|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$1,671.50
|
|
|
Service Code
|
NDC 66993042247
|
| 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: Cofinity Medicare Advantage |
$1,170.05
|
| 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 Commercial |
$1,420.78
|
| Rate for Payer: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.48
|
| 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
|
$1,301.70
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$572.75 |
| Max. Negotiated Rate |
$1,171.53 |
| Rate for Payer: Aetna American Axle |
$846.10
|
| Rate for Payer: Aetna Commercial |
$1,106.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.10
|
| Rate for Payer: Cash Price |
$1,041.36
|
| Rate for Payer: Cofinity Commercial |
$1,119.46
|
| Rate for Payer: Cofinity Commercial |
$911.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.36
|
| Rate for Payer: Healthscope Commercial |
$1,171.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.44
|
| Rate for Payer: PHP Commercial |
$1,106.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.10
|
| Rate for Payer: Priority Health SBD |
$820.07
|
| Rate for Payer: UMR Bronson Commercial |
$572.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.28
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3,342.99
|
|
|
Service Code
|
NDC 66993042285
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,236.91 |
| 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 Medicare |
$1,671.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,172.94
|
| Rate for Payer: BCBS Complete |
$1,337.20
|
| 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: Cofinity Medicare Advantage |
$2,340.09
|
| 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 Commercial |
$2,841.54
|
| Rate for Payer: PHP Commercial |
$2,841.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,172.94
|
| Rate for Payer: Priority Health SBD |
$2,106.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,236.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,507.24
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,859.14
|
|
|
Service Code
|
NDC 54092025245
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$687.88 |
| 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 Medicare |
$929.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.44
|
| Rate for Payer: BCBS Complete |
$743.66
|
| 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: Cofinity Medicare Advantage |
$1,301.40
|
| 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 Commercial |
$1,580.27
|
| Rate for Payer: PHP Commercial |
$1,580.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.44
|
| Rate for Payer: Priority Health SBD |
$1,171.26
|
| Rate for Payer: UMR Bronson Commercial |
$687.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,394.36
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$650.85
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.81 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna American Axle |
$423.05
|
| Rate for Payer: Aetna Commercial |
$553.22
|
| Rate for Payer: Aetna Medicare |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.05
|
| Rate for Payer: BCBS Complete |
$260.34
|
| Rate for Payer: Cash Price |
$520.68
|
| Rate for Payer: Cofinity Commercial |
$455.60
|
| Rate for Payer: Cofinity Commercial |
$559.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.68
|
| Rate for Payer: Healthscope Commercial |
$585.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.22
|
| Rate for Payer: PHP Commercial |
$553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.05
|
| Rate for Payer: Priority Health SBD |
$410.04
|
| Rate for Payer: UMR Bronson Commercial |
$240.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.14
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,671.50
|
|
|
Service Code
|
NDC 66993042247
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$618.46 |
| 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 Medicare |
$835.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,086.48
|
| Rate for Payer: BCBS Complete |
$668.60
|
| 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: Cofinity Medicare Advantage |
$1,170.05
|
| 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 Commercial |
$1,420.78
|
| Rate for Payer: PHP Commercial |
$1,420.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,086.48
|
| Rate for Payer: Priority Health SBD |
$1,053.04
|
| Rate for Payer: UMR Bronson Commercial |
$618.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,253.62
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$3,718.28
|
|
|
Service Code
|
NDC 54092025290
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,375.76 |
| 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 Medicare |
$1,859.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,416.88
|
| Rate for Payer: BCBS Complete |
$1,487.31
|
| 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: Cofinity Medicare Advantage |
$2,602.80
|
| 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 Commercial |
$3,160.54
|
| Rate for Payer: PHP Commercial |
$3,160.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,416.88
|
| Rate for Payer: Priority Health SBD |
$2,342.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,375.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,788.71
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
IP
|
$650.85
|
|
|
Service Code
|
NDC 69097093457
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.37 |
| Max. Negotiated Rate |
$585.76 |
| Rate for Payer: Aetna American Axle |
$423.05
|
| Rate for Payer: Aetna Commercial |
$553.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.05
|
| Rate for Payer: Cash Price |
$520.68
|
| Rate for Payer: Cofinity Commercial |
$455.60
|
| Rate for Payer: Cofinity Commercial |
$559.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.68
|
| Rate for Payer: Healthscope Commercial |
$585.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.22
|
| Rate for Payer: PHP Commercial |
$553.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.05
|
| Rate for Payer: Priority Health SBD |
$410.04
|
| Rate for Payer: UMR Bronson Commercial |
$286.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.14
|
|
|
LANTHANUM 500 MG CHEWABLE TABLET
|
Facility
|
OP
|
$1,301.70
|
|
|
Service Code
|
NDC 69097093498
|
| Hospital Charge Code |
39975
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.63 |
| Max. Negotiated Rate |
$1,171.53 |
| Rate for Payer: Aetna American Axle |
$846.10
|
| Rate for Payer: Aetna Commercial |
$1,106.44
|
| Rate for Payer: Aetna Medicare |
$650.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.10
|
| Rate for Payer: BCBS Complete |
$520.68
|
| Rate for Payer: Cash Price |
$1,041.36
|
| Rate for Payer: Cofinity Commercial |
$1,119.46
|
| Rate for Payer: Cofinity Commercial |
$911.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$911.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,041.36
|
| Rate for Payer: Healthscope Commercial |
$1,171.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$911.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$976.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.44
|
| Rate for Payer: PHP Commercial |
$1,106.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.10
|
| Rate for Payer: Priority Health SBD |
$820.07
|
| Rate for Payer: UMR Bronson Commercial |
$481.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$976.28
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$784.59 |
| 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 |
$3,391.27
|
| Rate for Payer: BCN Commercial |
$3,391.27
|
| 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) |
$863.05
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$784.59
|
| 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
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$768.12 |
| 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 |
$5,166.99
|
| Rate for Payer: BCN Commercial |
$5,166.99
|
| 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) |
$844.93
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$768.12
|
| 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
|
|
|
LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 49320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.96 |
| 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 |
$4,141.99
|
| Rate for Payer: BCN Commercial |
$4,141.99
|
| 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) |
$354.16
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$321.96
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL, ABLATION OF 1 OR MORE LIVER TUMOR(S); RADIOFREQUENCY
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 47370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,228.88 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$6,509.71
|
| Rate for Payer: BCN Commercial |
$6,509.71
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,351.77
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$1,228.88
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
LAPAROSCOPY, SURGICAL, APPENDECTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$589.92 |
| 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 |
$5,054.28
|
| Rate for Payer: BCN Commercial |
$5,054.28
|
| 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) |
$648.91
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$589.92
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 47562
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$647.37 |
| 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 |
$5,046.45
|
| Rate for Payer: BCN Commercial |
$5,046.45
|
| 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) |
$712.11
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$647.37
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 47563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$704.04 |
| 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 |
$5,490.95
|
| Rate for Payer: BCN Commercial |
$5,490.95
|
| 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) |
$774.44
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$704.04
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 47564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,095.35 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$3,391.27
|
| Rate for Payer: BCN Commercial |
$3,391.27
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,204.88
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$1,095.35
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
LAPAROSCOPY, SURGICAL, COLPOPEXY (SUSPENSION OF VAGINAL APEX)
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 57425
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$945.36 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$9,781.69
|
| Rate for Payer: BCN Commercial |
$9,781.69
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.90
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$945.36
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44180
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$900.49 |
| 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 |
$4,765.22
|
| Rate for Payer: BCN Commercial |
$4,765.22
|
| 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) |
$990.54
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$900.49
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES)
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 43280
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,055.89 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$7,192.85
|
| Rate for Payer: BCN Commercial |
$7,192.85
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,161.48
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$1,055.89
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
|
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 |
$942.50 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: Aetna Medicare |
$3,876.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,659.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,659.50
|
| Rate for Payer: BCBS Complete |
$2,097.89
|
| Rate for Payer: BCBS MAPPO |
$3,727.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,560.82
|
| Rate for Payer: BCN Commercial |
$4,560.82
|
| Rate for Payer: BCN Medicare Advantage |
$3,727.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,727.60
|
| Rate for Payer: Mclaren Medicaid |
$1,997.99
|
| Rate for Payer: Mclaren Medicare |
$3,727.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,913.98
|
| Rate for Payer: Meridian Medicaid |
$2,097.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,286.74
|
| Rate for Payer: Nomi Health Commercial |
$7,827.96
|
| Rate for Payer: PACE Medicare |
$3,541.22
|
| Rate for Payer: PACE SWMI |
$3,727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,727.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,997.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,715.79
|
| Rate for Payer: Priority Health Medicare |
$3,727.60
|
| Rate for Payer: Priority Health Narrow Network |
$9,372.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,727.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,036.75
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,727.60
|
| Rate for Payer: UHC Exchange |
$942.50
|
| Rate for Payer: UHC Medicare Advantage |
$3,727.60
|
| Rate for Payer: UHCCP Medicaid |
$1,997.99
|
| Rate for Payer: VA VA |
$3,727.60
|
|
|
LAPAROSCOPY, SURGICAL; GASTROSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG, STAMM PROCEDURE) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 43653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.50 |
| 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 |
$3,175.61
|
| Rate for Payer: BCN Commercial |
$3,175.61
|
| 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) |
$620.95
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$564.50
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING)
|
Facility
|
OP
|
$17,966.53
|
|
|
Service Code
|
CPT 44186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$637.82 |
| 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) |
$701.60
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$637.82
|
| 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
|
|
|
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
|
$17,966.53
|
|
|
Service Code
|
CPT 58545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$879.56 |
| 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 |
$10,711.83
|
| Rate for Payer: BCN Commercial |
$10,711.83
|
| 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) |
$967.52
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$879.56
|
| 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
|
|
|
LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 5 OR MORE INTRAMURAL MYOMAS AND/OR INTRAMURAL MYOMAS WITH TOTAL WEIGHT GREATER THAN 250 G
|
Facility
|
OP
|
$32,060.66
|
|
|
Service Code
|
CPT 58546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,086.41 |
| Max. Negotiated Rate |
$32,060.66 |
| Rate for Payer: Aetna Medicare |
$10,608.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,750.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,750.89
|
| Rate for Payer: BCBS Complete |
$5,740.96
|
| Rate for Payer: BCBS MAPPO |
$10,200.71
|
| Rate for Payer: BCBS Trust/PPO |
$10,192.32
|
| Rate for Payer: BCN Commercial |
$10,192.32
|
| Rate for Payer: BCN Medicare Advantage |
$10,200.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,200.71
|
| Rate for Payer: Mclaren Medicaid |
$5,467.58
|
| Rate for Payer: Mclaren Medicare |
$10,200.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,710.75
|
| Rate for Payer: Meridian Medicaid |
$5,740.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,730.82
|
| Rate for Payer: Nomi Health Commercial |
$21,421.49
|
| Rate for Payer: PACE Medicare |
$9,690.67
|
| Rate for Payer: PACE SWMI |
$10,200.71
|
| Rate for Payer: PHP Medicare Advantage |
$10,200.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,467.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32,060.66
|
| Rate for Payer: Priority Health Medicare |
$10,200.71
|
| Rate for Payer: Priority Health Narrow Network |
$25,648.53
|
| Rate for Payer: Railroad Medicare Medicare |
$10,200.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,195.05
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,200.71
|
| Rate for Payer: UHC Exchange |
$1,086.41
|
| Rate for Payer: UHC Medicare Advantage |
$10,200.71
|
| Rate for Payer: UHCCP Medicaid |
$5,467.58
|
| Rate for Payer: VA VA |
$10,200.71
|
|
