|
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 44186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$642.44 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,739.39
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$706.68
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$642.44
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$890.31 |
| 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 |
$10,213.29
|
| 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) |
$979.34
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$890.31
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 58546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,096.93 |
| 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 |
$9,717.96
|
| 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) |
$1,206.62
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,096.93
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; ORCHIECTOMY
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 54690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$641.79 |
| 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 |
$3,532.46
|
| 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) |
$705.97
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$641.79
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 54692
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.05 |
| 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 |
$4,037.08
|
| 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) |
$811.86
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$738.05
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 50543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,449.59 |
| 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 |
$9,659.55
|
| 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) |
$1,594.55
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,449.59
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 55866
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,163.40 |
| 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 |
$10,415.95
|
| 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) |
$1,279.74
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,163.40
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; PYELOPLASTY
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 50544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,205.31 |
| 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 |
$10,149.19
|
| 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) |
$1,325.84
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,205.31
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$429.60 |
| 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 |
$5,317.02
|
| 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) |
$472.56
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$429.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 43282
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,694.18 |
| 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 |
$7,444.10
|
| 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) |
$1,863.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,694.18
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 43281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,504.27 |
| 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 |
$7,711.19
|
| 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) |
$1,654.70
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,504.27
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$560.58 |
| 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 |
$5,617.73
|
| 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) |
$616.64
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$560.58
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL, SPLENECTOMY
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 38120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,042.58 |
| 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) |
$1,146.84
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$1,042.58
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 58542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$819.26 |
| 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 |
$8,088.39
|
| 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) |
$901.19
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$819.26
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL, TOTAL HYSTERECTOMY FOR RESECTION OF MALIGNANCY (TUMOR DEBULKING), WITH OMENTECTOMY INCLUDING SALPINGO-OOPHORECTOMY, UNILATERAL OR BILATERAL, WHEN PERFORMED
|
Facility
|
OP
|
$6,459.44
|
|
|
Service Code
|
CPT 58575
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,906.04 |
| Max. Negotiated Rate |
$6,459.44 |
| Rate for Payer: BCBS Trust/PPO |
$6,459.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,096.64
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Exchange |
$1,906.04
|
|
|
LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$370.01 |
| 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 |
$3,804.26
|
| 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) |
$407.01
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$370.01
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 38571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.35 |
| 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 |
$7,358.85
|
| 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) |
$712.08
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$647.35
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE
|
Facility
|
OP
|
$28,804.18
|
|
|
Service Code
|
CPT 38572
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$881.47 |
| 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 |
$4,053.84
|
| 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) |
$969.62
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,149.86
|
| Rate for Payer: UHC Exchange |
$881.47
|
| Rate for Payer: UHC Medicare Advantage |
$9,424.36
|
| Rate for Payer: VA VA |
$9,149.86
|
|
|
LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.21 |
| 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 |
$4,972.10
|
| 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) |
$374.23
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$340.21
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.37 |
| 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 |
$3,276.78
|
| 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) |
$405.21
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$368.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.33 |
| 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 |
$4,648.51
|
| 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) |
$774.76
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$704.33
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 49324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$380.82 |
| 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 |
$4,719.98
|
| 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) |
$418.90
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$380.82
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$676.17 |
| 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 |
$4,395.14
|
| 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) |
$743.79
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$676.17
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58671
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.37 |
| 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 |
$2,377.96
|
| 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) |
$405.21
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$368.37
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)
|
Facility
|
OP
|
$16,145.72
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$643.42 |
| 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 |
$4,611.86
|
| 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) |
$707.76
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$643.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
