO |
$194.68
|
| Rate for Payer: BCBS Trust/PPO |
$82.08
|
| Rate for Payer: BCN Commercial |
$82.08
|
| Rate for Payer: BCN Medicare Advantage |
$194.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.68
|
| Rate for Payer: Mclaren Medicaid |
$104.35
|
| Rate for Payer: Mclaren Medicare |
$194.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$204.41
|
| Rate for Payer: Meridian Medicaid |
$109.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.88
|
| Rate for Payer: Nomi Health Commercial |
$584.04
|
| Rate for Payer: PACE Medicare |
$184.95
|
| Rate for Payer: PACE SWMI |
$194.68
|
| Rate for Payer: PHP Medicare Advantage |
$194.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$611.90
|
| Rate for Payer: Priority Health Medicare |
$194.68
|
| Rate for Payer: Priority Health Narrow Network |
$489.52
|
| Rate for Payer: Railroad Medicare Medicare |
$194.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.00
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.68
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$194.68
|
| Rate for Payer: UHCCP Medicaid |
$109.60
|
| Rate for Payer: VA VA |
$194.68
|
|
|
UNLISTED PROCEDURE, URINARY SYSTEM
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 53899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$115.81 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$115.81
|
| Rate for Payer: BCN Commercial |
$115.81
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$670.76
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
URETHROLYSIS, TRANSVAGINAL, SECONDARY, OPEN, INCLUDING CYSTOURETHROSCOPY (EG, POSTSURGICAL OBSTRUCTION, SCARRING)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 53500
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$795.18 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.87
|
| Rate for Payer: BCN Commercial |
$1,362.87
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.18
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE PROCEDURE)
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 53460
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$485.32 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$933.97
|
| Rate for Payer: BCN Commercial |
$933.97
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.32
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE
|
Facility
|
OP
|
$10,620.87
|
|
|
Service Code
|
CPT 53502
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.50 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.55
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.50
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Exchange |
$4,450.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE
|
Facility
|
OP
|
$15,654.68
|
|
|
Service Code
|
CPT 53505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$515.17 |
| Max. Negotiated Rate |
$15,654.68 |
| Rate for Payer: Aetna Medicare |
$5,180.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,226.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,226.04
|
| Rate for Payer: BCBS Complete |
$2,803.21
|
| Rate for Payer: BCBS MAPPO |
$4,980.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,555.60
|
| Rate for Payer: BCN Commercial |
$1,555.60
|
| Rate for Payer: BCN Medicare Advantage |
$4,980.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,980.83
|
| Rate for Payer: Mclaren Medicaid |
$2,669.72
|
| Rate for Payer: Mclaren Medicare |
$4,980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,229.87
|
| Rate for Payer: Meridian Medicaid |
$2,803.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,727.95
|
| Rate for Payer: Nomi Health Commercial |
$10,459.74
|
| Rate for Payer: PACE Medicare |
$4,731.79
|
| Rate for Payer: PACE SWMI |
$4,980.83
|
| Rate for Payer: PHP Medicare Advantage |
$4,980.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,669.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,654.68
|
| Rate for Payer: Priority Health Medicare |
$4,980.83
|
| Rate for Payer: Priority Health Narrow Network |
$12,523.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4,980.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.17
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,980.83
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$4,980.83
|
| Rate for Payer: UHCCP Medicaid |
$2,804.21
|
| Rate for Payer: VA VA |
$4,980.83
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
OP
|
$233.33
|
|
|
Service Code
|
NDC 00904689004
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.33 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$198.33
|
| Rate for Payer: Aetna Medicare |
$116.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.66
|
| Rate for Payer: BCBS Complete |
$93.33
|
| Rate for Payer: Cash Price |
$186.66
|
| Rate for Payer: Cofinity Commercial |
$163.33
|
| Rate for Payer: Cofinity Commercial |
$200.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.66
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.33
|
| Rate for Payer: PHP Commercial |
$198.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.66
|
| Rate for Payer: Priority Health SBD |
$147.00
|
|
|
URSODIOL 250 MG TABLET
|
Facility
|
IP
|
$233.33
|
|
|
Service Code
|
NDC 00904689004
|
| Hospital Charge Code |
22660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$198.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.66
|
| Rate for Payer: Cash Price |
$186.66
|
| Rate for Payer: Cofinity Commercial |
$163.33
|
| Rate for Payer: Cofinity Commercial |
$200.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$163.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.66
|
| Rate for Payer: Healthscope Commercial |
$210.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.33
|
| Rate for Payer: PHP Commercial |
$198.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.66
|
| Rate for Payer: Priority Health SBD |
$147.00
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$365.75
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$439.68
|
|
|
Service Code
|
NDC 50268079715
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.00 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Commercial |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.73
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.79
|
| Rate for Payer: Priority Health SBD |
$277.00
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$8.80
|
|
|
Service Code
|
NDC 50268079711
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Cofinity Commercial |
$7.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.48
|
| Rate for Payer: PHP Commercial |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.72
|
| Rate for Payer: Priority Health SBD |
$5.54
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$8.80
|
|
|
Service Code
|
NDC 50268079711
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$7.92 |
| Rate for Payer: Aetna Commercial |
$7.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: Cash Price |
$7.04
|
| Rate for Payer: Cofinity Commercial |
$6.16
|
| Rate for Payer: Cofinity Commercial |
$7.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.04
|
| Rate for Payer: Healthscope Commercial |
$7.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.48
|
| Rate for Payer: PHP Commercial |
$7.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.72
|
| Rate for Payer: Priority Health SBD |
$5.54
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$568.88
|
|
|
Service Code
|
NDC 00904622106
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$358.39 |
| Max. Negotiated Rate |
$511.99 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.77
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cofinity Commercial |
$398.22
|
| Rate for Payer: Cofinity Commercial |
$489.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.10
|
| Rate for Payer: Healthscope Commercial |
$511.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.55
|
| Rate for Payer: PHP Commercial |
$483.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.77
|
| Rate for Payer: Priority Health SBD |
$358.39
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
IP
|
$558.24
|
|
|
Service Code
|
NDC 00527132601
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$351.69 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Commercial |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.59
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.50
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.86
|
| Rate for Payer: Priority Health SBD |
$351.69
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$558.24
|
|
|
Service Code
|
NDC 00527132601
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.30 |
| Max. Negotiated Rate |
$502.42 |
| Rate for Payer: Aetna Commercial |
$474.50
|
| Rate for Payer: Aetna Medicare |
$279.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.86
|
| Rate for Payer: BCBS Complete |
$223.30
|
| Rate for Payer: Cash Price |
$446.59
|
| Rate for Payer: Cofinity Commercial |
$390.77
|
| Rate for Payer: Cofinity Commercial |
$480.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$390.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$446.59
|
| Rate for Payer: Healthscope Commercial |
$502.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474.50
|
| Rate for Payer: PHP Commercial |
$474.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.86
|
| Rate for Payer: Priority Health SBD |
$351.69
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$439.68
|
|
|
Service Code
|
NDC 50268079715
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.87 |
| Max. Negotiated Rate |
$395.71 |
| Rate for Payer: Aetna Commercial |
$373.73
|
| Rate for Payer: Aetna Medicare |
$219.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.79
|
| Rate for Payer: BCBS Complete |
$175.87
|
| Rate for Payer: Cash Price |
$351.74
|
| Rate for Payer: Cofinity Commercial |
$307.78
|
| Rate for Payer: Cofinity Commercial |
$378.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.74
|
| Rate for Payer: Healthscope Commercial |
$395.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.73
|
| Rate for Payer: PHP Commercial |
$373.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.79
|
| Rate for Payer: Priority Health SBD |
$277.00
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$568.88
|
|
|
Service Code
|
NDC 00904622106
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.55 |
| Max. Negotiated Rate |
$511.99 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna Medicare |
$284.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.77
|
| Rate for Payer: BCBS Complete |
$227.55
|
| Rate for Payer: Cash Price |
$455.10
|
| Rate for Payer: Cofinity Commercial |
$398.22
|
| Rate for Payer: Cofinity Commercial |
$489.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$398.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$455.10
|
| Rate for Payer: Healthscope Commercial |
$511.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.55
|
| Rate for Payer: PHP Commercial |
$483.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.77
|
| Rate for Payer: Priority Health SBD |
$358.39
|
|
|
URSODIOL 300 MG CAPSULE
|
Facility
|
OP
|
$365.75
|
|
|
Service Code
|
NDC 42806050301
|
| Hospital Charge Code |
11624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.30 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$310.89
|
| Rate for Payer: Aetna Medicare |
$182.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.74
|
| Rate for Payer: BCBS Complete |
$146.30
|
| Rate for Payer: Cash Price |
$292.60
|
| Rate for Payer: Cofinity Commercial |
$256.02
|
| Rate for Payer: Cofinity Commercial |
$314.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$256.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.60
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.89
|
| Rate for Payer: PHP Commercial |
$310.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.74
|
| Rate for Payer: Priority Health SBD |
$230.42
|
|
|
USTEKINUMAB 130 MG/26 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,511.09
|
|
|
Service Code
|
HCPCS J3358
|
| Hospital Charge Code |
180872
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$4,959.98 |
| Rate for Payer: Aetna Commercial |
$4,684.43
|
| Rate for Payer: Aetna Medicare |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,582.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.95
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS MAPPO |
$12.76
|
| Rate for Payer: BCBS Trust/PPO |
$36.62
|
| Rate for Payer: BCN Commercial |
$36.62
|
| Rate for Payer: BCN Medicare Advantage |
$12.76
|
| Rate for Payer: Cash Price |
$4,408.87
|
| Rate for Payer: Cash Price |
$4,408.87
|
| Rate for Payer: Cofinity Commercial |
$4,739.54
|
| Rate for Payer: Cofinity Commercial |
$3,857.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,857.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,408.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.76
|
| Rate for Payer: Healthscope Commercial |
$4,959.98
|
| Rate for Payer: Mclaren Medicaid |
$6.84
|
| Rate for Payer: Mclaren Medicare |
$12.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.40
|
| Rate for Payer: Meridian Medicaid |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,684.43
|
| Rate for Payer: Nomi Health Commercial |
$38.28
|
| Rate for Payer: PACE Medicare |
$12.12
|
| Rate for Payer: PACE SWMI |
$12.76
|
| Rate for Payer: PHP Commercial |
$4,684.43
|
| Rate for Payer: PHP Medicare Advantage |
$12.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.31
|
| Rate for Payer: Priority Health Medicare |
$12.76
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: Priority Health SBD |
$3,471.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.76
|
| Rate for Payer: UHC Medicare Advantage |
$12.76
|
| Rate for Payer: UHCCP Medicaid |
$7.18
|
| Rate for Payer: VA VA |
$12.76
|
|
