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Service Code CPT 49521
Hospital Charge Code 49521
Hospital Revenue Code 960
Min. Negotiated Rate $707.93
Max. Negotiated Rate $8,414.74
Rate for Payer: Aetna Commercial $1,743.35
Rate for Payer: Aetna Medicare $7,001.06
Rate for Payer: Aetna New Business (MI Preferred) $1,333.15
Rate for Payer: Allen County Amish Medical Aid Commercial $8,414.74
Rate for Payer: Amish Plain Church Group Commercial $8,414.74
Rate for Payer: BCBS Complete $3,866.74
Rate for Payer: BCBS MAPPO $6,731.79
Rate for Payer: BCBS Trust/PPO $1,472.51
Rate for Payer: BCN Medicare Advantage $6,731.79
Rate for Payer: Cash Price $1,640.80
Rate for Payer: Cash Price $1,640.80
Rate for Payer: Cofinity Commercial $1,763.86
Rate for Payer: Cofinity Commercial $1,435.70
Rate for Payer: Health Alliance Plan Medicare Advantage $6,731.79
Rate for Payer: Healthscope Commercial $1,845.90
Rate for Payer: Mclaren Medicaid $3,682.29
Rate for Payer: Mclaren Medicare $6,731.79
Rate for Payer: Meridian Medicaid $3,866.74
Rate for Payer: Meridian Wellcare - Medicare Advantage $7,068.38
Rate for Payer: MI Amish Medical Board Commercial $7,741.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS $1,743.35
Rate for Payer: PACE Medicare $6,395.20
Rate for Payer: PACE SWMI $6,731.79
Rate for Payer: PHP Commercial $1,743.35
Rate for Payer: PHP Medicare Advantage $6,731.79
Rate for Payer: Priority Health Choice Medicaid $3,682.29
Rate for Payer: Priority Health Cigna Priority Health $1,435.70
Rate for Payer: Priority Health Medicare $6,731.79
Rate for Payer: Priority Health SBD $1,292.13
Rate for Payer: Railroad Medicare Medicare $6,731.79
Rate for Payer: UHC All Payor (Choice/PPO) $778.72
Rate for Payer: UHC Dual Complete DSNP $6,731.79
Rate for Payer: UHC Exchange $707.93
Rate for Payer: UHC Medicare Advantage $6,933.74
Rate for Payer: VA VA $6,731.79
Service Code HCPCS 49521
Min. Negotiated Rate $134.72
Max. Negotiated Rate $1,435.70
Rate for Payer: Aetna Commercial $967.53
Rate for Payer: BCBS Complete $483.54
Rate for Payer: BCBS Trust/PPO $134.72
Rate for Payer: Cash Price $1,640.80
Rate for Payer: Cash Price $1,640.80
Rate for Payer: Mclaren Medicaid $460.51
Rate for Payer: Meridian Medicaid $483.54
Rate for Payer: Priority Health Choice Medicaid $460.51
Rate for Payer: Priority Health Cigna Priority Health $1,435.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $1,264.13
Rate for Payer: Priority Health Narrow Network $1,264.13
Rate for Payer: Priority Health SBD $1,264.13
Service Code HCPCS 38115
Min. Negotiated Rate $710.04
Max. Negotiated Rate $3,066.70
Rate for Payer: Aetna Commercial $1,592.12
Rate for Payer: BCBS Complete $865.30
Rate for Payer: BCBS Trust/PPO $710.04
Rate for Payer: Cash Price $3,504.80
Rate for Payer: Cash Price $3,504.80
Rate for Payer: Mclaren Medicaid $824.10
Rate for Payer: Meridian Medicaid $865.30
Rate for Payer: Priority Health Choice Medicaid $824.10
Rate for Payer: Priority Health Cigna Priority Health $3,066.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $2,790.15
Rate for Payer: Priority Health Narrow Network $2,790.15
Rate for Payer: Priority Health SBD $2,790.15
Service Code HCPCS 49600
Min. Negotiated Rate $472.43
Max. Negotiated Rate $2,035.01
Rate for Payer: Aetna Commercial $991.65
Rate for Payer: BCBS Complete $496.05
Rate for Payer: BCBS Trust/PPO $2,035.01
Rate for Payer: Cash Price $1,545.60
Rate for Payer: Cash Price $1,545.60
Rate for Payer: Mclaren Medicaid $472.43
Rate for Payer: Meridian Medicaid $496.05
Rate for Payer: Priority Health Choice Medicaid $472.43
Rate for Payer: Priority Health Cigna Priority Health $1,352.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network $1,296.48
Rate for Payer: Priority Health Narrow Network $1,296.48
Rate for Payer: Priority Health SBD $1,296.48
Service Code HCPCS 49590
Min. Negotiated Rate $637.60
Max. Negotiated Rate $1,115.80
Rate for Payer: BCBS Complete $637.60
Rate for Payer: Cash Price $1,275.20
Rate for Payer: Priority Health Cigna Priority Health $1,115.80
Service Code HCPCS 38780
Min. Negotiated Rate $672.02
Max. Negotiated Rate $5,411.70
Rate for Payer: Aetna Commercial $1,285.27
Rate for Payer: BCBS Complete $705.62
Rate for Payer: BCBS Trust/PPO $957.28
Rate for Payer: Cash Price $6,184.80
Rate for Payer: Cash Price $6,184.80
Rate for Payer: Mclaren Medicaid $672.02
Rate for Payer: Meridian Medicaid $705.62
Rate for Payer: Priority Health Choice Medicaid $672.02
Rate for Payer: Priority Health Cigna Priority Health $5,411.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $2,243.29
Rate for Payer: Priority Health Narrow Network $2,243.29
Rate for Payer: Priority Health SBD $2,243.29
Service Code HCPCS 28200
Min. Negotiated Rate $211.08
Max. Negotiated Rate $1,084.07
Rate for Payer: Aetna Commercial $428.78
Rate for Payer: BCBS Complete $221.63
Rate for Payer: BCBS Trust/PPO $1,084.07
Rate for Payer: Cash Price $982.40
Rate for Payer: Cash Price $982.40
Rate for Payer: Mclaren Medicaid $211.08
Rate for Payer: Meridian Medicaid $221.63
Rate for Payer: Priority Health Choice Medicaid $211.08
Rate for Payer: Priority Health Cigna Priority Health $859.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network $498.91
Rate for Payer: Priority Health Narrow Network $498.91
Rate for Payer: Priority Health SBD $498.91
Service Code HCPCS 25263
Min. Negotiated Rate $413.22
Max. Negotiated Rate $3,601.42
Rate for Payer: Aetna Commercial $843.92
Rate for Payer: BCBS Complete $433.88
Rate for Payer: BCBS Trust/PPO $3,601.42
Rate for Payer: Cash Price $983.20
Rate for Payer: Cash Price $983.20
Rate for Payer: Mclaren Medicaid $413.22
Rate for Payer: Meridian Medicaid $433.88
Rate for Payer: Priority Health Choice Medicaid $413.22
Rate for Payer: Priority Health Cigna Priority Health $860.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network $980.44
Rate for Payer: Priority Health Narrow Network $980.44
Rate for Payer: Priority Health SBD $980.44
Service Code HCPCS 25260
Min. Negotiated Rate $413.22
Max. Negotiated Rate $1,459.69
Rate for Payer: Aetna Commercial $841.29
Rate for Payer: BCBS Complete $433.88
Rate for Payer: BCBS Trust/PPO $1,459.69
Rate for Payer: Cash Price $1,334.40
Rate for Payer: Cash Price $1,334.40
Rate for Payer: Mclaren Medicaid $413.22
Rate for Payer: Meridian Medicaid $433.88
Rate for Payer: Priority Health Choice Medicaid $413.22
Rate for Payer: Priority Health Cigna Priority Health $1,167.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network $982.49
Rate for Payer: Priority Health Narrow Network $982.49
Rate for Payer: Priority Health SBD $982.49
Service Code HCPCS 25270
Min. Negotiated Rate $322.91
Max. Negotiated Rate $3,579.76
Rate for Payer: Aetna Commercial $656.88
Rate for Payer: BCBS Complete $339.06
Rate for Payer: BCBS Trust/PPO $3,579.76
Rate for Payer: Cash Price $1,112.00
Rate for Payer: Cash Price $1,112.00
Rate for Payer: Mclaren Medicaid $322.91
Rate for Payer: Meridian Medicaid $339.06
Rate for Payer: Priority Health Choice Medicaid $322.91
Rate for Payer: Priority Health Cigna Priority Health $973.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network $765.98
Rate for Payer: Priority Health Narrow Network $765.98
Rate for Payer: Priority Health SBD $765.98
Service Code HCPCS 25272
Min. Negotiated Rate $365.30
Max. Negotiated Rate $3,566.55
Rate for Payer: Aetna Commercial $747.23
Rate for Payer: BCBS Complete $383.56
Rate for Payer: BCBS Trust/PPO $3,566.55
Rate for Payer: Cash Price $1,271.20
Rate for Payer: Cash Price $1,271.20
Rate for Payer: Mclaren Medicaid $365.30
Rate for Payer: Meridian Medicaid $383.56
Rate for Payer: Priority Health Choice Medicaid $365.30
Rate for Payer: Priority Health Cigna Priority Health $1,112.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network $866.58
Rate for Payer: Priority Health Narrow Network $866.58
Rate for Payer: Priority Health SBD $866.58
Service Code HCPCS 25275
Min. Negotiated Rate $436.86
Max. Negotiated Rate $1,389.50
Rate for Payer: Aetna Commercial $894.15
Rate for Payer: BCBS Complete $458.70
Rate for Payer: BCBS Trust/PPO $1,102.56
Rate for Payer: Cash Price $1,588.00
Rate for Payer: Cash Price $1,588.00
Rate for Payer: Mclaren Medicaid $436.86
Rate for Payer: Meridian Medicaid $458.70
Rate for Payer: Priority Health Choice Medicaid $436.86
Rate for Payer: Priority Health Cigna Priority Health $1,389.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network $1,037.64
Rate for Payer: Priority Health Narrow Network $1,037.64
Rate for Payer: Priority Health SBD $1,037.64
Service Code HCPCS 28210
Min. Negotiated Rate $273.49
Max. Negotiated Rate $912.90
Rate for Payer: Aetna Commercial $564.04
Rate for Payer: BCBS Complete $287.16
Rate for Payer: BCBS Trust/PPO $912.90
Rate for Payer: Cash Price $742.40
Rate for Payer: Cash Price $742.40
Rate for Payer: Mclaren Medicaid $273.49
Rate for Payer: Meridian Medicaid $287.16
Rate for Payer: Priority Health Choice Medicaid $273.49
Rate for Payer: Priority Health Cigna Priority Health $649.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network $649.04
Rate for Payer: Priority Health Narrow Network $649.04
Rate for Payer: Priority Health SBD $649.04
Service Code HCPCS 33877
Min. Negotiated Rate $2,114.78
Max. Negotiated Rate $5,964.00
Rate for Payer: Aetna Commercial $4,855.61
Rate for Payer: BCBS Complete $2,362.42
Rate for Payer: BCBS Trust/PPO $2,114.78
Rate for Payer: Cash Price $6,816.00
Rate for Payer: Cash Price $6,816.00
Rate for Payer: Mclaren Medicaid $2,249.92
Rate for Payer: Meridian Medicaid $2,362.42
Rate for Payer: Priority Health Choice Medicaid $2,249.92
Rate for Payer: Priority Health Cigna Priority Health $5,964.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network $5,602.04
Rate for Payer: Priority Health Narrow Network $5,602.04
Rate for Payer: Priority Health SBD $5,602.04
Service Code HCPCS 35190
Min. Negotiated Rate $474.78
Max. Negotiated Rate $1,192.11
Rate for Payer: Aetna Commercial $1,022.68
Rate for Payer: BCBS Complete $498.52
Rate for Payer: BCBS Trust/PPO $706.87
Rate for Payer: Cash Price $1,208.80
Rate for Payer: Cash Price $1,208.80
Rate for Payer: Mclaren Medicaid $474.78
Rate for Payer: Meridian Medicaid $498.52
Rate for Payer: Priority Health Choice Medicaid $474.78
Rate for Payer: Priority Health Cigna Priority Health $1,057.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network $1,192.11
Rate for Payer: Priority Health Narrow Network $1,192.11
Rate for Payer: Priority Health SBD $1,192.11
Service Code HCPCS 35188
Min. Negotiated Rate $833.26
Max. Negotiated Rate $2,909.90
Rate for Payer: Aetna Commercial $1,718.98
Rate for Payer: BCBS Complete $874.92
Rate for Payer: BCBS Trust/PPO $933.51
Rate for Payer: Cash Price $3,325.60
Rate for Payer: Cash Price $3,325.60
Rate for Payer: Mclaren Medicaid $833.26
Rate for Payer: Meridian Medicaid $874.92
Rate for Payer: Priority Health Choice Medicaid $833.26
Rate for Payer: Priority Health Cigna Priority Health $2,909.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network $2,060.80
Rate for Payer: Priority Health Narrow Network $2,060.80
Rate for Payer: Priority Health SBD $2,060.80
Service Code HCPCS 55060
Min. Negotiated Rate $243.67
Max. Negotiated Rate $1,220.90
Rate for Payer: Aetna Commercial $486.63
Rate for Payer: BCBS Complete $255.85
Rate for Payer: BCBS Trust/PPO $1,220.90
Rate for Payer: Cash Price $494.40
Rate for Payer: Cash Price $494.40
Rate for Payer: Mclaren Medicaid $243.67
Rate for Payer: Meridian Medicaid $255.85
Rate for Payer: Priority Health Choice Medicaid $243.67
Rate for Payer: Priority Health Cigna Priority Health $432.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network $609.53
Rate for Payer: Priority Health Narrow Network $609.53
Rate for Payer: Priority Health SBD $609.53
Service Code HCPCS 36575
Min. Negotiated Rate $20.87
Max. Negotiated Rate $1,177.58
Rate for Payer: Aetna Commercial $46.01
Rate for Payer: BCBS Complete $21.91
Rate for Payer: BCBS Trust/PPO $1,177.58
Rate for Payer: Cash Price $351.20
Rate for Payer: Cash Price $351.20
Rate for Payer: Mclaren Medicaid $20.87
Rate for Payer: Meridian Medicaid $21.91
Rate for Payer: Priority Health Choice Medicaid $20.87
Rate for Payer: Priority Health Cigna Priority Health $307.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network $52.13
Rate for Payer: Priority Health Narrow Network $52.13
Rate for Payer: Priority Health SBD $52.13
Service Code HCPCS 49582
Min. Negotiated Rate $573.60
Max. Negotiated Rate $1,003.80
Rate for Payer: BCBS Complete $573.60
Rate for Payer: Cash Price $1,147.20
Rate for Payer: Priority Health Cigna Priority Health $1,003.80
Service Code HCPCS 49580
Min. Negotiated Rate $497.20
Max. Negotiated Rate $870.10
Rate for Payer: BCBS Complete $497.20
Rate for Payer: Cash Price $994.40
Rate for Payer: Priority Health Cigna Priority Health $870.10
Service Code HCPCS 49587
Min. Negotiated Rate $660.80
Max. Negotiated Rate $1,156.40
Rate for Payer: BCBS Complete $660.80
Rate for Payer: Cash Price $1,321.60
Rate for Payer: Priority Health Cigna Priority Health $1,156.40
Service Code HCPCS 49585
Min. Negotiated Rate $573.60
Max. Negotiated Rate $1,003.80
Rate for Payer: BCBS Complete $573.60
Rate for Payer: Cash Price $1,147.20
Rate for Payer: Priority Health Cigna Priority Health $1,003.80
Service Code HCPCS 33414
Min. Negotiated Rate $509.28
Max. Negotiated Rate $5,518.10
Rate for Payer: Aetna Commercial $2,886.79
Rate for Payer: BCBS Complete $1,413.69
Rate for Payer: BCBS Trust/PPO $509.28
Rate for Payer: Cash Price $6,306.40
Rate for Payer: Cash Price $6,306.40
Rate for Payer: Mclaren Medicaid $1,346.37
Rate for Payer: Meridian Medicaid $1,413.69
Rate for Payer: Priority Health Choice Medicaid $1,346.37
Rate for Payer: Priority Health Cigna Priority Health $5,518.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network $3,348.67
Rate for Payer: Priority Health Narrow Network $3,348.67
Rate for Payer: Priority Health SBD $3,348.67
Service Code HCPCS 26428
Min. Negotiated Rate $98.26
Max. Negotiated Rate $1,937.60
Rate for Payer: Aetna Commercial $1,057.07
Rate for Payer: BCBS Complete $541.68
Rate for Payer: BCBS Trust/PPO $98.26
Rate for Payer: Cash Price $2,214.40
Rate for Payer: Cash Price $2,214.40
Rate for Payer: Mclaren Medicaid $515.89
Rate for Payer: Meridian Medicaid $541.68
Rate for Payer: Priority Health Choice Medicaid $515.89
Rate for Payer: Priority Health Cigna Priority Health $1,937.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network $1,239.34
Rate for Payer: Priority Health Narrow Network $1,239.34
Rate for Payer: Priority Health SBD $1,239.34
Service Code HCPCS 26426
Min. Negotiated Rate $195.47
Max. Negotiated Rate $1,360.80
Rate for Payer: Aetna Commercial $669.62
Rate for Payer: BCBS Complete $345.54
Rate for Payer: BCBS Trust/PPO $195.47
Rate for Payer: Cash Price $1,555.20
Rate for Payer: Cash Price $1,555.20
Rate for Payer: Mclaren Medicaid $329.09
Rate for Payer: Meridian Medicaid $345.54
Rate for Payer: Priority Health Choice Medicaid $329.09
Rate for Payer: Priority Health Cigna Priority Health $1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network $780.79
Rate for Payer: Priority Health Narrow Network $780.79
Rate for Payer: Priority Health SBD $780.79