|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$544.00
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCN Commercial |
$490.01
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Mclaren Medicaid |
$196.81
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.81
|
| Rate for Payer: UHC Medicaid |
$196.81
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Aetna Commercial |
$417.83
|
| Rate for Payer: Aetna Medicare |
$544.00
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCN Commercial |
$490.01
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Mclaren Medicaid |
$196.81
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.81
|
| Rate for Payer: UHC Medicaid |
$196.81
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$191.81 |
| Max. Negotiated Rate |
$979.20 |
| Rate for Payer: Aetna Commercial |
$924.80
|
| Rate for Payer: Aetna Medicare |
$282.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.00
|
| Rate for Payer: BCBS Complete |
$201.39
|
| Rate for Payer: BCBS MAPPO |
$272.00
|
| Rate for Payer: BCBS Trust/PPO |
$894.44
|
| Rate for Payer: BCN Commercial |
$894.44
|
| Rate for Payer: BCN Medicare Advantage |
$272.00
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$935.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$870.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.00
|
| Rate for Payer: Healthscope Commercial |
$979.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.00
|
| Rate for Payer: Mclaren Medicaid |
$191.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$201.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$924.80
|
| Rate for Payer: Nomi Health Commercial |
$892.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE Senior Care Partners |
$258.40
|
| Rate for Payer: PACE SWMI |
$272.00
|
| Rate for Payer: PHP Commercial |
$924.80
|
| Rate for Payer: PHP Medicare Advantage |
$272.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$946.56
|
| Rate for Payer: Priority Health Medicare |
$274.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$757.25
|
| Rate for Payer: Railroad Medicare Medicare |
$272.00
|
| Rate for Payer: UHC Core |
$908.48
|
| Rate for Payer: UHC Exchange |
$272.00
|
| Rate for Payer: UHC Medicaid |
$191.81
|
| Rate for Payer: UHC Medicare Advantage |
$272.00
|
| Rate for Payer: UHCCP Medicaid |
$191.81
|
| Rate for Payer: VA VA |
$272.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.00
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$684.75 |
| Rate for Payer: Aetna Commercial |
$404.59
|
| Rate for Payer: Aetna Medicare |
$456.50
|
| Rate for Payer: BCBS Complete |
$197.26
|
| Rate for Payer: BCN Commercial |
$470.59
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Mclaren Medicaid |
$187.87
|
| Rate for Payer: Meridian Medicaid |
$197.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$503.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.04
|
| Rate for Payer: UHC Medicaid |
$187.87
|
| Rate for Payer: UHCCP Medicaid |
$187.87
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$913.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$635.45 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Aetna Commercial |
$776.05
|
| Rate for Payer: BCBS Trust/PPO |
$754.05
|
| Rate for Payer: BCN Commercial |
$754.05
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$785.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.40
|
| Rate for Payer: Healthscope Commercial |
$821.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.05
|
| Rate for Payer: Nomi Health Commercial |
$748.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PHP Commercial |
$776.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$794.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.45
|
| Rate for Payer: UHC Core |
$762.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$913.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$160.96 |
| Max. Negotiated Rate |
$821.70 |
| Rate for Payer: Aetna Commercial |
$776.05
|
| Rate for Payer: Aetna Medicare |
$237.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$285.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$285.31
|
| Rate for Payer: BCBS Complete |
$169.00
|
| Rate for Payer: BCBS MAPPO |
$228.25
|
| Rate for Payer: BCBS Trust/PPO |
$750.58
|
| Rate for Payer: BCN Commercial |
$750.58
|
| Rate for Payer: BCN Medicare Advantage |
$228.25
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$785.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.25
|
| Rate for Payer: Healthscope Commercial |
$821.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$684.75
|
| Rate for Payer: Mclaren Medicaid |
$160.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$239.66
|
| Rate for Payer: Meridian Medicaid |
$169.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$262.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$251.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.05
|
| Rate for Payer: Nomi Health Commercial |
$748.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE Senior Care Partners |
$216.84
|
| Rate for Payer: PACE SWMI |
$228.25
|
| Rate for Payer: PHP Commercial |
$776.05
|
| Rate for Payer: PHP Medicare Advantage |
$228.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$160.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$794.31
|
| Rate for Payer: Priority Health Medicare |
$230.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$635.45
|
| Rate for Payer: Railroad Medicare Medicare |
$228.25
|
| Rate for Payer: UHC Core |
$762.36
|
| Rate for Payer: UHC Exchange |
$228.25
|
| Rate for Payer: UHC Medicaid |
$160.96
|
| Rate for Payer: UHC Medicare Advantage |
$228.25
|
| Rate for Payer: UHCCP Medicaid |
$160.96
|
| Rate for Payer: VA VA |
$228.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$684.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$187.87 |
| Max. Negotiated Rate |
$684.75 |
| Rate for Payer: Aetna Commercial |
$404.59
|
| Rate for Payer: Aetna Medicare |
$456.50
|
| Rate for Payer: BCBS Complete |
$197.26
|
| Rate for Payer: BCN Commercial |
$470.59
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Mclaren Medicaid |
$187.87
|
| Rate for Payer: Meridian Medicaid |
$197.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$503.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$503.04
|
| Rate for Payer: UHC Medicaid |
$187.87
|
| Rate for Payer: UHCCP Medicaid |
$187.87
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Aetna Commercial |
$353.01
|
| Rate for Payer: Aetna Medicare |
$427.00
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCN Commercial |
$415.81
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Mclaren Medicaid |
$166.35
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$640.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$444.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.49
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$611.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$143.99 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$318.43
|
| Rate for Payer: Aetna Medicare |
$305.50
|
| Rate for Payer: BCBS Complete |
$151.19
|
| Rate for Payer: BCN Commercial |
$367.51
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Cash Price |
$488.80
|
| Rate for Payer: Mclaren Medicaid |
$143.99
|
| Rate for Payer: Meridian Medicaid |
$151.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$458.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$143.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$447.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.79
|
| Rate for Payer: UHC Medicaid |
$143.99
|
| Rate for Payer: UHCCP Medicaid |
$143.99
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$350.99
|
| Rate for Payer: Aetna Medicare |
$390.00
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCN Commercial |
$398.88
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$486.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.02
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$1,137.68 |
| Rate for Payer: Aetna Commercial |
$810.36
|
| Rate for Payer: Aetna Medicare |
$595.00
|
| Rate for Payer: BCBS Complete |
$367.24
|
| Rate for Payer: BCN Commercial |
$933.72
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Mclaren Medicaid |
$349.75
|
| Rate for Payer: Meridian Medicaid |
$367.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,137.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,137.68
|
| Rate for Payer: UHC Medicaid |
$349.75
|
| Rate for Payer: UHCCP Medicaid |
$349.75
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$168.48 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Aetna Commercial |
$383.32
|
| Rate for Payer: Aetna Medicare |
$366.00
|
| Rate for Payer: BCBS Complete |
$176.90
|
| Rate for Payer: BCN Commercial |
$440.71
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Mclaren Medicaid |
$168.48
|
| Rate for Payer: Meridian Medicaid |
$176.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$549.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$536.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.99
|
| Rate for Payer: UHC Medicaid |
$168.48
|
| Rate for Payer: UHCCP Medicaid |
$168.48
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna Commercial |
$156.16
|
| Rate for Payer: Aetna Medicare |
$216.50
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCN Commercial |
$184.25
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Mclaren Medicaid |
$70.72
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.50
|
| Rate for Payer: UHC Medicaid |
$70.72
|
| Rate for Payer: UHCCP Medicaid |
$70.72
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$380.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$159.38
|
| Rate for Payer: Aetna Medicare |
$190.00
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCN Commercial |
$184.75
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Mclaren Medicaid |
$73.27
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$225.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.12
|
| Rate for Payer: UHC Medicaid |
$73.27
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$2,042.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$317.58 |
| Max. Negotiated Rate |
$1,531.50 |
| Rate for Payer: Aetna Commercial |
$731.34
|
| Rate for Payer: Aetna Medicare |
$1,021.00
|
| Rate for Payer: BCBS Complete |
$333.46
|
| Rate for Payer: BCN Commercial |
$831.63
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Cash Price |
$1,633.60
|
| Rate for Payer: Mclaren Medicaid |
$317.58
|
| Rate for Payer: Meridian Medicaid |
$333.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,531.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$317.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,013.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,013.29
|
| Rate for Payer: UHC Medicaid |
$317.58
|
| Rate for Payer: UHCCP Medicaid |
$317.58
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$748.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$644.98 |
| Rate for Payer: Aetna Commercial |
$459.97
|
| Rate for Payer: Aetna Medicare |
$374.00
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCN Commercial |
$529.35
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Mclaren Medicaid |
$202.35
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$644.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$644.98
|
| Rate for Payer: UHC Medicaid |
$202.35
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$915.00 |
| Rate for Payer: Aetna Commercial |
$468.59
|
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$218.96
|
| Rate for Payer: BCN Commercial |
$543.80
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Mclaren Medicaid |
$208.53
|
| Rate for Payer: Meridian Medicaid |
$218.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$662.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$662.57
|
| Rate for Payer: UHC Medicaid |
$208.53
|
| Rate for Payer: UHCCP Medicaid |
$208.53
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,898.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$732.72 |
| Max. Negotiated Rate |
$2,248.64 |
| Rate for Payer: Aetna Commercial |
$1,652.07
|
| Rate for Payer: Aetna Medicare |
$949.00
|
| Rate for Payer: BCBS Complete |
$769.36
|
| Rate for Payer: BCN Commercial |
$1,845.52
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Cash Price |
$1,518.40
|
| Rate for Payer: Mclaren Medicaid |
$732.72
|
| Rate for Payer: Meridian Medicaid |
$769.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,423.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,248.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,248.64
|
| Rate for Payer: UHC Medicaid |
$732.72
|
| Rate for Payer: UHCCP Medicaid |
$732.72
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,440.50 |
| Rate for Payer: Aetna Commercial |
$1,326.15
|
| Rate for Payer: Aetna Medicare |
$1,627.00
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCN Commercial |
$1,466.56
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Mclaren Medicaid |
$586.60
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,440.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,786.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,786.89
|
| Rate for Payer: UHC Medicaid |
$586.60
|
| Rate for Payer: UHCCP Medicaid |
$586.60
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Aetna Commercial |
$175.64
|
| Rate for Payer: Aetna Medicare |
$150.50
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCN Commercial |
$189.73
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.03
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$630.48 |
| Max. Negotiated Rate |
$1,658.49 |
| Rate for Payer: Aetna Commercial |
$1,400.04
|
| Rate for Payer: Aetna Medicare |
$1,094.00
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCN Commercial |
$1,542.25
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Mclaren Medicaid |
$630.48
|
| Rate for Payer: Meridian Medicaid |
$662.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,641.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,658.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,658.49
|
| Rate for Payer: UHC Medicaid |
$630.48
|
| Rate for Payer: UHCCP Medicaid |
$630.48
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,177.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$1,632.75 |
| Rate for Payer: Aetna Commercial |
$1,037.13
|
| Rate for Payer: Aetna Medicare |
$1,088.50
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCN Commercial |
$1,169.25
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Mclaren Medicaid |
$471.80
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,632.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,424.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,424.67
|
| Rate for Payer: UHC Medicaid |
$471.80
|
| Rate for Payer: UHCCP Medicaid |
$471.80
|
|
|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$357.02
|
| Rate for Payer: Aetna Medicare |
$300.00
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCN Commercial |
$398.38
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Mclaren Medicaid |
$157.19
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$485.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$485.40
|
| Rate for Payer: UHC Medicaid |
$157.19
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,962.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Aetna Commercial |
$515.29
|
| Rate for Payer: Aetna Medicare |
$981.00
|
| Rate for Payer: BCBS Complete |
$261.89
|
| Rate for Payer: BCN Commercial |
$622.48
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Mclaren Medicaid |
$249.42
|
| Rate for Payer: Meridian Medicaid |
$261.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$722.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$722.99
|
| Rate for Payer: UHC Medicaid |
$249.42
|
| Rate for Payer: UHCCP Medicaid |
$249.42
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$773.62 |
| Max. Negotiated Rate |
$1,894.82 |
| Rate for Payer: Aetna Commercial |
$1,376.32
|
| Rate for Payer: Aetna Medicare |
$1,031.50
|
| Rate for Payer: BCBS Complete |
$812.30
|
| Rate for Payer: BCN Commercial |
$1,631.39
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Mclaren Medicaid |
$773.62
|
| Rate for Payer: Meridian Medicaid |
$812.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,547.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,894.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,894.82
|
| Rate for Payer: UHC Medicaid |
$773.62
|
| Rate for Payer: UHCCP Medicaid |
$773.62
|
|
