|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,680.93
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$588.09 |
| Max. Negotiated Rate |
$9,680.93 |
| Rate for Payer: Aetna Medicare |
$3,198.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,844.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,844.02
|
| Rate for Payer: BCBS Complete |
$1,766.41
|
| Rate for Payer: BCBS MAPPO |
$3,075.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.25
|
| Rate for Payer: BCN Medicare Advantage |
$3,075.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,075.22
|
| Rate for Payer: Mclaren Medicaid |
$1,682.15
|
| Rate for Payer: Mclaren Medicare |
$3,075.22
|
| Rate for Payer: Meridian Medicaid |
$1,766.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,228.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,536.50
|
| Rate for Payer: PACE Medicare |
$2,921.46
|
| Rate for Payer: PACE SWMI |
$3,075.22
|
| Rate for Payer: PHP Medicare Advantage |
$3,075.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,682.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,680.93
|
| Rate for Payer: Priority Health Medicare |
$3,075.22
|
| Rate for Payer: Priority Health Narrow Network |
$7,744.74
|
| Rate for Payer: Railroad Medicare Medicare |
$3,075.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.90
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,075.22
|
| Rate for Payer: UHC Exchange |
$588.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,167.48
|
| Rate for Payer: VA VA |
$3,075.22
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$108.71
|
|
|
Service Code
|
NDC 0173-0873-06
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.83 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna American Axle |
$70.66
|
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.66
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.97
|
| Rate for Payer: Healthscope Commercial |
$97.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$92.40
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.10
|
| Rate for Payer: Priority Health SBD |
$68.49
|
| Rate for Payer: UMR Bronson Commercial |
$47.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.53
|
|
|
UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION
|
Facility
|
IP
|
$211.30
|
|
|
Service Code
|
NDC 0173-0869-06
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.97 |
| Max. Negotiated Rate |
$190.17 |
| Rate for Payer: Aetna American Axle |
$137.34
|
| Rate for Payer: Aetna Commercial |
$179.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.34
|
| Rate for Payer: Cash Price |
$169.04
|
| Rate for Payer: Cofinity Commercial |
$147.91
|
| Rate for Payer: Cofinity Commercial |
$181.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.04
|
| Rate for Payer: Healthscope Commercial |
$190.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$179.60
|
| Rate for Payer: PHP Commercial |
$179.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.91
|
| Rate for Payer: Priority Health SBD |
$133.12
|
| Rate for Payer: UMR Bronson Commercial |
$92.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.48
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$22,281.88
|
|
|
Service Code
|
MS-DRG 383
|
| Min. Negotiated Rate |
$10,722.57 |
| Max. Negotiated Rate |
$22,281.88 |
| Rate for Payer: Aetna Medicare |
$11,738.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,108.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,108.65
|
| Rate for Payer: BCBS MAPPO |
$11,286.92
|
| Rate for Payer: BCBS Trust/PPO |
$22,281.88
|
| Rate for Payer: BCN Medicare Advantage |
$11,286.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,286.92
|
| Rate for Payer: Mclaren Medicare |
$11,286.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,851.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,979.96
|
| Rate for Payer: PACE Medicare |
$10,722.57
|
| Rate for Payer: PACE SWMI |
$11,286.92
|
| Rate for Payer: PHP Medicare Advantage |
$11,286.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,064.06
|
| Rate for Payer: Priority Health Medicare |
$11,286.92
|
| Rate for Payer: Priority Health Narrow Network |
$16,051.25
|
| Rate for Payer: Railroad Medicare Medicare |
$11,286.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,328.14
|
| Rate for Payer: UHC Core |
$17,488.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,286.92
|
| Rate for Payer: UHC Exchange |
$13,903.70
|
| Rate for Payer: UHC Medicare Advantage |
$11,625.53
|
| Rate for Payer: VA VA |
$11,286.92
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$13,954.13
|
|
|
Service Code
|
MS-DRG 384
|
| Min. Negotiated Rate |
$6,897.50 |
| Max. Negotiated Rate |
$13,954.13 |
| Rate for Payer: Aetna Medicare |
$7,550.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,075.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,075.66
|
| Rate for Payer: BCBS MAPPO |
$7,260.53
|
| Rate for Payer: BCBS Trust/PPO |
$13,954.13
|
| Rate for Payer: BCN Medicare Advantage |
$7,260.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,260.53
|
| Rate for Payer: Mclaren Medicare |
$7,260.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,623.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,349.61
|
| Rate for Payer: PACE Medicare |
$6,897.50
|
| Rate for Payer: PACE SWMI |
$7,260.53
|
| Rate for Payer: PHP Medicare Advantage |
$7,260.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,566.22
|
| Rate for Payer: Priority Health Medicare |
$7,260.53
|
| Rate for Payer: Priority Health Narrow Network |
$10,052.98
|
| Rate for Payer: Railroad Medicare Medicare |
$7,260.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,357.93
|
| Rate for Payer: UHC Core |
$10,953.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,260.53
|
| Rate for Payer: UHC Exchange |
$8,707.96
|
| Rate for Payer: UHC Medicare Advantage |
$7,478.35
|
| Rate for Payer: VA VA |
$7,260.53
|
|
|
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$96.88 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$184.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.40
|
| Rate for Payer: BCBS Complete |
$101.74
|
| Rate for Payer: BCBS MAPPO |
$177.12
|
| Rate for Payer: BCBS Trust/PPO |
$135.54
|
| Rate for Payer: BCN Medicare Advantage |
$177.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.12
|
| Rate for Payer: Mclaren Medicaid |
$96.88
|
| Rate for Payer: Mclaren Medicare |
$177.12
|
| Rate for Payer: Meridian Medicaid |
$101.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.69
|
| Rate for Payer: PACE Medicare |
$168.26
|
| Rate for Payer: PACE SWMI |
$177.12
|
| Rate for Payer: PHP Medicare Advantage |
$177.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$557.61
|
| Rate for Payer: Priority Health Medicare |
$177.12
|
| Rate for Payer: Priority Health Narrow Network |
$446.09
|
| Rate for Payer: Railroad Medicare Medicare |
$177.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.12
|
| Rate for Payer: UHC Medicare Advantage |
$182.43
|
| Rate for Payer: VA VA |
$177.12
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,844.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 44979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 47579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 51999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 44238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 38589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 45499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 43659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, URETER
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 50949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58578
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,805.46 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 22999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$177.95
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.87
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$527.90
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.62
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
|
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$2,536.56
|
|
|
Service Code
|
CPT 49999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$440.75 |
| Max. Negotiated Rate |
$2,536.56 |
| Rate for Payer: Aetna Medicare |
$837.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,007.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,007.19
|
| Rate for Payer: BCBS Complete |
$462.82
|
| Rate for Payer: BCBS MAPPO |
$805.75
|
| Rate for Payer: BCBS Trust/PPO |
$623.16
|
| Rate for Payer: BCN Medicare Advantage |
$805.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.75
|
| Rate for Payer: Mclaren Medicaid |
$440.75
|
| Rate for Payer: Mclaren Medicare |
$805.75
|
| Rate for Payer: Meridian Medicaid |
$462.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$846.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$926.61
|
| Rate for Payer: PACE Medicare |
$765.46
|
| Rate for Payer: PACE SWMI |
$805.75
|
| Rate for Payer: PHP Medicare Advantage |
$805.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$440.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,536.56
|
| Rate for Payer: Priority Health Medicare |
$805.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.25
|
| Rate for Payer: Railroad Medicare Medicare |
$805.75
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.75
|
| Rate for Payer: UHC Medicare Advantage |
$829.92
|
| Rate for Payer: VA VA |
$805.75
|
|
|
UNLISTED PROCEDURE, ACCESSORY SINUSES
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 31299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$118.76 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$225.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.40
|
| Rate for Payer: BCBS Complete |
$124.71
|
| Rate for Payer: BCBS MAPPO |
$217.12
|
| Rate for Payer: BCBS Trust/PPO |
$157.70
|
| Rate for Payer: BCN Medicare Advantage |
$217.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.12
|
| Rate for Payer: Mclaren Medicaid |
$118.76
|
| Rate for Payer: Mclaren Medicare |
$217.12
|
| Rate for Payer: Meridian Medicaid |
$124.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$227.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.69
|
| Rate for Payer: PACE Medicare |
$206.26
|
| Rate for Payer: PACE SWMI |
$217.12
|
| Rate for Payer: PHP Medicare Advantage |
$217.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.51
|
| Rate for Payer: Priority Health Medicare |
$217.12
|
| Rate for Payer: Priority Health Narrow Network |
$546.81
|
| Rate for Payer: Railroad Medicare Medicare |
$217.12
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.12
|
| Rate for Payer: UHC Medicare Advantage |
$223.63
|
| Rate for Payer: VA VA |
$217.12
|
|
|
UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
|
Facility
|
OP
|
$6,520.89
|
|
|
Service Code
|
CPT 66999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.06 |
| Max. Negotiated Rate |
$6,520.89 |
| Rate for Payer: Aetna Medicare |
$2,154.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,589.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,589.26
|
| Rate for Payer: BCBS Complete |
$1,189.82
|
| Rate for Payer: BCBS MAPPO |
$2,071.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,624.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,071.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,071.41
|
| Rate for Payer: Mclaren Medicaid |
$1,133.06
|
| Rate for Payer: Mclaren Medicare |
$2,071.41
|
| Rate for Payer: Meridian Medicaid |
$1,189.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,174.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,382.12
|
| Rate for Payer: PACE Medicare |
$1,967.84
|
| Rate for Payer: PACE SWMI |
$2,071.41
|
| Rate for Payer: PHP Medicare Advantage |
$2,071.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,133.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,520.89
|
| Rate for Payer: Priority Health Medicare |
$2,071.41
|
| Rate for Payer: Priority Health Narrow Network |
$5,216.71
|
| Rate for Payer: Railroad Medicare Medicare |
$2,071.41
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,071.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,133.55
|
| Rate for Payer: VA VA |
$2,071.41
|
|
|
UNLISTED PROCEDURE, ANUS
|
Facility
|
OP
|
$2,557.47
|
|
|
Service Code
|
CPT 46999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$444.38 |
| Max. Negotiated Rate |
$2,557.47 |
| Rate for Payer: Aetna Medicare |
$844.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,015.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,015.50
|
| Rate for Payer: BCBS Complete |
$466.64
|
| Rate for Payer: BCBS MAPPO |
$812.40
|
| Rate for Payer: BCBS Trust/PPO |
$594.57
|
| Rate for Payer: BCN Medicare Advantage |
$812.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.40
|
| Rate for Payer: Mclaren Medicaid |
$444.38
|
| Rate for Payer: Mclaren Medicare |
$812.40
|
| Rate for Payer: Meridian Medicaid |
$466.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$934.26
|
| Rate for Payer: PACE Medicare |
$771.78
|
| Rate for Payer: PACE SWMI |
$812.40
|
| Rate for Payer: PHP Medicare Advantage |
$812.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,557.47
|
| Rate for Payer: Priority Health Medicare |
$812.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,045.98
|
| Rate for Payer: Railroad Medicare Medicare |
$812.40
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.40
|
| Rate for Payer: UHC Medicare Advantage |
$836.77
|
| Rate for Payer: VA VA |
$812.40
|
|
|
UNLISTED PROCEDURE, ARTHROSCOPY
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 29999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.02
|
| Rate for Payer: BCBS Complete |
$120.41
|
| Rate for Payer: BCBS MAPPO |
$209.62
|
| Rate for Payer: BCBS Trust/PPO |
$555.14
|
| Rate for Payer: BCN Medicare Advantage |
$209.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.62
|
| Rate for Payer: Mclaren Medicaid |
$114.66
|
| Rate for Payer: Mclaren Medicare |
$209.62
|
| Rate for Payer: Meridian Medicaid |
$120.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.06
|
| Rate for Payer: PACE Medicare |
$199.14
|
| Rate for Payer: PACE SWMI |
$209.62
|
| Rate for Payer: PHP Medicare Advantage |
$209.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$659.87
|
| Rate for Payer: Priority Health Medicare |
$209.62
|
| Rate for Payer: Priority Health Narrow Network |
$527.90
|
| Rate for Payer: Railroad Medicare Medicare |
$209.62
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.62
|
| Rate for Payer: UHC Medicare Advantage |
$215.91
|
| Rate for Payer: VA VA |
$209.62
|
|
