|
PR EXC LESION ESOPHAGUS W/PRIM RPR THRC/ABDL APPR
|
Professional
|
Both
|
$1,870.00
|
|
|
Service Code
|
HCPCS 43101
|
| Min. Negotiated Rate |
$748.00 |
| Max. Negotiated Rate |
$1,396.35 |
| Rate for Payer: Aetna Commercial |
$1,299.38
|
| Rate for Payer: Aetna Medicare |
$1,008.48
|
| Rate for Payer: BCBS Complete |
$748.00
|
| Rate for Payer: BCBS MAPPO |
$969.69
|
| Rate for Payer: BCN Medicare Advantage |
$969.69
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cash Price |
$1,496.00
|
| Rate for Payer: Cofinity Commercial |
$1,396.35
|
| Rate for Payer: Cofinity Commercial |
$1,299.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$969.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,018.17
|
| Rate for Payer: Nomi Health Commercial |
$1,163.63
|
| Rate for Payer: PACE SWMI |
$969.69
|
| Rate for Payer: PHP Medicare Advantage |
$969.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,215.50
|
| Rate for Payer: Priority Health Medicare |
$979.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$969.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$969.69
|
| Rate for Payer: UHC Exchange |
$969.69
|
| Rate for Payer: UHC Medicare Advantage |
$969.69
|
|
|
PR EXC LESION EYELID W/O CLSR/W/SIMPLE DIR CLOSURE
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 67840
|
| Min. Negotiated Rate |
$144.99 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Commercial |
$194.29
|
| Rate for Payer: Aetna Medicare |
$150.79
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: BCBS MAPPO |
$144.99
|
| Rate for Payer: BCN Medicare Advantage |
$144.99
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$208.79
|
| Rate for Payer: Cofinity Commercial |
$194.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.24
|
| Rate for Payer: Nomi Health Commercial |
$173.99
|
| Rate for Payer: PACE SWMI |
$144.99
|
| Rate for Payer: PHP Medicare Advantage |
$144.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
| Rate for Payer: Priority Health Medicare |
$146.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.99
|
| Rate for Payer: UHC Exchange |
$144.99
|
| Rate for Payer: UHC Medicare Advantage |
$144.99
|
|
|
PR EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 40816
|
| Min. Negotiated Rate |
$286.99 |
| Max. Negotiated Rate |
$794.95 |
| Rate for Payer: Aetna Commercial |
$384.57
|
| Rate for Payer: Aetna Medicare |
$298.47
|
| Rate for Payer: BCBS Complete |
$489.20
|
| Rate for Payer: BCBS MAPPO |
$286.99
|
| Rate for Payer: BCN Medicare Advantage |
$286.99
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Cofinity Commercial |
$384.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.34
|
| Rate for Payer: Nomi Health Commercial |
$344.39
|
| Rate for Payer: PACE SWMI |
$286.99
|
| Rate for Payer: PHP Medicare Advantage |
$286.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$794.95
|
| Rate for Payer: Priority Health Medicare |
$289.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.99
|
| Rate for Payer: UHC Exchange |
$286.99
|
| Rate for Payer: UHC Medicare Advantage |
$286.99
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$679.00
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$267.74 |
| Max. Negotiated Rate |
$441.35 |
| Rate for Payer: Aetna Commercial |
$358.77
|
| Rate for Payer: Aetna Medicare |
$278.45
|
| Rate for Payer: BCBS Complete |
$271.60
|
| Rate for Payer: BCBS MAPPO |
$267.74
|
| Rate for Payer: BCN Medicare Advantage |
$267.74
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cofinity Commercial |
$385.55
|
| Rate for Payer: Cofinity Commercial |
$358.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.13
|
| Rate for Payer: Nomi Health Commercial |
$321.29
|
| Rate for Payer: PACE SWMI |
$267.74
|
| Rate for Payer: PHP Medicare Advantage |
$267.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.35
|
| Rate for Payer: Priority Health Medicare |
$270.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.74
|
| Rate for Payer: UHC Exchange |
$267.74
|
| Rate for Payer: UHC Medicare Advantage |
$267.74
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$171.31 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$229.56
|
| Rate for Payer: Aetna Medicare |
$178.16
|
| Rate for Payer: BCBS Complete |
$230.00
|
| Rate for Payer: BCBS MAPPO |
$171.31
|
| Rate for Payer: BCN Medicare Advantage |
$171.31
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$246.69
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.88
|
| Rate for Payer: Nomi Health Commercial |
$205.57
|
| Rate for Payer: PACE SWMI |
$171.31
|
| Rate for Payer: PHP Medicare Advantage |
$171.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$173.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.31
|
| Rate for Payer: UHC Exchange |
$171.31
|
| Rate for Payer: UHC Medicare Advantage |
$171.31
|
|
|
PR EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 42107
|
| Min. Negotiated Rate |
$308.88 |
| Max. Negotiated Rate |
$586.30 |
| Rate for Payer: Aetna Commercial |
$413.90
|
| Rate for Payer: Aetna Medicare |
$321.24
|
| Rate for Payer: BCBS Complete |
$360.80
|
| Rate for Payer: BCBS MAPPO |
$308.88
|
| Rate for Payer: BCN Medicare Advantage |
$308.88
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$444.79
|
| Rate for Payer: Cofinity Commercial |
$413.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.32
|
| Rate for Payer: Nomi Health Commercial |
$370.66
|
| Rate for Payer: PACE SWMI |
$308.88
|
| Rate for Payer: PHP Medicare Advantage |
$308.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health Medicare |
$311.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.88
|
| Rate for Payer: UHC Exchange |
$308.88
|
| Rate for Payer: UHC Medicare Advantage |
$308.88
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$127.55 |
| Max. Negotiated Rate |
$250.25 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Medicare |
$132.65
|
| Rate for Payer: BCBS Complete |
$154.00
|
| Rate for Payer: BCBS MAPPO |
$127.55
|
| Rate for Payer: BCN Medicare Advantage |
$127.55
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cash Price |
$308.00
|
| Rate for Payer: Cofinity Commercial |
$183.67
|
| Rate for Payer: Cofinity Commercial |
$170.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.93
|
| Rate for Payer: Nomi Health Commercial |
$153.06
|
| Rate for Payer: PACE SWMI |
$127.55
|
| Rate for Payer: PHP Medicare Advantage |
$127.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.25
|
| Rate for Payer: Priority Health Medicare |
$128.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.55
|
| Rate for Payer: UHC Exchange |
$127.55
|
| Rate for Payer: UHC Medicare Advantage |
$127.55
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$152.32 |
| Max. Negotiated Rate |
$328.90 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$158.41
|
| Rate for Payer: BCBS Complete |
$202.40
|
| Rate for Payer: BCBS MAPPO |
$152.32
|
| Rate for Payer: BCN Medicare Advantage |
$152.32
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$219.34
|
| Rate for Payer: Cofinity Commercial |
$204.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.94
|
| Rate for Payer: Nomi Health Commercial |
$182.78
|
| Rate for Payer: PACE SWMI |
$152.32
|
| Rate for Payer: PHP Medicare Advantage |
$152.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.90
|
| Rate for Payer: Priority Health Medicare |
$153.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.32
|
| Rate for Payer: UHC Exchange |
$152.32
|
| Rate for Payer: UHC Medicare Advantage |
$152.32
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
IP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$825.50 |
| Max. Negotiated Rate |
$1,143.00 |
| Rate for Payer: Aetna Commercial |
$1,079.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,036.70
|
| Rate for Payer: BCN Commercial |
$981.46
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Healthscope Commercial |
$1,143.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$952.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$1,041.40
|
| Rate for Payer: PHP Commercial |
$1,079.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,104.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$850.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,117.60
|
| Rate for Payer: UHC Core |
$1,060.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$952.50
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$445.36 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$596.78
|
| Rate for Payer: Aetna Medicare |
$463.17
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$445.36
|
| Rate for Payer: BCN Medicare Advantage |
$445.36
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$641.32
|
| Rate for Payer: Cofinity Commercial |
$596.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.63
|
| Rate for Payer: Nomi Health Commercial |
$534.43
|
| Rate for Payer: PACE SWMI |
$445.36
|
| Rate for Payer: PHP Medicare Advantage |
$445.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$449.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.36
|
| Rate for Payer: UHC Exchange |
$445.36
|
| Rate for Payer: UHC Medicare Advantage |
$445.36
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$301.62 |
| Max. Negotiated Rate |
$2,618.46 |
| Rate for Payer: Aetna Commercial |
$1,079.50
|
| Rate for Payer: Aetna Medicare |
$330.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$396.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$396.88
|
| Rate for Payer: BCBS Complete |
$2,618.46
|
| Rate for Payer: BCBS MAPPO |
$317.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,044.07
|
| Rate for Payer: BCN Commercial |
$987.42
|
| Rate for Payer: BCN Medicare Advantage |
$317.50
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.50
|
| Rate for Payer: Healthscope Commercial |
$1,143.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$952.50
|
| Rate for Payer: Mclaren Medicaid |
$2,493.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$333.38
|
| Rate for Payer: Meridian Medicaid |
$2,618.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$365.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$1,041.40
|
| Rate for Payer: PACE Senior Care Partners |
$301.62
|
| Rate for Payer: PACE SWMI |
$317.50
|
| Rate for Payer: PHP Commercial |
$1,079.50
|
| Rate for Payer: PHP Medicare Advantage |
$317.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,493.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,104.90
|
| Rate for Payer: Priority Health Medicare |
$320.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$850.90
|
| Rate for Payer: Railroad Medicare Medicare |
$317.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,117.60
|
| Rate for Payer: UHC Core |
$1,060.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.50
|
| Rate for Payer: UHC Exchange |
$317.50
|
| Rate for Payer: UHC Medicare Advantage |
$317.50
|
| Rate for Payer: UHCCP Medicaid |
$2,493.61
|
| Rate for Payer: VA VA |
$317.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$952.50
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$445.36 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$596.78
|
| Rate for Payer: Aetna Medicare |
$463.17
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$445.36
|
| Rate for Payer: BCN Medicare Advantage |
$445.36
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$641.32
|
| Rate for Payer: Cofinity Commercial |
$596.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.63
|
| Rate for Payer: Nomi Health Commercial |
$534.43
|
| Rate for Payer: PACE SWMI |
$445.36
|
| Rate for Payer: PHP Medicare Advantage |
$445.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$449.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$445.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.36
|
| Rate for Payer: UHC Exchange |
$445.36
|
| Rate for Payer: UHC Medicare Advantage |
$445.36
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$305.83 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: BCBS Complete |
$422.40
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$308.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Exchange |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.40 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: BCBS Trust/PPO |
$862.01
|
| Rate for Payer: BCN Commercial |
$816.08
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$865.92
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO |
$918.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.28
|
| Rate for Payer: UHC Core |
$881.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna Medicare |
$274.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$330.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$330.00
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$264.00
|
| Rate for Payer: BCBS Trust/PPO |
$868.14
|
| Rate for Payer: BCN Commercial |
$821.04
|
| Rate for Payer: BCN Medicare Advantage |
$264.00
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.00
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$277.20
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$303.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$865.92
|
| Rate for Payer: PACE Senior Care Partners |
$250.80
|
| Rate for Payer: PACE SWMI |
$264.00
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: PHP Medicare Advantage |
$264.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO |
$918.72
|
| Rate for Payer: Priority Health Medicare |
$266.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$707.52
|
| Rate for Payer: Railroad Medicare Medicare |
$264.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.28
|
| Rate for Payer: UHC Core |
$881.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$264.00
|
| Rate for Payer: UHC Exchange |
$264.00
|
| Rate for Payer: UHC Medicare Advantage |
$264.00
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$264.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$305.83 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: BCBS Complete |
$422.40
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$308.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Exchange |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$210.43 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna Medicare |
$230.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$276.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$276.88
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$221.50
|
| Rate for Payer: BCBS Trust/PPO |
$728.38
|
| Rate for Payer: BCN Commercial |
$688.87
|
| Rate for Payer: BCN Medicare Advantage |
$221.50
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.50
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.57
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$726.52
|
| Rate for Payer: PACE Senior Care Partners |
$210.43
|
| Rate for Payer: PACE SWMI |
$221.50
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: PHP Medicare Advantage |
$221.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO |
$770.82
|
| Rate for Payer: Priority Health Medicare |
$223.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$593.62
|
| Rate for Payer: Railroad Medicare Medicare |
$221.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.68
|
| Rate for Payer: UHC Core |
$739.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$221.50
|
| Rate for Payer: UHC Exchange |
$221.50
|
| Rate for Payer: UHC Medicare Advantage |
$221.50
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$221.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$575.90 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: BCBS Trust/PPO |
$723.24
|
| Rate for Payer: BCN Commercial |
$684.70
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$726.52
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO |
$770.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$593.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.68
|
| Rate for Payer: UHC Core |
$739.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$295.72 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$298.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Exchange |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$295.72 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$298.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Exchange |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$538.85 |
| Rate for Payer: Aetna Commercial |
$348.72
|
| Rate for Payer: Aetna Medicare |
$270.65
|
| Rate for Payer: BCBS Complete |
$331.60
|
| Rate for Payer: BCBS MAPPO |
$260.24
|
| Rate for Payer: BCN Medicare Advantage |
$260.24
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$374.75
|
| Rate for Payer: Cofinity Commercial |
$348.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.25
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: PACE SWMI |
$260.24
|
| Rate for Payer: PHP Medicare Advantage |
$260.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.85
|
| Rate for Payer: Priority Health Medicare |
$262.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.24
|
| Rate for Payer: UHC Exchange |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$260.24
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$228.58 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Commercial |
$306.30
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: BCBS Complete |
$237.20
|
| Rate for Payer: BCBS MAPPO |
$228.58
|
| Rate for Payer: BCN Medicare Advantage |
$228.58
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$329.16
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.01
|
| Rate for Payer: Nomi Health Commercial |
$274.30
|
| Rate for Payer: PACE SWMI |
$228.58
|
| Rate for Payer: PHP Medicare Advantage |
$228.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: Priority Health Medicare |
$230.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.58
|
| Rate for Payer: UHC Exchange |
$228.58
|
| Rate for Payer: UHC Medicare Advantage |
$228.58
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$248.81 |
| Max. Negotiated Rate |
$492.05 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Aetna Medicare |
$258.76
|
| Rate for Payer: BCBS Complete |
$302.80
|
| Rate for Payer: BCBS MAPPO |
$248.81
|
| Rate for Payer: BCN Medicare Advantage |
$248.81
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cofinity Commercial |
$358.29
|
| Rate for Payer: Cofinity Commercial |
$333.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.25
|
| Rate for Payer: Nomi Health Commercial |
$298.57
|
| Rate for Payer: PACE SWMI |
$248.81
|
| Rate for Payer: PHP Medicare Advantage |
$248.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.05
|
| Rate for Payer: Priority Health Medicare |
$251.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.81
|
| Rate for Payer: UHC Exchange |
$248.81
|
| Rate for Payer: UHC Medicare Advantage |
$248.81
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$847.81 |
| Rate for Payer: Aetna Commercial |
$788.94
|
| Rate for Payer: Aetna Medicare |
$612.31
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$588.76
|
| Rate for Payer: BCN Medicare Advantage |
$588.76
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$847.81
|
| Rate for Payer: Cofinity Commercial |
$788.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.20
|
| Rate for Payer: Nomi Health Commercial |
$706.51
|
| Rate for Payer: PACE SWMI |
$588.76
|
| Rate for Payer: PHP Medicare Advantage |
$588.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$594.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.76
|
| Rate for Payer: UHC Exchange |
$588.76
|
| Rate for Payer: UHC Medicare Advantage |
$588.76
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$462.15 |
| Rate for Payer: Aetna Commercial |
$369.12
|
| Rate for Payer: Aetna Medicare |
$286.48
|
| Rate for Payer: BCBS Complete |
$284.40
|
| Rate for Payer: BCBS MAPPO |
$275.46
|
| Rate for Payer: BCN Medicare Advantage |
$275.46
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.23
|
| Rate for Payer: Nomi Health Commercial |
$330.55
|
| Rate for Payer: PACE SWMI |
$275.46
|
| Rate for Payer: PHP Medicare Advantage |
$275.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health Medicare |
$278.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.46
|
| Rate for Payer: UHC Exchange |
$275.46
|
| Rate for Payer: UHC Medicare Advantage |
$275.46
|
|
