|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,274.33 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$7,805.52
|
| Rate for Payer: BCN Commercial |
$7,805.52
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,401.76
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$1,274.33
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY, MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$991.16 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$7,390.50
|
| Rate for Payer: BCN Commercial |
$7,390.50
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,090.28
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$991.16
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
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
|
$18,216.88
|
|
|
Service Code
|
CPT 69633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.61 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$5,546.05
|
| Rate for Payer: BCN Commercial |
$5,546.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.57
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$999.61
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION
|
Facility
|
OP
|
$18,216.88
|
|
|
Service Code
|
CPT 69631
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$844.20 |
| Max. Negotiated Rate |
$18,216.88 |
| Rate for Payer: Aetna Medicare |
$6,027.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,245.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,245.06
|
| Rate for Payer: BCBS Complete |
$3,262.02
|
| Rate for Payer: BCBS MAPPO |
$5,796.05
|
| Rate for Payer: BCBS Trust/PPO |
$6,033.55
|
| Rate for Payer: BCN Commercial |
$6,033.55
|
| Rate for Payer: BCN Medicare Advantage |
$5,796.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,796.05
|
| Rate for Payer: Mclaren Medicaid |
$3,106.68
|
| Rate for Payer: Mclaren Medicare |
$5,796.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,085.85
|
| Rate for Payer: Meridian Medicaid |
$3,262.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,665.46
|
| Rate for Payer: Nomi Health Commercial |
$12,171.70
|
| Rate for Payer: PACE Medicare |
$5,506.25
|
| Rate for Payer: PACE SWMI |
$5,796.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,796.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,106.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,216.88
|
| Rate for Payer: Priority Health Medicare |
$5,796.05
|
| Rate for Payer: Priority Health Narrow Network |
$14,573.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5,796.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.62
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,796.05
|
| Rate for Payer: UHC Exchange |
$844.20
|
| Rate for Payer: UHC Medicare Advantage |
$5,796.05
|
| Rate for Payer: UHCCP Medicaid |
$3,106.68
|
| Rate for Payer: VA VA |
$5,796.05
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$4,561.52
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.72 |
| Max. Negotiated Rate |
$4,561.52 |
| Rate for Payer: Aetna Medicare |
$1,509.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,814.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,814.16
|
| Rate for Payer: BCBS Complete |
$816.81
|
| Rate for Payer: BCBS MAPPO |
$1,451.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.83
|
| Rate for Payer: BCN Commercial |
$1,830.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.33
|
| Rate for Payer: Mclaren Medicaid |
$777.91
|
| Rate for Payer: Mclaren Medicare |
$1,451.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,523.90
|
| Rate for Payer: Meridian Medicaid |
$816.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,669.03
|
| Rate for Payer: Nomi Health Commercial |
$3,047.79
|
| Rate for Payer: PACE Medicare |
$1,378.76
|
| Rate for Payer: PACE SWMI |
$1,451.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,561.52
|
| Rate for Payer: Priority Health Medicare |
$1,451.33
|
| Rate for Payer: Priority Health Narrow Network |
$3,649.22
|
| Rate for Payer: Railroad Medicare Medicare |
$1,451.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.99
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.33
|
| Rate for Payer: UHC Exchange |
$152.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.33
|
| Rate for Payer: UHCCP Medicaid |
$777.91
|
| Rate for Payer: VA VA |
$1,451.33
|
|
|
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 |
$37.00 |
| Max. Negotiated Rate |
$24,505.66 |
| Rate for Payer: Mclaren Medicare |
$69.03
|
| Rate for Payer: Aetna American Axle |
$17,698.53
|
| Rate for Payer: Aetna Commercial |
$23,144.23
|
| Rate for Payer: Aetna Medicare |
$71.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17,698.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.29
|
| Rate for Payer: BCBS Complete |
$38.85
|
| Rate for Payer: BCBS MAPPO |
$69.03
|
| Rate for Payer: BCBS Trust/PPO |
$187.21
|
| Rate for Payer: BCN Commercial |
$187.21
|
| Rate for Payer: BCN Medicare Advantage |
$69.03
|
| 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 |
$69.03
|
| 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 |
$37.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.48
|
| Rate for Payer: Meridian Medicaid |
$38.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,144.23
|
| Rate for Payer: Nomi Health Commercial |
$207.09
|
| Rate for Payer: PACE Medicare |
$65.58
|
| Rate for Payer: PACE SWMI |
$69.03
|
| Rate for Payer: PHP Commercial |
$23,144.23
|
| Rate for Payer: PHP Medicare Advantage |
$69.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17,698.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.84
|
| Rate for Payer: Priority Health Medicare |
$69.03
|
| Rate for Payer: Priority Health Narrow Network |
$159.87
|
| Rate for Payer: Priority Health SBD |
$17,153.96
|
| Rate for Payer: Railroad Medicare Medicare |
$69.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.03
|
| Rate for Payer: UHC Exchange |
$131.92
|
| Rate for Payer: UHC Medicare Advantage |
$69.03
|
| Rate for Payer: UHCCP Medicaid |
$37.00
|
| Rate for Payer: UMR Bronson Commercial |
$10,074.55
|
| Rate for Payer: VA VA |
$69.03
|
| 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
|
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 |
$80.40
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.40
|
| 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 |
$80.40
|
| 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
|
|
|
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 |
$80.40
|
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna Medicare |
$61.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.40
|
| 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 |
$80.40
|
| 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
|
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 |
$69.90
|
| 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
|
|
|
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES, DOCUMENTATION OF SELECTED VESSEL PATENCY, CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF VASCULAR NEEDLE ENTRY, WITH PERMANENT RECORDING AND REPORTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$50.63
|
|
|
Service Code
|
CPT 76937
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$50.63 |
| Rate for Payer: BCBS Trust/PPO |
$50.63
|
| Rate for Payer: BCN Commercial |
$50.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.07
|
| Rate for Payer: UHC Exchange |
$35.52
|
|
|
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$10,867.50
|
|
|
Service Code
|
CPT 49250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$579.93 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,264.64
|
| Rate for Payer: BCN Commercial |
$2,264.64
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.92
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Exchange |
$579.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,853.33
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
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 |
$54.36
|
| 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
|
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
|
|
|
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 |
$108.82
|
| 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
|
|
|
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 58579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$105.65 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$142.15
|
| Rate for Payer: BCN Commercial |
$142.15
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.82
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$376.68
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: VA VA |
$197.10
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$4,032.23
|
| Rate for Payer: BCN Commercial |
$4,032.23
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 47579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 51999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 49659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,063.99 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,921.92
|
| Rate for Payer: BCN Commercial |
$3,921.92
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,091.07
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$10,924.59
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
