|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$143.40
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,493.37
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,053.37
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: VA VA |
$48.44
|
|
|
LANREOTIDE 120 MG/0.5 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$42,933.38
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27,048.03 |
| Max. Negotiated Rate |
$38,640.04 |
| Rate for Payer: Aetna Commercial |
$36,493.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,906.70
|
| Rate for Payer: Cash Price |
$34,346.70
|
| Rate for Payer: Cofinity Commercial |
$30,053.37
|
| Rate for Payer: Cofinity Commercial |
$36,922.71
|
| Rate for Payer: Healthscope Commercial |
$38,640.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36,493.37
|
| Rate for Payer: PHP Commercial |
$36,493.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30,053.37
|
| Rate for Payer: Priority Health SBD |
$27,048.03
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17,221.13 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,234.85
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,134.58
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
|
|
LANREOTIDE 60 MG/0.2 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$27,335.12
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
88570
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$24,601.61 |
| Rate for Payer: Aetna Commercial |
$23,234.85
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,767.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$143.40
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cash Price |
$21,868.10
|
| Rate for Payer: Cofinity Commercial |
$23,508.20
|
| Rate for Payer: Cofinity Commercial |
$19,134.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$24,601.61
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23,234.85
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$23,234.85
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,134.58
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health SBD |
$17,221.13
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: VA VA |
$48.44
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,280.91 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,918.69
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,756.57
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
|
|
LANREOTIDE 90 MG/0.3 ML SUBCUTANEOUS SYRINGE
|
Facility
|
OP
|
$21,080.81
|
|
|
Service Code
|
HCPCS J1930
|
| Hospital Charge Code |
87860
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$18,972.73 |
| Rate for Payer: Aetna Commercial |
$17,918.69
|
| Rate for Payer: Aetna Medicare |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,702.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.55
|
| Rate for Payer: BCBS Complete |
$27.83
|
| Rate for Payer: BCBS MAPPO |
$48.44
|
| Rate for Payer: BCBS Trust/PPO |
$143.40
|
| Rate for Payer: BCN Medicare Advantage |
$48.44
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cash Price |
$16,864.65
|
| Rate for Payer: Cofinity Commercial |
$18,129.50
|
| Rate for Payer: Cofinity Commercial |
$14,756.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.44
|
| Rate for Payer: Healthscope Commercial |
$18,972.73
|
| Rate for Payer: Mclaren Medicaid |
$26.50
|
| Rate for Payer: Mclaren Medicare |
$48.44
|
| Rate for Payer: Meridian Medicaid |
$27.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17,918.69
|
| Rate for Payer: PACE Medicare |
$46.02
|
| Rate for Payer: PACE SWMI |
$48.44
|
| Rate for Payer: PHP Commercial |
$17,918.69
|
| Rate for Payer: PHP Medicare Advantage |
$48.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,756.57
|
| Rate for Payer: Priority Health Medicare |
$48.44
|
| Rate for Payer: Priority Health SBD |
$13,280.91
|
| Rate for Payer: Railroad Medicare Medicare |
$48.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.90
|
| Rate for Payer: VA VA |
$48.44
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
NDC 0378-6982-32
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.06
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.76
|
| Rate for Payer: Priority Health SBD |
$9.68
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$1,536.61
|
|
|
Service Code
|
NDC 0378-6982-88
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$1,382.95 |
| Rate for Payer: Aetna Commercial |
$1,306.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.80
|
| Rate for Payer: Cash Price |
$1,229.29
|
| Rate for Payer: Cofinity Commercial |
$1,075.63
|
| Rate for Payer: Cofinity Commercial |
$1,321.48
|
| Rate for Payer: Healthscope Commercial |
$1,382.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,306.12
|
| Rate for Payer: PHP Commercial |
$1,306.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.63
|
| Rate for Payer: Priority Health SBD |
$968.06
|
|
|
LANSOPRAZOLE 30 MG DELAYED RELEASE,DISINTEGRATING TABLET
|
Facility
|
IP
|
$768.31
|
|
|
Service Code
|
NDC 0378-6982-85
|
| Hospital Charge Code |
34595
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$484.04 |
| Max. Negotiated Rate |
$691.48 |
| Rate for Payer: Aetna Commercial |
$653.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.40
|
| Rate for Payer: Cash Price |
$614.65
|
| Rate for Payer: Cofinity Commercial |
$537.82
|
| Rate for Payer: Cofinity Commercial |
$660.75
|
| Rate for Payer: Healthscope Commercial |
$691.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$653.06
|
| Rate for Payer: PHP Commercial |
$653.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.82
|
| Rate for Payer: Priority Health SBD |
$484.04
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$29,624.89
|
|
|
Service Code
|
MS-DRG 418
|
| Min. Negotiated Rate |
$11,652.23 |
| Max. Negotiated Rate |
$29,624.89 |
| Rate for Payer: Aetna Medicare |
$12,756.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,331.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,331.89
|
| Rate for Payer: BCBS MAPPO |
$12,265.51
|
| Rate for Payer: BCBS Trust/PPO |
$29,624.89
|
| Rate for Payer: BCN Medicare Advantage |
$12,265.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,265.51
|
| Rate for Payer: Mclaren Medicare |
$12,265.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,878.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,105.34
|
| Rate for Payer: PACE Medicare |
$11,652.23
|
| Rate for Payer: PACE SWMI |
$12,265.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,265.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,457.81
|
| Rate for Payer: Priority Health Medicare |
$12,265.51
|
| Rate for Payer: Priority Health Narrow Network |
$18,766.25
|
| Rate for Payer: Railroad Medicare Medicare |
$12,265.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,935.71
|
| Rate for Payer: UHC Core |
$15,300.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$12,265.51
|
| Rate for Payer: UHC Exchange |
$16,387.87
|
| Rate for Payer: UHC Medicare Advantage |
$12,633.48
|
| Rate for Payer: VA VA |
$12,265.51
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$35,355.72
|
|
|
Service Code
|
MS-DRG 417
|
| Min. Negotiated Rate |
$16,325.79 |
| Max. Negotiated Rate |
$35,355.72 |
| Rate for Payer: Aetna Medicare |
$17,872.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,481.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,481.30
|
| Rate for Payer: BCBS MAPPO |
$17,185.04
|
| Rate for Payer: BCBS Trust/PPO |
$32,657.42
|
| Rate for Payer: BCN Medicare Advantage |
$17,185.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,185.04
|
| Rate for Payer: Mclaren Medicare |
$17,185.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,044.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19,762.80
|
| Rate for Payer: PACE Medicare |
$16,325.79
|
| Rate for Payer: PACE SWMI |
$17,185.04
|
| Rate for Payer: PHP Medicare Advantage |
$17,185.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,260.24
|
| Rate for Payer: Priority Health Medicare |
$17,185.04
|
| Rate for Payer: Priority Health Narrow Network |
$26,608.19
|
| Rate for Payer: Railroad Medicare Medicare |
$17,185.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,355.72
|
| Rate for Payer: UHC Core |
$21,694.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,185.04
|
| Rate for Payer: UHC Exchange |
$23,235.95
|
| Rate for Payer: UHC Medicare Advantage |
$17,700.59
|
| Rate for Payer: VA VA |
$17,185.04
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$26,416.68
|
|
|
Service Code
|
MS-DRG 419
|
| Min. Negotiated Rate |
$9,452.63 |
| Max. Negotiated Rate |
$26,416.68 |
| Rate for Payer: Aetna Medicare |
$10,348.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,437.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,437.68
|
| Rate for Payer: BCBS MAPPO |
$9,950.14
|
| Rate for Payer: BCBS Trust/PPO |
$26,416.68
|
| Rate for Payer: BCN Medicare Advantage |
$9,950.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,950.14
|
| Rate for Payer: Mclaren Medicare |
$9,950.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,447.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,442.66
|
| Rate for Payer: PACE Medicare |
$9,452.63
|
| Rate for Payer: PACE SWMI |
$9,950.14
|
| Rate for Payer: PHP Medicare Advantage |
$9,950.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,844.31
|
| Rate for Payer: Priority Health Medicare |
$9,950.14
|
| Rate for Payer: Priority Health Narrow Network |
$15,075.45
|
| Rate for Payer: Railroad Medicare Medicare |
$9,950.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,031.55
|
| Rate for Payer: UHC Core |
$12,291.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,950.14
|
| Rate for Payer: UHC Exchange |
$13,164.83
|
| Rate for Payer: UHC Medicare Advantage |
$10,248.64
|
| Rate for Payer: VA VA |
$9,950.14
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$15,628.84
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.52 |
| Max. Negotiated Rate |
$15,628.84 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,628.84
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,503.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$865.17
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$786.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$15,628.84
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.49 |
| Max. Negotiated Rate |
$15,628.84 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.71
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,628.84
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,503.07
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$846.44
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$769.49
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$325.48 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,308.45
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.03
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$325.48
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; ABLATION OF RENAL MASS LESION(S), INCLUDING INTRAOPERATIVE ULTRASOUND GUIDANCE AND MONITORING, WHEN PERFORMED
|
Facility
|
OP
|
$27,732.34
|
|
|
Service Code
|
CPT 50542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,130.33 |
| Max. Negotiated Rate |
$27,732.34 |
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,628.05
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,732.34
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Priority Health Narrow Network |
$22,185.87
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,243.36
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,130.33
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.29 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,816.89
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.82
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$595.29
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.26 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,812.53
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.49
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$652.26
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.91 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,060.26
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.80
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$708.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 47564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.84 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.05
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,212.02
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,101.84
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 57425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$958.10 |
| Max. Negotiated Rate |
$11,449.09 |
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$5,451.62
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,053.91
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$958.10
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 44180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$904.39 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,655.79
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.83
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$904.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
|
Facility
|
OP
|
$27,248.64
|
|
|
Service Code
|
CPT 43280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,058.29 |
| Max. Negotiated Rate |
$27,248.64 |
| Rate for Payer: Aetna Medicare |
$9,525.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,449.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,449.09
|
| Rate for Payer: BCBS Complete |
$5,261.08
|
| Rate for Payer: BCBS MAPPO |
$9,159.27
|
| Rate for Payer: BCBS Trust/PPO |
$4,008.79
|
| Rate for Payer: BCN Medicare Advantage |
$9,159.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,159.27
|
| Rate for Payer: Mclaren Medicaid |
$5,010.12
|
| Rate for Payer: Mclaren Medicare |
$9,159.27
|
| Rate for Payer: Meridian Medicaid |
$5,261.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,617.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,533.16
|
| Rate for Payer: PACE Medicare |
$8,701.31
|
| Rate for Payer: PACE SWMI |
$9,159.27
|
| Rate for Payer: PHP Medicare Advantage |
$9,159.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,010.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,248.64
|
| Rate for Payer: Priority Health Medicare |
$9,159.27
|
| Rate for Payer: Priority Health Narrow Network |
$21,798.91
|
| Rate for Payer: Railroad Medicare Medicare |
$9,159.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.12
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,058.29
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 44186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.44 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,185.80
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.68
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$642.44
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$890.31 |
| Max. Negotiated Rate |
$15,754.72 |
| Rate for Payer: Aetna Medicare |
$5,339.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,417.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,417.61
|
| Rate for Payer: BCBS Complete |
$2,949.02
|
| Rate for Payer: BCBS MAPPO |
$5,134.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,970.01
|
| Rate for Payer: BCN Medicare Advantage |
$5,134.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,134.09
|
| Rate for Payer: Mclaren Medicaid |
$2,808.35
|
| Rate for Payer: Mclaren Medicare |
$5,134.09
|
| Rate for Payer: Meridian Medicaid |
$2,949.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,390.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,904.20
|
| Rate for Payer: PACE Medicare |
$4,877.39
|
| Rate for Payer: PACE SWMI |
$5,134.09
|
| Rate for Payer: PHP Medicare Advantage |
$5,134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,808.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,754.72
|
| Rate for Payer: Priority Health Medicare |
$5,134.09
|
| Rate for Payer: Priority Health Narrow Network |
$12,603.78
|
| Rate for Payer: Railroad Medicare Medicare |
$5,134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.34
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$890.31
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
