|
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,096.93 |
| 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 |
$5,680.47
|
| 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) |
$1,206.62
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,096.93
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; ORCHIECTOMY
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 54690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.79 |
| 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 |
$2,064.84
|
| 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) |
$705.97
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$641.79
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
|
Facility
|
OP
|
$27,732.34
|
|
|
Service Code
|
CPT 50543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,449.59 |
| 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 |
$5,646.33
|
| 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) |
$1,594.55
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,449.59
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 55866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.40 |
| 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 |
$6,088.47
|
| 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) |
$1,279.74
|
| Rate for Payer: UHC Core |
$8,819.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,163.40
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; PYELOPLASTY
|
Facility
|
OP
|
$27,732.34
|
|
|
Service Code
|
CPT 50544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,205.31 |
| 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 |
$5,932.54
|
| 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) |
$1,325.84
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,205.31
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.60 |
| 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 |
$3,107.98
|
| 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) |
$472.56
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$429.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH
|
Facility
|
OP
|
$27,248.64
|
|
|
Service Code
|
CPT 43282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,694.18 |
| 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 |
$4,351.33
|
| 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) |
$1,863.60
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,694.18
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$560.58 |
| 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 |
$3,283.75
|
| 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) |
$616.64
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$721.68 |
| 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 |
$2,170.58
|
| 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) |
$793.85
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$721.68
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.01 |
| 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 |
$2,223.72
|
| 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) |
$407.01
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$370.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 38571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.35 |
| 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 |
$4,301.49
|
| 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) |
$712.08
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$647.35
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.21 |
| 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 |
$2,906.36
|
| 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) |
$374.23
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$340.21
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.37 |
| 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 |
$1,915.39
|
| 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) |
$405.21
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$368.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.33 |
| 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 |
$2,717.21
|
| 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) |
$774.76
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$704.33
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$380.82 |
| 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 |
$2,758.99
|
| 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) |
$418.90
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$380.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$676.17 |
| 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 |
$2,569.10
|
| 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) |
$743.79
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$676.17
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.42 |
| 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 |
$2,695.79
|
| 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) |
$707.76
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$643.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 38570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$508.52 |
| 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 |
$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 |
$15,754.72
|
| 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) |
$559.37
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$508.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 49325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$406.03 |
| 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 |
$1,769.86
|
| 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) |
$446.63
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$406.03
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$797.65 |
| 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 |
$3,789.97
|
| 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) |
$877.42
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$797.65
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$898.17 |
| 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 |
$4,021.11
|
| 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) |
$987.99
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$898.17
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G;
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,000.66 |
| 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 |
$3,375.08
|
| 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) |
$1,100.73
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,000.66
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,202.37 |
| 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 |
$5,167.49
|
| 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) |
$1,322.61
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$1,202.37
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$15,754.72
|
|
|
Service Code
|
CPT 58550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$871.00 |
| 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 |
$3,865.17
|
| 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) |
$958.10
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,134.09
|
| Rate for Payer: UHC Exchange |
$871.00
|
| Rate for Payer: UHC Medicare Advantage |
$5,288.11
|
| Rate for Payer: VA VA |
$5,134.09
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$11,449.09
|
|
|
Service Code
|
CPT 58552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$967.26 |
| 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 |
$3,870.83
|
| 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) |
$1,063.99
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,159.27
|
| Rate for Payer: UHC Exchange |
$967.26
|
| Rate for Payer: UHC Medicare Advantage |
$9,434.05
|
| Rate for Payer: VA VA |
$9,159.27
|
|
