|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69644
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,794.32
|
| Rate for Payer: BCN Commercial |
$4,794.32
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69643
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,634.48
|
| Rate for Payer: BCN Commercial |
$4,634.48
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$8,928.43
|
| Rate for Payer: BCN Commercial |
$8,928.43
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS (EG, PARTIAL OSSICULAR REPLACEMENT PROSTHESIS [PORP], TOTAL OSSICULAR REPLACEMENT PROSTHESIS [TORP])
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$6,700.16
|
| Rate for Payer: BCN Commercial |
$6,700.16
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION (EG, POSTFENESTRATION)
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$5,791.31
|
| Rate for Payer: BCN Commercial |
$5,791.31
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$19,075.37
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,084.94 |
| Max. Negotiated Rate |
$19,075.37 |
| Rate for Payer: Aetna Medicare |
$6,134.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,373.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,373.18
|
| Rate for Payer: BCBS Complete |
$3,239.48
|
| Rate for Payer: BCBS MAPPO |
$5,898.54
|
| Rate for Payer: BCBS Trust/PPO |
$7,289.10
|
| Rate for Payer: BCN Commercial |
$7,289.10
|
| Rate for Payer: BCN Medicare Advantage |
$5,898.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,898.54
|
| Rate for Payer: Mclaren Medicaid |
$5,898.54
|
| Rate for Payer: Mclaren Medicare |
$5,898.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,193.47
|
| Rate for Payer: Meridian Medicaid |
$6,193.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,783.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,488.39
|
| Rate for Payer: Nomi Health Commercial |
$17,695.62
|
| Rate for Payer: PACE Medicare |
$5,603.61
|
| Rate for Payer: PACE SWMI |
$5,898.54
|
| Rate for Payer: PHP Medicare Advantage |
$5,898.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,084.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,075.37
|
| Rate for Payer: Priority Health Medicare |
$5,898.54
|
| Rate for Payer: Priority Health Tiered Network |
$15,260.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5,898.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,898.54
|
| Rate for Payer: UHC Medicaid |
$3,084.94
|
| Rate for Payer: UHCCP Medicaid |
$3,084.94
|
| Rate for Payer: VA VA |
$5,898.54
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,999.64
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.56 |
| Max. Negotiated Rate |
$4,999.64 |
| Rate for Payer: Aetna Medicare |
$1,607.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,932.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,932.50
|
| Rate for Payer: BCBS Complete |
$849.06
|
| Rate for Payer: BCBS MAPPO |
$1,546.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,211.82
|
| Rate for Payer: BCN Commercial |
$2,211.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.00
|
| Rate for Payer: Mclaren Medicaid |
$1,546.00
|
| Rate for Payer: Mclaren Medicare |
$1,546.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.30
|
| Rate for Payer: Meridian Medicaid |
$1,623.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,777.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,700.60
|
| Rate for Payer: Nomi Health Commercial |
$4,638.00
|
| Rate for Payer: PACE Medicare |
$1,468.70
|
| Rate for Payer: PACE SWMI |
$1,546.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,999.64
|
| Rate for Payer: Priority Health Medicare |
$1,546.00
|
| Rate for Payer: Priority Health Tiered Network |
$3,999.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.00
|
| Rate for Payer: UHC Medicaid |
$808.56
|
| Rate for Payer: UHCCP Medicaid |
$808.56
|
| Rate for Payer: VA VA |
$1,546.00
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$30,763.59
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.96 |
| Max. Negotiated Rate |
$27,687.23 |
| Rate for Payer: Aetna American Axle |
$19,996.33
|
| Rate for Payer: Aetna Commercial |
$26,149.05
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,996.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.94
|
| Rate for Payer: BCBS Complete |
$37.76
|
| Rate for Payer: BCBS MAPPO |
$68.75
|
| Rate for Payer: BCBS Trust/PPO |
$227.56
|
| Rate for Payer: BCN Commercial |
$227.56
|
| Rate for Payer: BCN Medicare Advantage |
$68.75
|
| Rate for Payer: Cash Price |
$24,610.87
|
| Rate for Payer: Cash Price |
$24,610.87
|
| Rate for Payer: Cofinity Advantage |
$21,534.51
|
| Rate for Payer: Cofinity Commercial |
$26,456.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,610.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.75
|
| Rate for Payer: Healthscope Commercial |
$27,687.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,534.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,072.69
|
| Rate for Payer: Mclaren Medicaid |
$68.75
|
| Rate for Payer: Mclaren Medicare |
$68.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.19
|
| Rate for Payer: Meridian Medicaid |
$72.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,149.05
|
| Rate for Payer: Nomi Health Commercial |
$206.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,072.69
|
| Rate for Payer: PACE Medicare |
$65.31
|
| Rate for Payer: PACE SWMI |
$68.75
|
| Rate for Payer: PHP Commercial |
$26,149.05
|
| Rate for Payer: PHP Medicare Advantage |
$68.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$223.16
|
| Rate for Payer: Priority Health Medicare |
$68.75
|
| Rate for Payer: Priority Health SBD |
$19,381.06
|
| Rate for Payer: Priority Health Tiered Network |
$178.53
|
| Rate for Payer: Railroad Medicare Medicare |
$68.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.80
|
| Rate for Payer: UHC Core |
$115.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$68.75
|
| Rate for Payer: UHC Exchange |
$115.80
|
| Rate for Payer: UHC Medicaid |
$35.96
|
| Rate for Payer: UHCCP Medicaid |
$35.96
|
| Rate for Payer: UMR Bronson Commercial |
$11,382.53
|
| Rate for Payer: VA VA |
$68.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,072.69
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$30,763.59
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,535.98 |
| Max. Negotiated Rate |
$27,687.23 |
| Rate for Payer: Aetna American Axle |
$19,996.33
|
| Rate for Payer: Aetna Commercial |
$26,149.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19,996.33
|
| Rate for Payer: Cash Price |
$24,610.87
|
| Rate for Payer: Cofinity Advantage |
$21,534.51
|
| Rate for Payer: Cofinity Commercial |
$26,456.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24,610.87
|
| Rate for Payer: Healthscope Commercial |
$27,687.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21,534.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23,072.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,149.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23,072.69
|
| Rate for Payer: PHP Commercial |
$26,149.05
|
| Rate for Payer: Priority Health SBD |
$19,381.06
|
| Rate for Payer: UMR Bronson Commercial |
$13,535.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23,072.69
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$139.79
|
|
|
Service Code
|
NDC 73302045601
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.51 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna American Axle |
$90.86
|
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.86
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cofinity Advantage |
$97.85
|
| Rate for Payer: Cofinity Commercial |
$120.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.83
|
| Rate for Payer: Healthscope Commercial |
$125.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.84
|
| Rate for Payer: PHP Commercial |
$118.82
|
| Rate for Payer: Priority Health SBD |
$88.07
|
| Rate for Payer: UMR Bronson Commercial |
$61.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.84
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
OP
|
$139.79
|
|
|
Service Code
|
NDC 73302045601
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.72 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna American Axle |
$90.86
|
| Rate for Payer: Aetna Commercial |
$118.82
|
| Rate for Payer: Aetna Medicare |
$69.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.86
|
| Rate for Payer: BCBS Complete |
$55.92
|
| Rate for Payer: Cash Price |
$111.83
|
| Rate for Payer: Cofinity Advantage |
$97.85
|
| Rate for Payer: Cofinity Commercial |
$120.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.83
|
| Rate for Payer: Healthscope Commercial |
$125.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.84
|
| Rate for Payer: PHP Commercial |
$118.82
|
| Rate for Payer: Priority Health SBD |
$88.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.86
|
| Rate for Payer: UHC Core |
$72.83
|
| Rate for Payer: UHC Exchange |
$54.94
|
| Rate for Payer: UMR Bronson Commercial |
$51.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.84
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC
|
Facility
|
IP
|
$121,531.07
|
|
|
Service Code
|
MSDRG 278
|
| Min. Negotiated Rate |
$44,784.33 |
| Max. Negotiated Rate |
$121,531.07 |
| Rate for Payer: Aetna Medicare |
$49,027.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58,926.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58,926.75
|
| Rate for Payer: BCBS MAPPO |
$47,141.40
|
| Rate for Payer: BCBS Trust/PPO |
$121,531.07
|
| Rate for Payer: BCN Commercial |
$121,531.07
|
| Rate for Payer: BCN Medicare Advantage |
$47,141.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47,141.40
|
| Rate for Payer: Mclaren Medicare |
$47,141.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49,498.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54,212.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$51,855.54
|
| Rate for Payer: Nomi Health Commercial |
$71,803.98
|
| Rate for Payer: PACE Medicare |
$44,784.33
|
| Rate for Payer: PACE SWMI |
$47,141.40
|
| Rate for Payer: PHP Medicare Advantage |
$47,141.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89,739.06
|
| Rate for Payer: Priority Health Medicare |
$47,141.40
|
| Rate for Payer: Priority Health Tiered Network |
$71,791.23
|
| Rate for Payer: Railroad Medicare Medicare |
$47,141.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90,729.06
|
| Rate for Payer: UHC Core |
$75,906.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47,141.40
|
| Rate for Payer: UHC Exchange |
$61,990.77
|
| Rate for Payer: VA VA |
$47,141.40
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC
|
Facility
|
IP
|
$61,199.26
|
|
|
Service Code
|
MSDRG 279
|
| Min. Negotiated Rate |
$29,214.58 |
| Max. Negotiated Rate |
$61,199.26 |
| Rate for Payer: Aetna Medicare |
$31,982.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38,440.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38,440.24
|
| Rate for Payer: BCBS MAPPO |
$30,752.19
|
| Rate for Payer: BCBS Trust/PPO |
$61,199.26
|
| Rate for Payer: BCN Commercial |
$61,199.26
|
| Rate for Payer: BCN Medicare Advantage |
$30,752.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30,752.19
|
| Rate for Payer: Mclaren Medicare |
$30,752.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32,289.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35,365.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$33,827.41
|
| Rate for Payer: Nomi Health Commercial |
$46,522.56
|
| Rate for Payer: PACE Medicare |
$29,214.58
|
| Rate for Payer: PACE SWMI |
$30,752.19
|
| Rate for Payer: PHP Medicare Advantage |
$30,752.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58,142.89
|
| Rate for Payer: Priority Health Medicare |
$30,752.19
|
| Rate for Payer: Priority Health Tiered Network |
$46,514.30
|
| Rate for Payer: Railroad Medicare Medicare |
$30,752.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58,784.32
|
| Rate for Payer: UHC Core |
$49,180.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30,752.19
|
| Rate for Payer: UHC Exchange |
$40,164.48
|
| Rate for Payer: VA VA |
$30,752.19
|
|
|
ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM
|
Facility
|
IP
|
$59,236.51
|
|
|
Service Code
|
MSDRG 173
|
| Min. Negotiated Rate |
$24,209.50 |
| Max. Negotiated Rate |
$59,236.51 |
| Rate for Payer: Aetna Medicare |
$26,503.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,854.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,854.60
|
| Rate for Payer: BCBS MAPPO |
$25,483.68
|
| Rate for Payer: BCBS Trust/PPO |
$59,236.51
|
| Rate for Payer: BCN Commercial |
$59,236.51
|
| Rate for Payer: BCN Medicare Advantage |
$25,483.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,483.68
|
| Rate for Payer: Mclaren Medicare |
$25,483.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,757.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,306.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,032.05
|
| Rate for Payer: Nomi Health Commercial |
$38,395.56
|
| Rate for Payer: PACE Medicare |
$24,209.50
|
| Rate for Payer: PACE SWMI |
$25,483.68
|
| Rate for Payer: PHP Medicare Advantage |
$25,483.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47,985.94
|
| Rate for Payer: Priority Health Medicare |
$25,483.68
|
| Rate for Payer: Priority Health Tiered Network |
$38,388.74
|
| Rate for Payer: Railroad Medicare Medicare |
$25,483.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48,515.32
|
| Rate for Payer: UHC Core |
$40,589.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,483.68
|
| Rate for Payer: UHC Exchange |
$33,148.17
|
| Rate for Payer: VA VA |
$25,483.68
|
|
|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$11,537.07
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,865.82 |
| Max. Negotiated Rate |
$11,537.07 |
| Rate for Payer: Aetna Medicare |
$3,710.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,459.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,459.41
|
| Rate for Payer: BCBS Complete |
$1,959.29
|
| Rate for Payer: BCBS MAPPO |
$3,567.53
|
| Rate for Payer: BCBS Trust/PPO |
$2,735.91
|
| Rate for Payer: BCN Commercial |
$2,735.91
|
| Rate for Payer: BCN Medicare Advantage |
$3,567.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,567.53
|
| Rate for Payer: Mclaren Medicaid |
$3,567.53
|
| Rate for Payer: Mclaren Medicare |
$3,567.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,745.91
|
| Rate for Payer: Meridian Medicaid |
$3,745.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,924.28
|
| Rate for Payer: Nomi Health Commercial |
$10,702.59
|
| Rate for Payer: PACE Medicare |
$3,389.15
|
| Rate for Payer: PACE SWMI |
$3,567.53
|
| Rate for Payer: PHP Medicare Advantage |
$3,567.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,865.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,537.07
|
| Rate for Payer: Priority Health Medicare |
$3,567.53
|
| Rate for Payer: Priority Health Tiered Network |
$9,229.66
|
| Rate for Payer: Railroad Medicare Medicare |
$3,567.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,567.53
|
| Rate for Payer: UHC Medicaid |
$1,865.82
|
| Rate for Payer: UHCCP Medicaid |
$1,865.82
|
| Rate for Payer: VA VA |
$3,567.53
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
OP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.22 |
| Max. Negotiated Rate |
$97.84 |
| Rate for Payer: Aetna American Axle |
$70.66
|
| Rate for Payer: Aetna Commercial |
$92.40
|
| Rate for Payer: Aetna Medicare |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.66
|
| Rate for Payer: BCBS Complete |
$43.48
|
| Rate for Payer: Cash Price |
$86.97
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$86.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.53
|
| Rate for Payer: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health SBD |
$68.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.66
|
| Rate for Payer: UHC Core |
$56.64
|
| Rate for Payer: UHC Exchange |
$42.72
|
| Rate for Payer: UMR Bronson Commercial |
$40.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.53
|
|
|
UMECLIDINIUM 62.5 MCG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$108.71
|
|
|
Service Code
|
NDC 00173087306
|
| Hospital Charge Code |
173272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 Advantage |
$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 Commercial |
$92.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.53
|
| Rate for Payer: PHP Commercial |
$92.40
|
| 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
|
OP
|
$217.63
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$195.87 |
| Rate for Payer: Aetna American Axle |
$141.46
|
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: Aetna Medicare |
$108.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.46
|
| Rate for Payer: BCBS Complete |
$87.05
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PHP Commercial |
$184.99
|
| Rate for Payer: Priority Health SBD |
$137.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.46
|
| Rate for Payer: UHC Core |
$113.39
|
| Rate for Payer: UHC Exchange |
$85.53
|
| Rate for Payer: UMR Bronson Commercial |
$80.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
UMECLIDINIUM 62.5 MCG-VILANTEROL 25 MCG/ACTUATION POWDR FOR INHALATION
|
Facility
|
IP
|
$217.63
|
|
|
Service Code
|
NDC 00173086906
|
| Hospital Charge Code |
169758
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.76 |
| Max. Negotiated Rate |
$195.87 |
| Rate for Payer: Aetna American Axle |
$141.46
|
| Rate for Payer: Aetna Commercial |
$184.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.46
|
| Rate for Payer: Cash Price |
$174.10
|
| Rate for Payer: Cofinity Advantage |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.10
|
| Rate for Payer: Healthscope Commercial |
$195.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.22
|
| Rate for Payer: PHP Commercial |
$184.99
|
| Rate for Payer: Priority Health SBD |
$137.11
|
| Rate for Payer: UMR Bronson Commercial |
$95.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.22
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$24,340.80
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,532.37 |
| Max. Negotiated Rate |
$24,340.80 |
| Rate for Payer: Aetna Medicare |
$12,624.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,174.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,174.17
|
| Rate for Payer: BCBS MAPPO |
$12,139.34
|
| Rate for Payer: BCBS Trust/PPO |
$24,340.80
|
| Rate for Payer: BCN Commercial |
$24,340.80
|
| Rate for Payer: BCN Medicare Advantage |
$12,139.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,139.34
|
| Rate for Payer: Mclaren Medicare |
$12,139.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12,746.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,960.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,353.27
|
| Rate for Payer: Nomi Health Commercial |
$17,811.03
|
| Rate for Payer: PACE Medicare |
$11,532.37
|
| Rate for Payer: PACE SWMI |
$12,139.34
|
| Rate for Payer: PHP Medicare Advantage |
$12,139.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22,259.84
|
| Rate for Payer: Priority Health Medicare |
$12,139.34
|
| Rate for Payer: Priority Health Tiered Network |
$17,807.87
|
| Rate for Payer: Railroad Medicare Medicare |
$12,139.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22,505.41
|
| Rate for Payer: UHC Core |
$18,828.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,139.34
|
| Rate for Payer: UHC Exchange |
$15,376.86
|
| Rate for Payer: VA VA |
$12,139.34
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$15,243.54
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,354.34 |
| Max. Negotiated Rate |
$15,243.54 |
| Rate for Payer: Aetna Medicare |
$8,051.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,676.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,676.76
|
| Rate for Payer: BCBS MAPPO |
$7,741.41
|
| Rate for Payer: BCBS Trust/PPO |
$15,243.54
|
| Rate for Payer: BCN Commercial |
$15,243.54
|
| Rate for Payer: BCN Medicare Advantage |
$7,741.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,741.41
|
| Rate for Payer: Mclaren Medicare |
$7,741.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8,128.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,902.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,515.55
|
| Rate for Payer: Nomi Health Commercial |
$11,026.92
|
| Rate for Payer: PACE Medicare |
$7,354.34
|
| Rate for Payer: PACE SWMI |
$7,741.41
|
| Rate for Payer: PHP Medicare Advantage |
$7,741.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13,781.21
|
| Rate for Payer: Priority Health Medicare |
$7,741.41
|
| Rate for Payer: Priority Health Tiered Network |
$11,024.96
|
| Rate for Payer: Railroad Medicare Medicare |
$7,741.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,933.24
|
| Rate for Payer: UHC Core |
$11,656.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,741.41
|
| Rate for Payer: UHC Exchange |
$9,519.91
|
| Rate for Payer: VA VA |
$7,741.41
|
|
|
UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE
|
Facility
|
OP
|
$763.21
|
|
|
Service Code
|
CPT 21299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$763.21 |
| Rate for Payer: Aetna Medicare |
$245.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$295.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$295.00
|
| Rate for Payer: BCBS Complete |
$129.61
|
| Rate for Payer: BCBS MAPPO |
$236.00
|
| Rate for Payer: BCBS Trust/PPO |
$199.82
|
| Rate for Payer: BCN Commercial |
$199.82
|
| Rate for Payer: BCN Medicare Advantage |
$236.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.00
|
| Rate for Payer: Mclaren Medicaid |
$236.00
|
| Rate for Payer: Mclaren Medicare |
$236.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.80
|
| Rate for Payer: Meridian Medicaid |
$247.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$271.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.60
|
| Rate for Payer: Nomi Health Commercial |
$708.00
|
| Rate for Payer: PACE Medicare |
$224.20
|
| Rate for Payer: PACE SWMI |
$236.00
|
| Rate for Payer: PHP Medicare Advantage |
$236.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$763.21
|
| Rate for Payer: Priority Health Medicare |
$236.00
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$236.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$236.00
|
| Rate for Payer: UHC Medicaid |
$123.43
|
| Rate for Payer: UHCCP Medicaid |
$123.43
|
| Rate for Payer: VA VA |
$236.00
|
|
|
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$651.46
|
|
|
Service Code
|
CPT 58579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$651.46 |
| Rate for Payer: Aetna Medicare |
$209.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$251.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$251.80
|
| Rate for Payer: BCBS Complete |
$110.63
|
| Rate for Payer: BCBS MAPPO |
$201.44
|
| Rate for Payer: BCBS Trust/PPO |
$171.73
|
| Rate for Payer: BCN Commercial |
$171.73
|
| Rate for Payer: BCN Medicare Advantage |
$201.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.44
|
| Rate for Payer: Mclaren Medicaid |
$201.44
|
| Rate for Payer: Mclaren Medicare |
$201.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.51
|
| Rate for Payer: Meridian Medicaid |
$211.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.58
|
| Rate for Payer: Nomi Health Commercial |
$604.32
|
| Rate for Payer: PACE Medicare |
$191.37
|
| Rate for Payer: PACE SWMI |
$201.44
|
| Rate for Payer: PHP Medicare Advantage |
$201.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.46
|
| Rate for Payer: Priority Health Medicare |
$201.44
|
| Rate for Payer: Priority Health Tiered Network |
$521.17
|
| Rate for Payer: Railroad Medicare Medicare |
$201.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.44
|
| Rate for Payer: UHC Medicaid |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$105.35
|
| Rate for Payer: VA VA |
$201.44
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,738.06
|
| Rate for Payer: BCN Commercial |
$4,738.06
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,871.32
|
| Rate for Payer: BCN Commercial |
$4,871.32
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$6,023.79
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
