|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,807.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$785.76 |
| Max. Negotiated Rate |
$2,153.75 |
| Rate for Payer: Aetna Commercial |
$1,634.06
|
| Rate for Payer: Aetna Medicare |
$1,268.23
|
| Rate for Payer: BCBS Complete |
$825.05
|
| Rate for Payer: BCBS MAPPO |
$1,219.45
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$1,790.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,219.45
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cofinity Commercial |
$1,756.01
|
| Rate for Payer: Cofinity Commercial |
$1,634.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,219.45
|
| Rate for Payer: Mclaren Medicaid |
$785.76
|
| Rate for Payer: Meridian Medicaid |
$825.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,280.42
|
| Rate for Payer: PACE SWMI |
$1,219.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,219.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$785.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,153.75
|
| Rate for Payer: Priority Health Medicare |
$1,219.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,153.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,219.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,219.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,256.03
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$625.37 |
| Max. Negotiated Rate |
$2,167.90 |
| Rate for Payer: Aetna Commercial |
$1,305.96
|
| Rate for Payer: Aetna Medicare |
$1,013.58
|
| Rate for Payer: BCBS Complete |
$656.64
|
| Rate for Payer: BCBS MAPPO |
$974.60
|
| Rate for Payer: BCBS Trust/PPO |
$686.26
|
| Rate for Payer: BCN Commercial |
$1,429.87
|
| Rate for Payer: BCN Medicare Advantage |
$974.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.42
|
| Rate for Payer: Cofinity Commercial |
$1,305.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.60
|
| Rate for Payer: Mclaren Medicaid |
$625.37
|
| Rate for Payer: Meridian Medicaid |
$656.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,023.33
|
| Rate for Payer: PACE SWMI |
$974.60
|
| Rate for Payer: PHP Medicare Advantage |
$974.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,720.41
|
| Rate for Payer: Priority Health Medicare |
$974.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,720.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.84
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$80.73 |
| Max. Negotiated Rate |
$1,025.43 |
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Medicare |
$133.74
|
| Rate for Payer: BCBS Complete |
$84.77
|
| Rate for Payer: BCBS MAPPO |
$128.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.43
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$128.60
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$172.32
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.60
|
| Rate for Payer: Mclaren Medicaid |
$80.73
|
| Rate for Payer: Meridian Medicaid |
$84.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.03
|
| Rate for Payer: PACE SWMI |
$128.60
|
| Rate for Payer: PHP Medicare Advantage |
$128.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.21
|
| Rate for Payer: Priority Health Medicare |
$128.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$203.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.60
|
| Rate for Payer: UHC Medicare Advantage |
$132.46
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,082.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$656.04 |
| Max. Negotiated Rate |
$5,381.79 |
| Rate for Payer: Aetna Commercial |
$1,373.66
|
| Rate for Payer: Aetna Medicare |
$1,066.12
|
| Rate for Payer: BCBS Complete |
$688.84
|
| Rate for Payer: BCBS MAPPO |
$1,025.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,381.79
|
| Rate for Payer: BCN Commercial |
$1,497.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.12
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cofinity Commercial |
$1,476.17
|
| Rate for Payer: Cofinity Commercial |
$1,373.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.12
|
| Rate for Payer: Mclaren Medicaid |
$656.04
|
| Rate for Payer: Meridian Medicaid |
$688.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,076.38
|
| Rate for Payer: PACE SWMI |
$1,025.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$656.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,629.91
|
| Rate for Payer: Priority Health Medicare |
$1,025.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,629.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,055.87
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,451.10 |
| Rate for Payer: Aetna Commercial |
$1,029.07
|
| Rate for Payer: Aetna Medicare |
$798.68
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$767.96
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$767.96
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,105.86
|
| Rate for Payer: Cofinity Commercial |
$1,029.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.96
|
| Rate for Payer: Mclaren Medicaid |
$498.85
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.36
|
| Rate for Payer: PACE SWMI |
$767.96
|
| Rate for Payer: PHP Medicare Advantage |
$767.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.50
|
| Rate for Payer: Priority Health Medicare |
$767.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.96
|
| Rate for Payer: UHC Medicare Advantage |
$791.00
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$1,451.10 |
| Rate for Payer: Aetna Commercial |
$1,029.07
|
| Rate for Payer: Aetna Medicare |
$798.68
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$767.96
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$767.96
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,029.07
|
| Rate for Payer: Cofinity Commercial |
$1,105.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.96
|
| Rate for Payer: Mclaren Medicaid |
$498.85
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$806.36
|
| Rate for Payer: PACE SWMI |
$767.96
|
| Rate for Payer: PHP Medicare Advantage |
$767.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,363.50
|
| Rate for Payer: Priority Health Medicare |
$767.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,363.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.96
|
| Rate for Payer: UHC Medicare Advantage |
$791.00
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,073.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$492.34 |
| Max. Negotiated Rate |
$1,865.70 |
| Rate for Payer: Aetna Commercial |
$1,762.05
|
| Rate for Payer: Aetna Medicare |
$538.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$647.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$647.81
|
| Rate for Payer: BCBS Complete |
$829.20
|
| Rate for Payer: BCBS MAPPO |
$518.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.76
|
| Rate for Payer: BCN Commercial |
$1,611.76
|
| Rate for Payer: BCN Medicare Advantage |
$518.25
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,782.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.25
|
| Rate for Payer: Healthscope Commercial |
$1,865.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$544.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.05
|
| Rate for Payer: PACE Senior Care Partners |
$492.34
|
| Rate for Payer: PACE SWMI |
$518.25
|
| Rate for Payer: PHP Commercial |
$1,762.05
|
| Rate for Payer: PHP Medicare Advantage |
$518.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.51
|
| Rate for Payer: Priority Health Medicare |
$518.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,264.32
|
| Rate for Payer: Railroad Medicare Medicare |
$518.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.24
|
| Rate for Payer: UHC Core |
$1,730.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.25
|
| Rate for Payer: UHC Medicare Advantage |
$533.80
|
| Rate for Payer: VA VA |
$518.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.75
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
IP
|
$2,073.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$1,264.32 |
| Max. Negotiated Rate |
$1,865.70 |
| Rate for Payer: Aetna Commercial |
$1,762.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,602.01
|
| Rate for Payer: BCN Commercial |
$1,602.01
|
| Rate for Payer: Cash Price |
$1,658.40
|
| Rate for Payer: Cofinity Commercial |
$1,782.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,658.40
|
| Rate for Payer: Healthscope Commercial |
$1,865.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,554.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,762.05
|
| Rate for Payer: PHP Commercial |
$1,762.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,451.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,803.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,264.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,824.24
|
| Rate for Payer: UHC Core |
$1,730.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,554.75
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$762.87 |
| Rate for Payer: Aetna Commercial |
$344.51
|
| Rate for Payer: Aetna Medicare |
$267.38
|
| Rate for Payer: BCBS Complete |
$178.70
|
| Rate for Payer: BCBS MAPPO |
$257.10
|
| Rate for Payer: BCBS Trust/PPO |
$762.87
|
| Rate for Payer: BCN Commercial |
$539.99
|
| Rate for Payer: BCN Medicare Advantage |
$257.10
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cash Price |
$457.60
|
| Rate for Payer: Cofinity Commercial |
$344.51
|
| Rate for Payer: Cofinity Commercial |
$370.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.10
|
| Rate for Payer: Mclaren Medicaid |
$170.19
|
| Rate for Payer: Meridian Medicaid |
$178.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$269.96
|
| Rate for Payer: PACE SWMI |
$257.10
|
| Rate for Payer: PHP Medicare Advantage |
$257.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.79
|
| Rate for Payer: Priority Health Medicare |
$257.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.10
|
| Rate for Payer: UHC Medicare Advantage |
$264.81
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,868.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$161.13 |
| Max. Negotiated Rate |
$1,307.60 |
| Rate for Payer: Aetna Commercial |
$532.97
|
| Rate for Payer: Aetna Medicare |
$413.65
|
| Rate for Payer: BCBS Complete |
$278.22
|
| Rate for Payer: BCBS MAPPO |
$397.74
|
| Rate for Payer: BCBS Trust/PPO |
$161.13
|
| Rate for Payer: BCN Commercial |
$595.21
|
| Rate for Payer: BCN Medicare Advantage |
$397.74
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cash Price |
$1,494.40
|
| Rate for Payer: Cofinity Commercial |
$572.75
|
| Rate for Payer: Cofinity Commercial |
$532.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.74
|
| Rate for Payer: Mclaren Medicaid |
$264.97
|
| Rate for Payer: Meridian Medicaid |
$278.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$417.63
|
| Rate for Payer: PACE SWMI |
$397.74
|
| Rate for Payer: PHP Medicare Advantage |
$397.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.67
|
| Rate for Payer: Priority Health Medicare |
$397.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$397.74
|
| Rate for Payer: UHC Medicare Advantage |
$409.67
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$209.74 |
| Max. Negotiated Rate |
$1,806.82 |
| Rate for Payer: Aetna Commercial |
$1,413.12
|
| Rate for Payer: Aetna Medicare |
$1,096.75
|
| Rate for Payer: BCBS Complete |
$727.53
|
| Rate for Payer: BCBS MAPPO |
$1,054.57
|
| Rate for Payer: BCBS Trust/PPO |
$209.74
|
| Rate for Payer: BCN Commercial |
$1,559.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,054.57
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Cash Price |
$1,571.20
|
| Rate for Payer: Cofinity Commercial |
$1,518.58
|
| Rate for Payer: Cofinity Commercial |
$1,413.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,054.57
|
| Rate for Payer: Mclaren Medicaid |
$692.89
|
| Rate for Payer: Meridian Medicaid |
$727.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,107.30
|
| Rate for Payer: PACE SWMI |
$1,054.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,054.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,806.82
|
| Rate for Payer: Priority Health Medicare |
$1,054.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,806.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,054.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,054.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,086.21
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,334.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$1,633.80 |
| Rate for Payer: Aetna Commercial |
$1,124.93
|
| Rate for Payer: Aetna Medicare |
$873.08
|
| Rate for Payer: BCBS Complete |
$576.12
|
| Rate for Payer: BCBS MAPPO |
$839.50
|
| Rate for Payer: BCBS Trust/PPO |
$160.07
|
| Rate for Payer: BCN Commercial |
$1,243.68
|
| Rate for Payer: BCN Medicare Advantage |
$839.50
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cash Price |
$1,867.20
|
| Rate for Payer: Cofinity Commercial |
$1,208.88
|
| Rate for Payer: Cofinity Commercial |
$1,124.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$839.50
|
| Rate for Payer: Mclaren Medicaid |
$548.69
|
| Rate for Payer: Meridian Medicaid |
$576.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$881.48
|
| Rate for Payer: PACE SWMI |
$839.50
|
| Rate for Payer: PHP Medicare Advantage |
$839.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$548.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,441.04
|
| Rate for Payer: Priority Health Medicare |
$839.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,441.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$839.50
|
| Rate for Payer: UHC Medicare Advantage |
$864.68
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$266.26 |
| Max. Negotiated Rate |
$835.80 |
| Rate for Payer: Aetna Commercial |
$562.92
|
| Rate for Payer: Aetna Medicare |
$436.89
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS MAPPO |
$420.09
|
| Rate for Payer: BCBS Trust/PPO |
$266.26
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$420.09
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cofinity Commercial |
$562.92
|
| Rate for Payer: Cofinity Commercial |
$604.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.09
|
| Rate for Payer: Mclaren Medicaid |
$277.11
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$441.09
|
| Rate for Payer: PACE SWMI |
$420.09
|
| Rate for Payer: PHP Medicare Advantage |
$420.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$727.03
|
| Rate for Payer: Priority Health Medicare |
$420.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$727.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.09
|
| Rate for Payer: UHC Medicare Advantage |
$432.69
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$262.20 |
| Max. Negotiated Rate |
$863.80 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Medicare |
$406.99
|
| Rate for Payer: BCBS Complete |
$275.31
|
| Rate for Payer: BCBS MAPPO |
$391.34
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$584.95
|
| Rate for Payer: BCN Medicare Advantage |
$391.34
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cofinity Commercial |
$524.40
|
| Rate for Payer: Cofinity Commercial |
$563.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.34
|
| Rate for Payer: Mclaren Medicaid |
$262.20
|
| Rate for Payer: Meridian Medicaid |
$275.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$410.91
|
| Rate for Payer: PACE SWMI |
$391.34
|
| Rate for Payer: PHP Medicare Advantage |
$391.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$677.77
|
| Rate for Payer: Priority Health Medicare |
$391.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$677.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$391.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.34
|
| Rate for Payer: UHC Medicare Advantage |
$403.08
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,661.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$293.73 |
| Max. Negotiated Rate |
$1,162.70 |
| Rate for Payer: Aetna Commercial |
$599.02
|
| Rate for Payer: Aetna Medicare |
$464.91
|
| Rate for Payer: BCBS Complete |
$308.42
|
| Rate for Payer: BCBS MAPPO |
$447.03
|
| Rate for Payer: BCBS Trust/PPO |
$306.94
|
| Rate for Payer: BCN Commercial |
$666.56
|
| Rate for Payer: BCN Medicare Advantage |
$447.03
|
| Rate for Payer: Cash Price |
$1,328.80
|
| Rate for Payer: Cash Price |
$1,328.80
|
| Rate for Payer: Cofinity Commercial |
$599.02
|
| Rate for Payer: Cofinity Commercial |
$643.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.03
|
| Rate for Payer: Mclaren Medicaid |
$293.73
|
| Rate for Payer: Meridian Medicaid |
$308.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$469.38
|
| Rate for Payer: PACE SWMI |
$447.03
|
| Rate for Payer: PHP Medicare Advantage |
$447.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$293.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.33
|
| Rate for Payer: Priority Health Medicare |
$447.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$772.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.03
|
| Rate for Payer: UHC Medicare Advantage |
$460.44
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,440.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$958.14
|
| Rate for Payer: Aetna Medicare |
$743.63
|
| Rate for Payer: BCBS Complete |
$489.57
|
| Rate for Payer: BCBS MAPPO |
$715.03
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$1,063.36
|
| Rate for Payer: BCN Medicare Advantage |
$715.03
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cofinity Commercial |
$1,029.64
|
| Rate for Payer: Cofinity Commercial |
$958.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.03
|
| Rate for Payer: Mclaren Medicaid |
$466.26
|
| Rate for Payer: Meridian Medicaid |
$489.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$750.78
|
| Rate for Payer: PACE SWMI |
$715.03
|
| Rate for Payer: PHP Medicare Advantage |
$715.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,232.11
|
| Rate for Payer: Priority Health Medicare |
$715.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$715.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.03
|
| Rate for Payer: UHC Medicare Advantage |
$736.48
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$3,922.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$3,845.34 |
| Rate for Payer: Aetna Commercial |
$2,915.10
|
| Rate for Payer: Aetna Medicare |
$2,262.47
|
| Rate for Payer: BCBS Complete |
$1,485.71
|
| Rate for Payer: BCBS MAPPO |
$2,175.45
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$3,195.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.45
|
| Rate for Payer: Cash Price |
$3,137.60
|
| Rate for Payer: Cash Price |
$3,137.60
|
| Rate for Payer: Cofinity Commercial |
$3,132.65
|
| Rate for Payer: Cofinity Commercial |
$2,915.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.45
|
| Rate for Payer: Mclaren Medicaid |
$1,414.96
|
| Rate for Payer: Meridian Medicaid |
$1,485.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,284.22
|
| Rate for Payer: PACE SWMI |
$2,175.45
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,745.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,845.34
|
| Rate for Payer: Priority Health Medicare |
$2,175.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,845.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,175.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.45
|
| Rate for Payer: UHC Medicare Advantage |
$2,240.71
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,866.23 |
| Rate for Payer: Aetna Commercial |
$1,401.09
|
| Rate for Payer: Aetna Medicare |
$1,087.41
|
| Rate for Payer: BCBS Complete |
$713.44
|
| Rate for Payer: BCBS MAPPO |
$1,045.59
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$1,551.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,045.59
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$1,401.09
|
| Rate for Payer: Cofinity Commercial |
$1,505.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,045.59
|
| Rate for Payer: Mclaren Medicaid |
$679.47
|
| Rate for Payer: Meridian Medicaid |
$713.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,097.87
|
| Rate for Payer: PACE SWMI |
$1,045.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,045.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,866.23
|
| Rate for Payer: Priority Health Medicare |
$1,045.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,866.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,045.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,045.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,076.96
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Aetna Commercial |
$833.83
|
| Rate for Payer: Aetna Medicare |
$647.15
|
| Rate for Payer: BCBS Complete |
$426.06
|
| Rate for Payer: BCBS MAPPO |
$622.26
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCN Commercial |
$926.05
|
| Rate for Payer: BCN Medicare Advantage |
$622.26
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cofinity Commercial |
$896.05
|
| Rate for Payer: Cofinity Commercial |
$833.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.26
|
| Rate for Payer: Mclaren Medicaid |
$405.77
|
| Rate for Payer: Meridian Medicaid |
$426.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$653.37
|
| Rate for Payer: PACE SWMI |
$622.26
|
| Rate for Payer: PHP Medicare Advantage |
$622.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,114.20
|
| Rate for Payer: Priority Health Medicare |
$622.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,114.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.26
|
| Rate for Payer: UHC Medicare Advantage |
$640.93
|
|
|
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 |
$1,570.82
|
| Rate for Payer: Aetna Medicare |
$1,219.14
|
| Rate for Payer: BCBS Complete |
$797.76
|
| Rate for Payer: BCBS MAPPO |
$1,172.25
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,172.25
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cofinity Commercial |
$1,570.82
|
| Rate for Payer: Cofinity Commercial |
$1,688.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,172.25
|
| Rate for Payer: Mclaren Medicaid |
$759.77
|
| Rate for Payer: Meridian Medicaid |
$797.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,230.86
|
| Rate for Payer: PACE SWMI |
$1,172.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,172.25
|
| 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 Medicare |
$1,172.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,090.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,172.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,172.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,207.42
|
|
|
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 |
$1,702.71
|
| Rate for Payer: Aetna Medicare |
$1,321.51
|
| Rate for Payer: BCBS Complete |
$864.41
|
| Rate for Payer: BCBS MAPPO |
$1,270.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,920.90
|
| Rate for Payer: BCN Commercial |
$1,878.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,270.68
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Cofinity Commercial |
$1,829.78
|
| Rate for Payer: Cofinity Commercial |
$1,702.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,270.68
|
| Rate for Payer: Mclaren Medicaid |
$823.25
|
| Rate for Payer: Meridian Medicaid |
$864.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,334.21
|
| Rate for Payer: PACE SWMI |
$1,270.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,270.68
|
| 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 Medicare |
$1,270.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,260.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,270.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,270.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.80
|
|
|
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 |
$1,430.37
|
| Rate for Payer: Aetna Medicare |
$1,110.14
|
| Rate for Payer: BCBS Complete |
$723.73
|
| Rate for Payer: BCBS MAPPO |
$1,067.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,249.50
|
| Rate for Payer: BCN Commercial |
$1,574.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,067.44
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cofinity Commercial |
$1,537.11
|
| Rate for Payer: Cofinity Commercial |
$1,430.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,067.44
|
| Rate for Payer: Mclaren Medicaid |
$689.27
|
| Rate for Payer: Meridian Medicaid |
$723.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,120.81
|
| Rate for Payer: PACE SWMI |
$1,067.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,067.44
|
| 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 Medicare |
$1,067.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,893.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,067.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,067.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.46
|
|
|
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 |
$1,083.07
|
| Rate for Payer: Aetna Medicare |
$840.59
|
| Rate for Payer: BCBS Complete |
$553.54
|
| Rate for Payer: BCBS MAPPO |
$808.26
|
| Rate for Payer: BCBS Trust/PPO |
$478.64
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: BCN Medicare Advantage |
$808.26
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cofinity Commercial |
$1,083.07
|
| Rate for Payer: Cofinity Commercial |
$1,163.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.26
|
| Rate for Payer: Mclaren Medicaid |
$527.18
|
| Rate for Payer: Meridian Medicaid |
$553.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$848.67
|
| Rate for Payer: PACE SWMI |
$808.26
|
| Rate for Payer: PHP Medicare Advantage |
$808.26
|
| 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 Medicare |
$808.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,447.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$808.26
|
| Rate for Payer: UHC Medicare Advantage |
$832.51
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$318.96 |
| Max. Negotiated Rate |
$1,933.98 |
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna Medicare |
$349.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$419.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$419.69
|
| Rate for Payer: BCBS Complete |
$1,933.98
|
| Rate for Payer: BCBS MAPPO |
$335.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.18
|
| Rate for Payer: BCN Commercial |
$1,044.18
|
| Rate for Payer: BCN Medicare Advantage |
$335.75
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$335.75
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,007.25
|
| Rate for Payer: Mclaren Medicaid |
$1,841.89
|
| Rate for Payer: Meridian Medicaid |
$1,933.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$352.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$386.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.55
|
| Rate for Payer: PACE Senior Care Partners |
$318.96
|
| Rate for Payer: PACE SWMI |
$335.75
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: PHP Medicare Advantage |
$335.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,841.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,168.41
|
| Rate for Payer: Priority Health Medicare |
$335.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$819.10
|
| Rate for Payer: Railroad Medicare Medicare |
$335.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,181.84
|
| Rate for Payer: UHC Core |
$1,121.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$335.75
|
| Rate for Payer: UHC Medicare Advantage |
$345.82
|
| Rate for Payer: VA VA |
$335.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,007.25
|
|
|
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 |
$810.45
|
| Rate for Payer: Aetna Medicare |
$629.00
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS MAPPO |
$604.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: BCN Medicare Advantage |
$604.81
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$810.45
|
| Rate for Payer: Cofinity Commercial |
$870.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.81
|
| Rate for Payer: Mclaren Medicaid |
$395.97
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$635.05
|
| Rate for Payer: PACE SWMI |
$604.81
|
| Rate for Payer: PHP Medicare Advantage |
$604.81
|
| 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 Medicare |
$604.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,088.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.81
|
| Rate for Payer: UHC Medicare Advantage |
$622.95
|
|
