|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$209.30 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: BCBS Trust/PPO |
$262.85
|
| Rate for Payer: BCN Commercial |
$248.84
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.70
|
| Rate for Payer: Nomi Health Commercial |
$264.04
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO |
$280.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.36
|
| Rate for Payer: UHC Core |
$268.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.50
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$106.37
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$102.28
|
| Rate for Payer: BCN Medicare Advantage |
$102.28
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$147.28
|
| Rate for Payer: Cofinity Commercial |
$137.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$122.74
|
| Rate for Payer: PACE SWMI |
$102.28
|
| Rate for Payer: PHP Medicare Advantage |
$102.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$103.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.28
|
| Rate for Payer: UHC Exchange |
$102.28
|
| Rate for Payer: UHC Medicare Advantage |
$102.28
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 45990
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$137.06
|
| Rate for Payer: Aetna Medicare |
$106.37
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$102.28
|
| Rate for Payer: BCN Medicare Advantage |
$102.28
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$147.28
|
| Rate for Payer: Cofinity Commercial |
$137.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.39
|
| Rate for Payer: Nomi Health Commercial |
$122.74
|
| Rate for Payer: PACE SWMI |
$102.28
|
| Rate for Payer: PHP Medicare Advantage |
$102.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$103.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.28
|
| Rate for Payer: UHC Exchange |
$102.28
|
| Rate for Payer: UHC Medicare Advantage |
$102.28
|
|
|
PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 45990
|
| Hospital Charge Code |
45990
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$2,082.02 |
| Rate for Payer: Aetna Commercial |
$273.70
|
| Rate for Payer: Aetna Medicare |
$83.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.62
|
| Rate for Payer: BCBS Complete |
$2,082.02
|
| Rate for Payer: BCBS MAPPO |
$80.50
|
| Rate for Payer: BCBS Trust/PPO |
$264.72
|
| Rate for Payer: BCN Commercial |
$250.35
|
| Rate for Payer: BCN Medicare Advantage |
$80.50
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$276.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$257.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.50
|
| Rate for Payer: Healthscope Commercial |
$289.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$241.50
|
| Rate for Payer: Mclaren Medicaid |
$1,982.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.53
|
| Rate for Payer: Meridian Medicaid |
$2,082.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.70
|
| Rate for Payer: Nomi Health Commercial |
$264.04
|
| Rate for Payer: PACE Senior Care Partners |
$76.47
|
| Rate for Payer: PACE SWMI |
$80.50
|
| Rate for Payer: PHP Commercial |
$273.70
|
| Rate for Payer: PHP Medicare Advantage |
$80.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,982.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO |
$280.14
|
| Rate for Payer: Priority Health Medicare |
$81.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$215.74
|
| Rate for Payer: Railroad Medicare Medicare |
$80.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.36
|
| Rate for Payer: UHC Core |
$268.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.50
|
| Rate for Payer: UHC Exchange |
$80.50
|
| Rate for Payer: UHC Medicare Advantage |
$80.50
|
| Rate for Payer: UHCCP Medicaid |
$1,982.75
|
| Rate for Payer: VA VA |
$80.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$241.50
|
|
|
PR ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
HCPCS 59425
|
| Min. Negotiated Rate |
$424.09 |
| Max. Negotiated Rate |
$751.40 |
| Rate for Payer: Aetna Commercial |
$568.28
|
| Rate for Payer: Aetna Medicare |
$441.05
|
| Rate for Payer: BCBS Complete |
$462.40
|
| Rate for Payer: BCBS MAPPO |
$424.09
|
| Rate for Payer: BCN Medicare Advantage |
$424.09
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cash Price |
$924.80
|
| Rate for Payer: Cofinity Commercial |
$610.69
|
| Rate for Payer: Cofinity Commercial |
$568.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.29
|
| Rate for Payer: Nomi Health Commercial |
$508.91
|
| Rate for Payer: PACE SWMI |
$424.09
|
| Rate for Payer: PHP Medicare Advantage |
$424.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$751.40
|
| Rate for Payer: Priority Health Medicare |
$428.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$424.09
|
| Rate for Payer: UHC Exchange |
$424.09
|
| Rate for Payer: UHC Medicare Advantage |
$424.09
|
|
|
PR ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,589.00
|
|
|
Service Code
|
HCPCS 59426
|
| Min. Negotiated Rate |
$635.60 |
| Max. Negotiated Rate |
$1,122.31 |
| Rate for Payer: Aetna Commercial |
$1,044.37
|
| Rate for Payer: Aetna Medicare |
$810.56
|
| Rate for Payer: BCBS Complete |
$635.60
|
| Rate for Payer: BCBS MAPPO |
$779.38
|
| Rate for Payer: BCN Medicare Advantage |
$779.38
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cash Price |
$1,271.20
|
| Rate for Payer: Cofinity Commercial |
$1,122.31
|
| Rate for Payer: Cofinity Commercial |
$1,044.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$818.35
|
| Rate for Payer: Nomi Health Commercial |
$935.26
|
| Rate for Payer: PACE SWMI |
$779.38
|
| Rate for Payer: PHP Medicare Advantage |
$779.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,032.85
|
| Rate for Payer: Priority Health Medicare |
$787.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$779.38
|
| Rate for Payer: UHC Exchange |
$779.38
|
| Rate for Payer: UHC Medicare Advantage |
$779.38
|
|
|
PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS 57240
|
| Min. Negotiated Rate |
$587.39 |
| Max. Negotiated Rate |
$1,009.45 |
| Rate for Payer: Aetna Commercial |
$787.10
|
| Rate for Payer: Aetna Medicare |
$610.89
|
| Rate for Payer: BCBS Complete |
$621.20
|
| Rate for Payer: BCBS MAPPO |
$587.39
|
| Rate for Payer: BCN Medicare Advantage |
$587.39
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Cofinity Commercial |
$845.84
|
| Rate for Payer: Cofinity Commercial |
$787.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.76
|
| Rate for Payer: Nomi Health Commercial |
$704.87
|
| Rate for Payer: PACE SWMI |
$587.39
|
| Rate for Payer: PHP Medicare Advantage |
$587.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.45
|
| Rate for Payer: Priority Health Medicare |
$593.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.39
|
| Rate for Payer: UHC Exchange |
$587.39
|
| Rate for Payer: UHC Medicare Advantage |
$587.39
|
|
|
PR ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,881.00
|
|
|
Service Code
|
HCPCS 22845
|
| Min. Negotiated Rate |
$709.23 |
| Max. Negotiated Rate |
$2,522.65 |
| Rate for Payer: Aetna Commercial |
$950.37
|
| Rate for Payer: Aetna Medicare |
$737.60
|
| Rate for Payer: BCBS Complete |
$1,552.40
|
| Rate for Payer: BCBS MAPPO |
$709.23
|
| Rate for Payer: BCN Medicare Advantage |
$709.23
|
| Rate for Payer: Cash Price |
$3,104.80
|
| Rate for Payer: Cash Price |
$3,104.80
|
| Rate for Payer: Cofinity Commercial |
$950.37
|
| Rate for Payer: Cofinity Commercial |
$1,021.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.69
|
| Rate for Payer: Nomi Health Commercial |
$851.08
|
| Rate for Payer: PACE SWMI |
$709.23
|
| Rate for Payer: PHP Medicare Advantage |
$709.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,522.65
|
| Rate for Payer: Priority Health Medicare |
$716.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.23
|
| Rate for Payer: UHC Exchange |
$709.23
|
| Rate for Payer: UHC Medicare Advantage |
$709.23
|
|
|
PR ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$4,270.00
|
|
|
Service Code
|
HCPCS 22846
|
| Min. Negotiated Rate |
$739.06 |
| Max. Negotiated Rate |
$2,775.50 |
| Rate for Payer: Aetna Commercial |
$990.34
|
| Rate for Payer: Aetna Medicare |
$768.62
|
| Rate for Payer: BCBS Complete |
$1,708.00
|
| Rate for Payer: BCBS MAPPO |
$739.06
|
| Rate for Payer: BCN Medicare Advantage |
$739.06
|
| Rate for Payer: Cash Price |
$3,416.00
|
| Rate for Payer: Cash Price |
$3,416.00
|
| Rate for Payer: Cofinity Commercial |
$990.34
|
| Rate for Payer: Cofinity Commercial |
$1,064.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.01
|
| Rate for Payer: Nomi Health Commercial |
$886.87
|
| Rate for Payer: PACE SWMI |
$739.06
|
| Rate for Payer: PHP Medicare Advantage |
$739.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,775.50
|
| Rate for Payer: Priority Health Medicare |
$746.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.06
|
| Rate for Payer: UHC Exchange |
$739.06
|
| Rate for Payer: UHC Medicare Advantage |
$739.06
|
|
|
PR ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 22847
|
| Min. Negotiated Rate |
$766.79 |
| Max. Negotiated Rate |
$2,456.35 |
| Rate for Payer: Aetna Commercial |
$1,027.50
|
| Rate for Payer: Aetna Medicare |
$797.46
|
| Rate for Payer: BCBS Complete |
$1,511.60
|
| Rate for Payer: BCBS MAPPO |
$766.79
|
| Rate for Payer: BCN Medicare Advantage |
$766.79
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cofinity Commercial |
$1,104.18
|
| Rate for Payer: Cofinity Commercial |
$1,027.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$805.13
|
| Rate for Payer: Nomi Health Commercial |
$920.15
|
| Rate for Payer: PACE SWMI |
$766.79
|
| Rate for Payer: PHP Medicare Advantage |
$766.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,456.35
|
| Rate for Payer: Priority Health Medicare |
$774.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$766.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.79
|
| Rate for Payer: UHC Exchange |
$766.79
|
| Rate for Payer: UHC Medicare Advantage |
$766.79
|
|
|
PR ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 27418
|
| Min. Negotiated Rate |
$787.55 |
| Max. Negotiated Rate |
$1,675.05 |
| Rate for Payer: Aetna Commercial |
$1,055.32
|
| Rate for Payer: Aetna Medicare |
$819.05
|
| Rate for Payer: BCBS Complete |
$1,030.80
|
| Rate for Payer: BCBS MAPPO |
$787.55
|
| Rate for Payer: BCN Medicare Advantage |
$787.55
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,055.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.93
|
| Rate for Payer: Nomi Health Commercial |
$945.06
|
| Rate for Payer: PACE SWMI |
$787.55
|
| Rate for Payer: PHP Medicare Advantage |
$787.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.05
|
| Rate for Payer: Priority Health Medicare |
$795.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.55
|
| Rate for Payer: UHC Exchange |
$787.55
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR ANTICOAG MGMT, EACH SUBSEQ 90 DAYS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 99364
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
|
|
PR ANTICOAG MGMT, INITIAL 90 DAYS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 99363
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
|
|
PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 93793
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$10.62
|
| Rate for Payer: BCN Medicare Advantage |
$10.62
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.15
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: PACE SWMI |
$10.62
|
| Rate for Payer: PHP Medicare Advantage |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$10.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.62
|
| Rate for Payer: UHC Exchange |
$10.62
|
| Rate for Payer: UHC Medicare Advantage |
$10.62
|
|
|
PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 51840
|
| Min. Negotiated Rate |
$661.88 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$886.92
|
| Rate for Payer: Aetna Medicare |
$688.36
|
| Rate for Payer: BCBS Complete |
$983.60
|
| Rate for Payer: BCBS MAPPO |
$661.88
|
| Rate for Payer: BCN Medicare Advantage |
$661.88
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$953.11
|
| Rate for Payer: Cofinity Commercial |
$886.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.97
|
| Rate for Payer: Nomi Health Commercial |
$794.26
|
| Rate for Payer: PACE SWMI |
$661.88
|
| Rate for Payer: PHP Medicare Advantage |
$661.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.35
|
| Rate for Payer: Priority Health Medicare |
$668.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$661.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.88
|
| Rate for Payer: UHC Exchange |
$661.88
|
| Rate for Payer: UHC Medicare Advantage |
$661.88
|
|
|
PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 33866
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$1,270.18 |
| Rate for Payer: Aetna Commercial |
$1,181.97
|
| Rate for Payer: Aetna Medicare |
$917.35
|
| Rate for Payer: BCBS Complete |
$776.00
|
| Rate for Payer: BCBS MAPPO |
$882.07
|
| Rate for Payer: BCN Medicare Advantage |
$882.07
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cofinity Commercial |
$1,270.18
|
| Rate for Payer: Cofinity Commercial |
$1,181.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.17
|
| Rate for Payer: Nomi Health Commercial |
$1,058.48
|
| Rate for Payer: PACE SWMI |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$882.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,261.00
|
| Rate for Payer: Priority Health Medicare |
$890.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.07
|
| Rate for Payer: UHC Exchange |
$882.07
|
| Rate for Payer: UHC Medicare Advantage |
$882.07
|
|
|
PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX
|
Professional
|
Both
|
$1,864.00
|
|
|
Service Code
|
HCPCS 33800
|
| Min. Negotiated Rate |
$745.60 |
| Max. Negotiated Rate |
$1,365.83 |
| Rate for Payer: Aetna Commercial |
$1,270.98
|
| Rate for Payer: Aetna Medicare |
$986.43
|
| Rate for Payer: BCBS Complete |
$745.60
|
| Rate for Payer: BCBS MAPPO |
$948.49
|
| Rate for Payer: BCN Medicare Advantage |
$948.49
|
| Rate for Payer: Cash Price |
$1,491.20
|
| Rate for Payer: Cash Price |
$1,491.20
|
| Rate for Payer: Cofinity Commercial |
$1,365.83
|
| Rate for Payer: Cofinity Commercial |
$1,270.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.91
|
| Rate for Payer: Nomi Health Commercial |
$1,138.19
|
| Rate for Payer: PACE SWMI |
$948.49
|
| Rate for Payer: PHP Medicare Advantage |
$948.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.60
|
| Rate for Payer: Priority Health Medicare |
$957.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$948.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.49
|
| Rate for Payer: UHC Exchange |
$948.49
|
| Rate for Payer: UHC Medicare Advantage |
$948.49
|
|
|
PR AORTOPLASTY SUPRAVALVULAR STENOSIS
|
Professional
|
Both
|
$9,378.00
|
|
|
Service Code
|
HCPCS 33417
|
| Min. Negotiated Rate |
$1,603.26 |
| Max. Negotiated Rate |
$6,095.70 |
| Rate for Payer: Aetna Commercial |
$2,148.37
|
| Rate for Payer: Aetna Medicare |
$1,667.39
|
| Rate for Payer: BCBS Complete |
$3,751.20
|
| Rate for Payer: BCBS MAPPO |
$1,603.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,603.26
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Cofinity Commercial |
$2,308.69
|
| Rate for Payer: Cofinity Commercial |
$2,148.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,603.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,683.42
|
| Rate for Payer: Nomi Health Commercial |
$1,923.91
|
| Rate for Payer: PACE SWMI |
$1,603.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,603.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,095.70
|
| Rate for Payer: Priority Health Medicare |
$1,619.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,603.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,603.26
|
| Rate for Payer: UHC Exchange |
$1,603.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,603.26
|
|
|
PR APNEALINK
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$81.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Exchange |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$81.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Exchange |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$562.25 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: BCBS Trust/PPO |
$706.10
|
| Rate for Payer: BCN Commercial |
$668.47
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO |
$752.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.20
|
| Rate for Payer: UHC Core |
$722.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$205.44 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna Medicare |
$224.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$270.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$270.31
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$216.25
|
| Rate for Payer: BCBS Trust/PPO |
$711.12
|
| Rate for Payer: BCN Commercial |
$672.54
|
| Rate for Payer: BCN Medicare Advantage |
$216.25
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.25
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: Nomi Health Commercial |
$709.30
|
| Rate for Payer: PACE Senior Care Partners |
$205.44
|
| Rate for Payer: PACE SWMI |
$216.25
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: PHP Medicare Advantage |
$216.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO |
$752.55
|
| Rate for Payer: Priority Health Medicare |
$218.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$579.55
|
| Rate for Payer: Railroad Medicare Medicare |
$216.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.20
|
| Rate for Payer: UHC Core |
$722.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.25
|
| Rate for Payer: UHC Exchange |
$216.25
|
| Rate for Payer: UHC Medicare Advantage |
$216.25
|
| Rate for Payer: VA VA |
$216.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.75
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$2,137.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$853.15 |
| Max. Negotiated Rate |
$1,389.05 |
| Rate for Payer: Aetna Commercial |
$1,143.22
|
| Rate for Payer: Aetna Medicare |
$887.28
|
| Rate for Payer: BCBS Complete |
$854.80
|
| Rate for Payer: BCBS MAPPO |
$853.15
|
| Rate for Payer: BCN Medicare Advantage |
$853.15
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Cofinity Commercial |
$1,143.22
|
| Rate for Payer: Cofinity Commercial |
$1,228.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.81
|
| Rate for Payer: Nomi Health Commercial |
$1,023.78
|
| Rate for Payer: PACE SWMI |
$853.15
|
| Rate for Payer: PHP Medicare Advantage |
$853.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.05
|
| Rate for Payer: Priority Health Medicare |
$861.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.15
|
| Rate for Payer: UHC Exchange |
$853.15
|
| Rate for Payer: UHC Medicare Advantage |
$853.15
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$624.56 |
| Max. Negotiated Rate |
$1,129.70 |
| Rate for Payer: Aetna Commercial |
$836.91
|
| Rate for Payer: Aetna Medicare |
$649.54
|
| Rate for Payer: BCBS Complete |
$695.20
|
| Rate for Payer: BCBS MAPPO |
$624.56
|
| Rate for Payer: BCN Medicare Advantage |
$624.56
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$899.37
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.79
|
| Rate for Payer: Nomi Health Commercial |
$749.47
|
| Rate for Payer: PACE SWMI |
$624.56
|
| Rate for Payer: PHP Medicare Advantage |
$624.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$630.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.56
|
| Rate for Payer: UHC Exchange |
$624.56
|
| Rate for Payer: UHC Medicare Advantage |
$624.56
|
|
