|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$781.92
|
|
|
Service Code
|
NDC 65628-080-10
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.04 |
| Max. Negotiated Rate |
$703.73 |
| Rate for Payer: Aetna American Axle |
$508.25
|
| Rate for Payer: Aetna Commercial |
$664.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.25
|
| Rate for Payer: Cash Price |
$625.54
|
| Rate for Payer: Cofinity Commercial |
$547.34
|
| Rate for Payer: Cofinity Commercial |
$672.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$625.54
|
| Rate for Payer: Healthscope Commercial |
$703.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$547.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$586.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$664.63
|
| Rate for Payer: PHP Commercial |
$664.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.34
|
| Rate for Payer: Priority Health SBD |
$492.61
|
| Rate for Payer: UMR Bronson Commercial |
$344.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$586.44
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$781.20
|
|
|
Service Code
|
NDC 65628-080-05
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.73 |
| Max. Negotiated Rate |
$703.08 |
| Rate for Payer: Aetna American Axle |
$507.78
|
| Rate for Payer: Aetna Commercial |
$664.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.78
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cofinity Commercial |
$546.84
|
| Rate for Payer: Cofinity Commercial |
$671.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.96
|
| Rate for Payer: Healthscope Commercial |
$703.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$546.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$664.02
|
| Rate for Payer: PHP Commercial |
$664.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.84
|
| Rate for Payer: Priority Health SBD |
$492.16
|
| Rate for Payer: UMR Bronson Commercial |
$343.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.90
|
|
|
LANSOPRAZOLE (FIRST LANSOPRAZOLE) 3 MG/ML ORAL SUSPENSION
|
Facility
|
IP
|
$25.75
|
|
|
Service Code
|
NDC 9900-0009-34
|
| Hospital Charge Code |
158811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Commercial |
$22.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.60
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.89
|
| Rate for Payer: PHP Commercial |
$21.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health SBD |
$16.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.31
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$633.87
|
|
|
Service Code
|
NDC 69097-934-57
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.90 |
| Max. Negotiated Rate |
$570.48 |
| Rate for Payer: Aetna American Axle |
$412.02
|
| Rate for Payer: Aetna Commercial |
$538.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.02
|
| Rate for Payer: Cash Price |
$507.10
|
| Rate for Payer: Cofinity Commercial |
$443.71
|
| Rate for Payer: Cofinity Commercial |
$545.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$507.10
|
| Rate for Payer: Healthscope Commercial |
$570.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$443.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$475.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$538.79
|
| Rate for Payer: PHP Commercial |
$538.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.71
|
| Rate for Payer: Priority Health SBD |
$399.34
|
| Rate for Payer: UMR Bronson Commercial |
$278.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$475.40
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3,718.28
|
|
|
Service Code
|
NDC 54092-252-90
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,636.04 |
| Max. Negotiated Rate |
$3,346.45 |
| Rate for Payer: Aetna American Axle |
$2,416.88
|
| Rate for Payer: Aetna Commercial |
$3,160.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.88
|
| Rate for Payer: Cash Price |
$2,974.62
|
| Rate for Payer: Cofinity Commercial |
$2,602.80
|
| Rate for Payer: Cofinity Commercial |
$3,197.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,974.62
|
| Rate for Payer: Healthscope Commercial |
$3,346.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,602.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,788.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,160.54
|
| Rate for Payer: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,602.80
|
| Rate for Payer: Priority Health SBD |
$2,342.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,636.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,788.71
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,859.14
|
|
|
Service Code
|
NDC 54092-252-45
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$818.02 |
| Max. Negotiated Rate |
$1,673.23 |
| Rate for Payer: Aetna American Axle |
$1,208.44
|
| Rate for Payer: Aetna Commercial |
$1,580.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.44
|
| Rate for Payer: Cash Price |
$1,487.31
|
| Rate for Payer: Cofinity Commercial |
$1,301.40
|
| Rate for Payer: Cofinity Commercial |
$1,598.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,487.31
|
| Rate for Payer: Healthscope Commercial |
$1,673.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,301.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,394.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,580.27
|
| Rate for Payer: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.40
|
| Rate for Payer: Priority Health SBD |
$1,171.26
|
| Rate for Payer: UMR Bronson Commercial |
$818.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,394.36
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$3,342.99
|
|
|
Service Code
|
NDC 66993-422-85
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,470.92 |
| Max. Negotiated Rate |
$3,008.69 |
| Rate for Payer: Aetna American Axle |
$2,172.94
|
| Rate for Payer: Aetna Commercial |
$2,841.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.94
|
| Rate for Payer: Cash Price |
$2,674.39
|
| Rate for Payer: Cofinity Commercial |
$2,340.09
|
| Rate for Payer: Cofinity Commercial |
$2,874.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,674.39
|
| Rate for Payer: Healthscope Commercial |
$3,008.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,340.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,507.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,841.54
|
| Rate for Payer: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,340.09
|
| Rate for Payer: Priority Health SBD |
$2,106.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.24
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,671.50
|
|
|
Service Code
|
NDC 66993-422-47
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$735.46 |
| Max. Negotiated Rate |
$1,504.35 |
| Rate for Payer: Aetna American Axle |
$1,086.48
|
| Rate for Payer: Aetna Commercial |
$1,420.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.48
|
| Rate for Payer: Cash Price |
$1,337.20
|
| Rate for Payer: Cofinity Commercial |
$1,170.05
|
| Rate for Payer: Cofinity Commercial |
$1,437.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,337.20
|
| Rate for Payer: Healthscope Commercial |
$1,504.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,170.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,253.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,420.78
|
| Rate for Payer: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,170.05
|
| Rate for Payer: Priority Health SBD |
$1,053.04
|
| Rate for Payer: UMR Bronson Commercial |
$735.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.62
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,267.74
|
|
|
Service Code
|
NDC 69097-934-98
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$557.81 |
| Max. Negotiated Rate |
$1,140.97 |
| Rate for Payer: Aetna American Axle |
$824.03
|
| Rate for Payer: Aetna Commercial |
$1,077.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.03
|
| Rate for Payer: Cash Price |
$1,014.19
|
| Rate for Payer: Cofinity Commercial |
$1,090.26
|
| Rate for Payer: Cofinity Commercial |
$887.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,014.19
|
| Rate for Payer: Healthscope Commercial |
$1,140.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$887.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,077.58
|
| Rate for Payer: PHP Commercial |
$1,077.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.42
|
| Rate for Payer: Priority Health SBD |
$798.68
|
| Rate for Payer: UMR Bronson Commercial |
$557.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.80
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$33,901.53
|
|
|
Service Code
|
MS-DRG 418
|
| Min. Negotiated Rate |
$12,453.94 |
| Max. Negotiated Rate |
$33,901.53 |
| Rate for Payer: Aetna Medicare |
$13,633.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,386.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,386.76
|
| Rate for Payer: BCBS MAPPO |
$13,109.41
|
| Rate for Payer: BCBS Trust/PPO |
$33,901.53
|
| Rate for Payer: BCN Medicare Advantage |
$13,109.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,109.41
|
| Rate for Payer: Mclaren Medicare |
$13,109.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,764.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,075.82
|
| Rate for Payer: PACE Medicare |
$12,453.94
|
| Rate for Payer: PACE SWMI |
$13,109.41
|
| Rate for Payer: PHP Medicare Advantage |
$13,109.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,457.81
|
| Rate for Payer: Priority Health Medicare |
$13,109.41
|
| Rate for Payer: Priority Health Narrow Network |
$18,766.25
|
| Rate for Payer: Railroad Medicare Medicare |
$13,109.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24,935.71
|
| Rate for Payer: UHC Core |
$20,446.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,109.41
|
| Rate for Payer: UHC Exchange |
$16,255.46
|
| Rate for Payer: UHC Medicare Advantage |
$13,502.69
|
| Rate for Payer: VA VA |
$13,109.41
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$37,371.85
|
|
|
Service Code
|
MS-DRG 417
|
| Min. Negotiated Rate |
$17,454.72 |
| Max. Negotiated Rate |
$37,371.85 |
| Rate for Payer: Aetna Medicare |
$19,108.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,966.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,966.74
|
| Rate for Payer: BCBS MAPPO |
$18,373.39
|
| Rate for Payer: BCBS Trust/PPO |
$37,371.85
|
| Rate for Payer: BCN Medicare Advantage |
$18,373.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,373.39
|
| Rate for Payer: Mclaren Medicare |
$18,373.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,292.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,129.40
|
| Rate for Payer: PACE Medicare |
$17,454.72
|
| Rate for Payer: PACE SWMI |
$18,373.39
|
| Rate for Payer: PHP Medicare Advantage |
$18,373.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33,260.24
|
| Rate for Payer: Priority Health Medicare |
$18,373.39
|
| Rate for Payer: Priority Health Narrow Network |
$26,608.19
|
| Rate for Payer: Railroad Medicare Medicare |
$18,373.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35,355.72
|
| Rate for Payer: UHC Core |
$28,991.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$18,373.39
|
| Rate for Payer: UHC Exchange |
$23,048.20
|
| Rate for Payer: UHC Medicare Advantage |
$18,924.59
|
| Rate for Payer: VA VA |
$18,373.39
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$30,230.19
|
|
|
Service Code
|
MS-DRG 419
|
| Min. Negotiated Rate |
$10,100.32 |
| Max. Negotiated Rate |
$30,230.19 |
| Rate for Payer: Aetna Medicare |
$11,057.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,289.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,289.90
|
| Rate for Payer: BCBS MAPPO |
$10,631.92
|
| Rate for Payer: BCBS Trust/PPO |
$30,230.19
|
| Rate for Payer: BCN Medicare Advantage |
$10,631.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,631.92
|
| Rate for Payer: Mclaren Medicare |
$10,631.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,163.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,226.71
|
| Rate for Payer: PACE Medicare |
$10,100.32
|
| Rate for Payer: PACE SWMI |
$10,631.92
|
| Rate for Payer: PHP Medicare Advantage |
$10,631.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,844.31
|
| Rate for Payer: Priority Health Medicare |
$10,631.92
|
| Rate for Payer: Priority Health Narrow Network |
$15,075.45
|
| Rate for Payer: Railroad Medicare Medicare |
$10,631.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,031.55
|
| Rate for Payer: UHC Core |
$16,425.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,631.92
|
| Rate for Payer: UHC Exchange |
$13,058.46
|
| Rate for Payer: UHC Medicare Advantage |
$10,950.88
|
| Rate for Payer: VA VA |
$10,631.92
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$786.52 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,233.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$865.17
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$786.52
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$769.49 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,926.51
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$846.44
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$769.49
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$325.48 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,949.22
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.03
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$325.48
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, ABLATION OF 1 OR MORE LIVER TUMOR(S); RADIOFREQUENCY
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 47370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,233.15 |
| Max. Negotiated Rate |
$28,804.18 |
| Rate for Payer: Aetna Medicare |
$9,515.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,437.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,437.32
|
| Rate for Payer: BCBS Complete |
$5,255.68
|
| Rate for Payer: BCBS MAPPO |
$9,149.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,206.74
|
| Rate for Payer: BCN Medicare Advantage |
$9,149.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,149.86
|
| Rate for Payer: Mclaren Medicaid |
$5,004.97
|
| Rate for Payer: Mclaren Medicare |
$9,149.86
|
| Rate for Payer: Meridian Medicaid |
$5,255.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,607.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,522.34
|
| Rate for Payer: PACE Medicare |
$8,692.37
|
| Rate for Payer: PACE SWMI |
$9,149.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,004.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,804.18
|
| Rate for Payer: Priority Health Medicare |
$9,149.86
|
| Rate for Payer: Priority Health Narrow Network |
$23,043.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,356.46
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,233.15
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$595.29 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,819.05
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.82
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$595.29
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.26 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,811.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.49
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$652.26
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$708.91 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,235.40
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.80
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$708.91
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 47564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.84 |
| Max. Negotiated Rate |
$28,804.18 |
| Rate for Payer: Aetna Medicare |
$9,515.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,437.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,437.32
|
| Rate for Payer: BCBS Complete |
$5,255.68
|
| Rate for Payer: BCBS MAPPO |
$9,149.86
|
| Rate for Payer: BCBS Trust/PPO |
$3,233.44
|
| Rate for Payer: BCN Medicare Advantage |
$9,149.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,149.86
|
| Rate for Payer: Mclaren Medicaid |
$5,004.97
|
| Rate for Payer: Mclaren Medicare |
$9,149.86
|
| Rate for Payer: Meridian Medicaid |
$5,255.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,607.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,522.34
|
| Rate for Payer: PACE Medicare |
$8,692.37
|
| Rate for Payer: PACE SWMI |
$9,149.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,004.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,804.18
|
| Rate for Payer: Priority Health Medicare |
$9,149.86
|
| Rate for Payer: Priority Health Narrow Network |
$23,043.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,212.02
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,101.84
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 57425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$958.10 |
| Max. Negotiated Rate |
$28,804.18 |
| Rate for Payer: Aetna Medicare |
$9,515.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,437.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,437.32
|
| Rate for Payer: BCBS Complete |
$5,255.68
|
| Rate for Payer: BCBS MAPPO |
$9,149.86
|
| Rate for Payer: BCBS Trust/PPO |
$9,326.44
|
| Rate for Payer: BCN Medicare Advantage |
$9,149.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,149.86
|
| Rate for Payer: Mclaren Medicaid |
$5,004.97
|
| Rate for Payer: Mclaren Medicare |
$9,149.86
|
| Rate for Payer: Meridian Medicaid |
$5,255.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,607.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,522.34
|
| Rate for Payer: PACE Medicare |
$8,692.37
|
| Rate for Payer: PACE SWMI |
$9,149.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,004.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,804.18
|
| Rate for Payer: Priority Health Medicare |
$9,149.86
|
| Rate for Payer: Priority Health Narrow Network |
$23,043.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,053.91
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$958.10
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 44180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$904.39 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,543.44
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$994.83
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$904.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 43280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,058.29 |
| Max. Negotiated Rate |
$28,804.18 |
| Rate for Payer: Aetna Medicare |
$9,515.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,437.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,437.32
|
| Rate for Payer: BCBS Complete |
$5,255.68
|
| Rate for Payer: BCBS MAPPO |
$9,149.86
|
| Rate for Payer: BCBS Trust/PPO |
$6,858.09
|
| Rate for Payer: BCN Medicare Advantage |
$9,149.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,149.86
|
| Rate for Payer: Mclaren Medicaid |
$5,004.97
|
| Rate for Payer: Mclaren Medicare |
$9,149.86
|
| Rate for Payer: Meridian Medicaid |
$5,255.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,607.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,522.34
|
| Rate for Payer: PACE Medicare |
$8,692.37
|
| Rate for Payer: PACE SWMI |
$9,149.86
|
| Rate for Payer: PHP Medicare Advantage |
$9,149.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,004.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28,804.18
|
| Rate for Payer: Priority Health Medicare |
$9,149.86
|
| Rate for Payer: Priority Health Narrow Network |
$23,043.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,149.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,164.12
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,058.29
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS
|
Facility
|
OP
|
$13,752.00
|
|
|
Service Code
|
CPT 43774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$946.31 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: Aetna Medicare |
$3,540.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,255.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,255.24
|
| Rate for Payer: BCBS Complete |
$1,955.37
|
| Rate for Payer: BCBS MAPPO |
$3,404.19
|
| Rate for Payer: BCBS Trust/PPO |
$4,348.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,404.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,404.19
|
| Rate for Payer: Mclaren Medicaid |
$1,862.09
|
| Rate for Payer: Mclaren Medicare |
$3,404.19
|
| Rate for Payer: Meridian Medicaid |
$1,955.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,574.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,914.82
|
| Rate for Payer: PACE Medicare |
$3,233.98
|
| Rate for Payer: PACE SWMI |
$3,404.19
|
| Rate for Payer: PHP Medicare Advantage |
$3,404.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,862.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,716.54
|
| Rate for Payer: Priority Health Medicare |
$3,404.19
|
| Rate for Payer: Priority Health Narrow Network |
$8,573.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3,404.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,040.94
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,404.19
|
| Rate for Payer: UHC Exchange |
$946.31
|
| Rate for Payer: UHC Medicare Advantage |
$3,506.32
|
| Rate for Payer: VA VA |
$3,404.19
|
|
|
LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 43653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$572.37 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,027.81
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.61
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$572.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
