|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,992.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$2,090.24 |
| Rate for Payer: Aetna Commercial |
$1,570.77
|
| Rate for Payer: BCBS Complete |
$797.76
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Mclaren Medicaid |
$759.77
|
| Rate for Payer: Meridian Medicaid |
$797.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,090.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,090.24
|
| Rate for Payer: Priority Health SBD |
$2,090.24
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$823.25 |
| Max. Negotiated Rate |
$2,260.16 |
| Rate for Payer: Aetna Commercial |
$1,721.13
|
| Rate for Payer: BCBS Complete |
$864.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,920.90
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Mclaren Medicaid |
$823.25
|
| Rate for Payer: Meridian Medicaid |
$864.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$823.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,260.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,260.16
|
| Rate for Payer: Priority Health SBD |
$2,260.16
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$689.27 |
| Max. Negotiated Rate |
$2,249.50 |
| Rate for Payer: Aetna Commercial |
$1,446.17
|
| Rate for Payer: BCBS Complete |
$723.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,249.50
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Mclaren Medicaid |
$689.27
|
| Rate for Payer: Meridian Medicaid |
$723.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,940.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,893.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,893.87
|
| Rate for Payer: Priority Health SBD |
$1,893.87
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$478.64 |
| Max. Negotiated Rate |
$1,447.58 |
| Rate for Payer: Aetna Commercial |
$1,102.79
|
| Rate for Payer: BCBS Complete |
$553.54
|
| Rate for Payer: BCBS Trust/PPO |
$478.64
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Mclaren Medicaid |
$527.18
|
| Rate for Payer: Meridian Medicaid |
$553.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,447.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,447.58
|
| Rate for Payer: Priority Health SBD |
$1,447.58
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$608.71 |
| Max. Negotiated Rate |
$7,606.62 |
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.55
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,606.62
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Priority Health Narrow Network |
$6,085.30
|
| Rate for Payer: Priority Health SBD |
$846.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$608.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Mclaren Medicaid |
$395.97
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.92
|
| Rate for Payer: Priority Health SBD |
$1,088.92
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$846.09 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.55
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health SBD |
$846.09
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Mclaren Medicaid |
$395.97
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.92
|
| Rate for Payer: Priority Health SBD |
$1,088.92
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$658.17 |
| Max. Negotiated Rate |
$1,805.67 |
| Rate for Payer: Aetna Commercial |
$1,385.01
|
| Rate for Payer: BCBS Complete |
$691.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Mclaren Medicaid |
$658.17
|
| Rate for Payer: Meridian Medicaid |
$691.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,805.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,805.67
|
| Rate for Payer: Priority Health SBD |
$1,805.67
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$575.31 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$982.56
|
| Rate for Payer: BCBS Complete |
$604.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Mclaren Medicaid |
$575.31
|
| Rate for Payer: Meridian Medicaid |
$604.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.21
|
| Rate for Payer: Priority Health SBD |
$1,110.21
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,066.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$1,446.20 |
| Rate for Payer: Aetna Commercial |
$1,133.75
|
| Rate for Payer: BCBS Complete |
$696.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,266.07
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Mclaren Medicaid |
$663.50
|
| Rate for Payer: Meridian Medicaid |
$696.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.90
|
| Rate for Payer: Priority Health SBD |
$1,284.90
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$613.84 |
| Rate for Payer: Aetna Commercial |
$459.09
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS Trust/PPO |
$229.28
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Mclaren Medicaid |
$223.44
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.84
|
| Rate for Payer: Priority Health Narrow Network |
$613.84
|
| Rate for Payer: Priority Health SBD |
$613.84
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$537.33 |
| Max. Negotiated Rate |
$8,817.68 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Medicare |
$2,995.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,600.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,600.14
|
| Rate for Payer: BCBS Complete |
$1,654.34
|
| Rate for Payer: BCBS MAPPO |
$2,880.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,880.11
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Cofinity Commercial |
$1,236.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,880.11
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Mclaren Medicaid |
$1,575.42
|
| Rate for Payer: Mclaren Medicare |
$2,880.11
|
| Rate for Payer: Meridian Medicaid |
$1,654.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,024.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,312.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: PACE Medicare |
$2,736.10
|
| Rate for Payer: PACE SWMI |
$2,880.11
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,880.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,575.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,817.68
|
| Rate for Payer: Priority Health Medicare |
$2,880.11
|
| Rate for Payer: Priority Health Narrow Network |
$7,054.14
|
| Rate for Payer: Priority Health SBD |
$1,113.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,880.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,880.11
|
| Rate for Payer: UHC Exchange |
$537.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,966.51
|
| Rate for Payer: VA VA |
$2,880.11
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$349.53 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: BCBS Complete |
$367.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Mclaren Medicaid |
$349.53
|
| Rate for Payer: Meridian Medicaid |
$367.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.81
|
| Rate for Payer: Priority Health Narrow Network |
$829.81
|
| Rate for Payer: Priority Health SBD |
$829.81
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$349.53 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: BCBS Complete |
$367.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Mclaren Medicaid |
$349.53
|
| Rate for Payer: Meridian Medicaid |
$367.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.81
|
| Rate for Payer: Priority Health Narrow Network |
$829.81
|
| Rate for Payer: Priority Health SBD |
$829.81
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$1,113.21 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.55
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,236.90
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health SBD |
$1,113.21
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$2,226.78 |
| Rate for Payer: Aetna Commercial |
$150.24
|
| Rate for Payer: BCBS Complete |
$76.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.78
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Mclaren Medicaid |
$73.06
|
| Rate for Payer: Meridian Medicaid |
$76.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.74
|
| Rate for Payer: Priority Health Narrow Network |
$198.74
|
| Rate for Payer: Priority Health SBD |
$198.74
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$409.17 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$662.98
|
| Rate for Payer: BCBS Complete |
$429.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Mclaren Medicaid |
$409.17
|
| Rate for Payer: Meridian Medicaid |
$429.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$785.49
|
| Rate for Payer: Priority Health Narrow Network |
$785.49
|
| Rate for Payer: Priority Health SBD |
$785.49
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$1,431.65 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: BCBS Complete |
$797.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Mclaren Medicaid |
$759.98
|
| Rate for Payer: Meridian Medicaid |
$797.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.65
|
| Rate for Payer: Priority Health SBD |
$1,431.65
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$1,375.92 |
| Max. Negotiated Rate |
$1,965.60 |
| Rate for Payer: Aetna Commercial |
$1,856.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,419.60
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cofinity Commercial |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,878.24
|
| Rate for Payer: Healthscope Commercial |
$1,965.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,856.40
|
| Rate for Payer: PHP Commercial |
$1,856.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health SBD |
$1,375.92
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$534.71 |
| Max. Negotiated Rate |
$7,382.58 |
| Rate for Payer: Aetna Commercial |
$1,856.40
|
| Rate for Payer: Aetna Medicare |
$2,629.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,419.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,160.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,160.42
|
| Rate for Payer: BCBS Complete |
$1,452.28
|
| Rate for Payer: BCBS MAPPO |
$2,528.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,528.34
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cofinity Commercial |
$1,878.24
|
| Rate for Payer: Cofinity Commercial |
$1,528.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,528.34
|
| Rate for Payer: Healthscope Commercial |
$1,965.60
|
| Rate for Payer: Mclaren Medicaid |
$1,383.00
|
| Rate for Payer: Mclaren Medicare |
$2,528.34
|
| Rate for Payer: Meridian Medicaid |
$1,452.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,654.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,907.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,856.40
|
| Rate for Payer: PACE Medicare |
$2,401.92
|
| Rate for Payer: PACE SWMI |
$2,528.34
|
| Rate for Payer: PHP Commercial |
$1,856.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,528.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,383.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,382.58
|
| Rate for Payer: Priority Health Medicare |
$2,528.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,906.06
|
| Rate for Payer: Priority Health SBD |
$1,375.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,528.34
|
| Rate for Payer: UHC Exchange |
$534.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,604.19
|
| Rate for Payer: VA VA |
$2,528.34
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Mclaren Medicaid |
$347.83
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.25
|
| Rate for Payer: Priority Health Narrow Network |
$827.25
|
| Rate for Payer: Priority Health SBD |
$827.25
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Mclaren Medicaid |
$347.83
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.25
|
| Rate for Payer: Priority Health Narrow Network |
$827.25
|
| Rate for Payer: Priority Health SBD |
$827.25
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$1,209.00
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$846.30 |
| Rate for Payer: Aetna Commercial |
$597.45
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS Trust/PPO |
$25.86
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Mclaren Medicaid |
$288.83
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.31
|
| Rate for Payer: Priority Health Narrow Network |
$686.31
|
| Rate for Payer: Priority Health SBD |
$686.31
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
21552
|
| Min. Negotiated Rate |
$761.67 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Aetna Commercial |
$1,027.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.85
|
| Rate for Payer: Cash Price |
$967.20
|
| Rate for Payer: Cofinity Commercial |
$1,039.74
|
| Rate for Payer: Cofinity Commercial |
$846.30
|
| Rate for Payer: Healthscope Commercial |
$1,088.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,027.65
|
| Rate for Payer: PHP Commercial |
$1,027.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.30
|
| Rate for Payer: Priority Health SBD |
$761.67
|
|
