|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27,228.51
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.92 |
| Max. Negotiated Rate |
$24,505.66 |
| Rate for Payer: Aetna American Axle |
$17,698.53
|
| Rate for Payer: Aetna Commercial |
$23,144.23
|
| Rate for Payer: Aetna Medicare |
$73.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,698.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.44
|
| Rate for Payer: BCBS Complete |
$39.82
|
| Rate for Payer: BCBS MAPPO |
$70.75
|
| Rate for Payer: BCN Medicare Advantage |
$70.75
|
| Rate for Payer: Cash Price |
$21,782.81
|
| Rate for Payer: Cash Price |
$21,782.81
|
| Rate for Payer: Cofinity Commercial |
$23,416.52
|
| Rate for Payer: Cofinity Commercial |
$19,059.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,059.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,782.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.75
|
| Rate for Payer: Healthscope Commercial |
$24,505.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,059.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,421.38
|
| Rate for Payer: Mclaren Medicaid |
$37.92
|
| Rate for Payer: Mclaren Medicare |
$70.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.29
|
| Rate for Payer: Meridian Medicaid |
$39.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,144.23
|
| Rate for Payer: PACE Medicare |
$67.21
|
| Rate for Payer: PACE SWMI |
$70.75
|
| Rate for Payer: PHP Commercial |
$23,144.23
|
| Rate for Payer: PHP Medicare Advantage |
$70.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,698.53
|
| Rate for Payer: Priority Health Medicare |
$70.75
|
| Rate for Payer: Priority Health SBD |
$17,153.96
|
| Rate for Payer: Railroad Medicare Medicare |
$70.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.75
|
| Rate for Payer: UHC Exchange |
$135.21
|
| Rate for Payer: UHC Medicare Advantage |
$70.75
|
| Rate for Payer: UHCCP Medicaid |
$37.92
|
| Rate for Payer: UMR Bronson Commercial |
$10,074.55
|
| Rate for Payer: VA VA |
$70.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,421.38
|
|
|
UBLITUXIMAB-XIIY 25 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27,228.51
|
|
|
Service Code
|
HCPCS J2329
|
| Hospital Charge Code |
202689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,980.54 |
| Max. Negotiated Rate |
$24,505.66 |
| Rate for Payer: Aetna American Axle |
$17,698.53
|
| Rate for Payer: Aetna Commercial |
$23,144.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,698.53
|
| Rate for Payer: Cash Price |
$21,782.81
|
| Rate for Payer: Cofinity Commercial |
$19,059.96
|
| Rate for Payer: Cofinity Commercial |
$23,416.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$19,059.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21,782.81
|
| Rate for Payer: Healthscope Commercial |
$24,505.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,059.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20,421.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,144.23
|
| Rate for Payer: PHP Commercial |
$23,144.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,698.53
|
| Rate for Payer: Priority Health SBD |
$17,153.96
|
| Rate for Payer: UMR Bronson Commercial |
$11,980.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20,421.38
|
|
|
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 Commercial |
$120.22
|
| Rate for Payer: Cofinity Commercial |
$97.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.85
|
| 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: PHP Commercial |
$118.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.86
|
| 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 Commercial |
$120.22
|
| Rate for Payer: Cofinity Commercial |
$97.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.85
|
| 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: PHP Commercial |
$118.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.86
|
| Rate for Payer: Priority Health SBD |
$88.07
|
| Rate for Payer: UMR Bronson Commercial |
$51.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.84
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
OP
|
$123.70
|
|
|
Service Code
|
NDC 50102091101
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.77 |
| Max. Negotiated Rate |
$111.33 |
| Rate for Payer: Aetna American Axle |
$80.41
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna Medicare |
$61.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.41
|
| Rate for Payer: BCBS Complete |
$49.48
|
| Rate for Payer: Cash Price |
$98.96
|
| Rate for Payer: Cofinity Commercial |
$106.38
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.96
|
| Rate for Payer: Healthscope Commercial |
$111.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.14
|
| Rate for Payer: PHP Commercial |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.41
|
| Rate for Payer: Priority Health SBD |
$77.93
|
| Rate for Payer: UMR Bronson Commercial |
$45.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.78
|
|
|
ULIPRISTAL 30 MG TABLET
|
Facility
|
IP
|
$123.70
|
|
|
Service Code
|
NDC 50102091101
|
| Hospital Charge Code |
106079
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.43 |
| Max. Negotiated Rate |
$111.33 |
| Rate for Payer: Aetna American Axle |
$80.41
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.41
|
| Rate for Payer: Cash Price |
$98.96
|
| Rate for Payer: Cofinity Commercial |
$106.38
|
| Rate for Payer: Cofinity Commercial |
$86.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$86.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.96
|
| Rate for Payer: Healthscope Commercial |
$111.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$86.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$92.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.14
|
| Rate for Payer: PHP Commercial |
$105.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.41
|
| Rate for Payer: Priority Health SBD |
$77.93
|
| Rate for Payer: UMR Bronson Commercial |
$54.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$92.78
|
|
|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$9,688.38
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,844.82 |
| Max. Negotiated Rate |
$9,688.38 |
| Rate for Payer: Aetna Medicare |
$3,579.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,302.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,302.27
|
| Rate for Payer: BCBS Complete |
$1,937.06
|
| Rate for Payer: BCBS MAPPO |
$3,441.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,441.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,441.82
|
| Rate for Payer: Mclaren Medicaid |
$1,844.82
|
| Rate for Payer: Mclaren Medicare |
$3,441.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,613.91
|
| Rate for Payer: Meridian Medicaid |
$1,937.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,958.09
|
| Rate for Payer: PACE Medicare |
$3,269.73
|
| Rate for Payer: PACE SWMI |
$3,441.82
|
| Rate for Payer: PHP Medicare Advantage |
$3,441.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,844.82
|
| Rate for Payer: Priority Health Medicare |
$3,441.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,441.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,688.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,441.82
|
| Rate for Payer: UHC Exchange |
$6,577.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,441.82
|
| Rate for Payer: UHCCP Medicaid |
$1,844.82
|
| Rate for Payer: VA VA |
$3,441.82
|
|
|
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 Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.10
|
| 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: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.66
|
| Rate for Payer: Priority Health SBD |
$68.49
|
| 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 Commercial |
$76.10
|
| Rate for Payer: Cofinity Commercial |
$93.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$76.10
|
| 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: PHP Commercial |
$92.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.66
|
| 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 Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.34
|
| 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: PHP Commercial |
$184.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.46
|
| Rate for Payer: Priority Health SBD |
$137.11
|
| 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 Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$187.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.34
|
| 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: PHP Commercial |
$184.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.46
|
| 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
|
|
|
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$552.28
|
|
|
Service Code
|
CPT 58579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.16 |
| Max. Negotiated Rate |
$552.28 |
| Rate for Payer: Aetna Medicare |
$204.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$245.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$245.25
|
| Rate for Payer: BCBS Complete |
$110.42
|
| Rate for Payer: BCBS MAPPO |
$196.20
|
| Rate for Payer: BCN Medicare Advantage |
$196.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.20
|
| Rate for Payer: Mclaren Medicaid |
$105.16
|
| Rate for Payer: Mclaren Medicare |
$196.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.01
|
| Rate for Payer: Meridian Medicaid |
$110.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$225.63
|
| Rate for Payer: PACE Medicare |
$186.39
|
| Rate for Payer: PACE SWMI |
$196.20
|
| Rate for Payer: PHP Medicare Advantage |
$196.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.16
|
| Rate for Payer: Priority Health Medicare |
$196.20
|
| Rate for Payer: Railroad Medicare Medicare |
$196.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.20
|
| Rate for Payer: UHC Exchange |
$374.96
|
| Rate for Payer: UHC Medicare Advantage |
$196.20
|
| Rate for Payer: UHCCP Medicaid |
$105.16
|
| Rate for Payer: VA VA |
$196.20
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 44979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 47579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 51999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 49659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 44238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 38589
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 58679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 45499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 55559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, STOMACH
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 43659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, URETER
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 50949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
