|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 24075
|
| Hospital Charge Code |
24075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$308.04 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$1,102.45
|
| Rate for Payer: Aetna Medicare |
$337.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$405.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$405.31
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$324.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.26
|
| Rate for Payer: BCN Commercial |
$1,008.42
|
| Rate for Payer: BCN Medicare Advantage |
$324.25
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$1,115.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,037.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.25
|
| Rate for Payer: Healthscope Commercial |
$1,167.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$972.75
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.46
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,102.45
|
| Rate for Payer: Nomi Health Commercial |
$1,063.54
|
| Rate for Payer: PACE Senior Care Partners |
$308.04
|
| Rate for Payer: PACE SWMI |
$324.25
|
| Rate for Payer: PHP Commercial |
$1,102.45
|
| Rate for Payer: PHP Medicare Advantage |
$324.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,128.39
|
| Rate for Payer: Priority Health Medicare |
$327.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$868.99
|
| Rate for Payer: Railroad Medicare Medicare |
$324.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,141.36
|
| Rate for Payer: UHC Core |
$1,082.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.25
|
| Rate for Payer: UHC Exchange |
$324.25
|
| Rate for Payer: UHC Medicare Advantage |
$324.25
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$324.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$972.75
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 24075
|
| Hospital Charge Code |
24075
|
| Min. Negotiated Rate |
$318.76 |
| Max. Negotiated Rate |
$843.05 |
| Rate for Payer: Aetna Commercial |
$427.14
|
| Rate for Payer: Aetna Medicare |
$331.51
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$318.76
|
| Rate for Payer: BCN Medicare Advantage |
$318.76
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$459.01
|
| Rate for Payer: Cofinity Commercial |
$427.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.70
|
| Rate for Payer: Nomi Health Commercial |
$382.51
|
| Rate for Payer: PACE SWMI |
$318.76
|
| Rate for Payer: PHP Medicare Advantage |
$318.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$321.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.76
|
| Rate for Payer: UHC Exchange |
$318.76
|
| Rate for Payer: UHC Medicare Advantage |
$318.76
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 24075
|
| Min. Negotiated Rate |
$318.76 |
| Max. Negotiated Rate |
$843.05 |
| Rate for Payer: Aetna Commercial |
$427.14
|
| Rate for Payer: Aetna Medicare |
$331.51
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$318.76
|
| Rate for Payer: BCN Medicare Advantage |
$318.76
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$459.01
|
| Rate for Payer: Cofinity Commercial |
$427.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.70
|
| Rate for Payer: Nomi Health Commercial |
$382.51
|
| Rate for Payer: PACE SWMI |
$318.76
|
| Rate for Payer: PHP Medicare Advantage |
$318.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$321.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.76
|
| Rate for Payer: UHC Exchange |
$318.76
|
| Rate for Payer: UHC Medicare Advantage |
$318.76
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 24073
|
| Min. Negotiated Rate |
$672.27 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Commercial |
$900.84
|
| Rate for Payer: Aetna Medicare |
$699.16
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: BCBS MAPPO |
$672.27
|
| Rate for Payer: BCN Medicare Advantage |
$672.27
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$968.07
|
| Rate for Payer: Cofinity Commercial |
$900.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.88
|
| Rate for Payer: Nomi Health Commercial |
$806.72
|
| Rate for Payer: PACE SWMI |
$672.27
|
| Rate for Payer: PHP Medicare Advantage |
$672.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health Medicare |
$678.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.27
|
| Rate for Payer: UHC Exchange |
$672.27
|
| Rate for Payer: UHC Medicare Advantage |
$672.27
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Facility
|
IP
|
$1,693.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
24073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,100.45 |
| Max. Negotiated Rate |
$1,523.70 |
| Rate for Payer: Aetna Commercial |
$1,439.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,382.00
|
| Rate for Payer: BCN Commercial |
$1,308.35
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.40
|
| Rate for Payer: Healthscope Commercial |
$1,523.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,269.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.05
|
| Rate for Payer: Nomi Health Commercial |
$1,388.26
|
| Rate for Payer: PHP Commercial |
$1,439.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,472.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,134.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,489.84
|
| Rate for Payer: UHC Core |
$1,413.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,269.75
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Facility
|
OP
|
$1,693.00
|
|
|
Service Code
|
CPT 24073
|
| Hospital Charge Code |
24073
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$402.09 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: Aetna Commercial |
$1,439.05
|
| Rate for Payer: Aetna Medicare |
$440.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$529.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$529.06
|
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: BCBS MAPPO |
$423.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,391.82
|
| Rate for Payer: BCN Commercial |
$1,316.31
|
| Rate for Payer: BCN Medicare Advantage |
$423.25
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,455.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,354.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.25
|
| Rate for Payer: Healthscope Commercial |
$1,523.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,269.75
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.41
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$486.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,439.05
|
| Rate for Payer: Nomi Health Commercial |
$1,388.26
|
| Rate for Payer: PACE Senior Care Partners |
$402.09
|
| Rate for Payer: PACE SWMI |
$423.25
|
| Rate for Payer: PHP Commercial |
$1,439.05
|
| Rate for Payer: PHP Medicare Advantage |
$423.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,472.91
|
| Rate for Payer: Priority Health Medicare |
$427.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,134.31
|
| Rate for Payer: Railroad Medicare Medicare |
$423.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,489.84
|
| Rate for Payer: UHC Core |
$1,413.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.25
|
| Rate for Payer: UHC Exchange |
$423.25
|
| Rate for Payer: UHC Medicare Advantage |
$423.25
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
| Rate for Payer: VA VA |
$423.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,269.75
|
|
|
PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 24073
|
| Hospital Charge Code |
24073
|
| Min. Negotiated Rate |
$672.27 |
| Max. Negotiated Rate |
$1,100.45 |
| Rate for Payer: Aetna Commercial |
$900.84
|
| Rate for Payer: Aetna Medicare |
$699.16
|
| Rate for Payer: BCBS Complete |
$677.20
|
| Rate for Payer: BCBS MAPPO |
$672.27
|
| Rate for Payer: BCN Medicare Advantage |
$672.27
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$968.07
|
| Rate for Payer: Cofinity Commercial |
$900.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.88
|
| Rate for Payer: Nomi Health Commercial |
$806.72
|
| Rate for Payer: PACE SWMI |
$672.27
|
| Rate for Payer: PHP Medicare Advantage |
$672.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,100.45
|
| Rate for Payer: Priority Health Medicare |
$678.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.27
|
| Rate for Payer: UHC Exchange |
$672.27
|
| Rate for Payer: UHC Medicare Advantage |
$672.27
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$750.75 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: BCBS Trust/PPO |
$942.83
|
| Rate for Payer: BCN Commercial |
$892.58
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$993.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Healthscope Commercial |
$1,039.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: PHP Commercial |
$981.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,004.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,016.40
|
| Rate for Payer: UHC Core |
$964.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.25
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$762.39 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$550.62
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$534.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Exchange |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$274.31 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Aetna Medicare |
$300.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$360.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$360.94
|
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: BCBS MAPPO |
$288.75
|
| Rate for Payer: BCBS Trust/PPO |
$949.53
|
| Rate for Payer: BCN Commercial |
$898.01
|
| Rate for Payer: BCN Medicare Advantage |
$288.75
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$993.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.75
|
| Rate for Payer: Healthscope Commercial |
$1,039.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$866.25
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.19
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: Nomi Health Commercial |
$947.10
|
| Rate for Payer: PACE Senior Care Partners |
$274.31
|
| Rate for Payer: PACE SWMI |
$288.75
|
| Rate for Payer: PHP Commercial |
$981.75
|
| Rate for Payer: PHP Medicare Advantage |
$288.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO |
$1,004.85
|
| Rate for Payer: Priority Health Medicare |
$291.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.85
|
| Rate for Payer: Railroad Medicare Medicare |
$288.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,016.40
|
| Rate for Payer: UHC Core |
$964.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.75
|
| Rate for Payer: UHC Exchange |
$288.75
|
| Rate for Payer: UHC Medicare Advantage |
$288.75
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
| Rate for Payer: VA VA |
$288.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$866.25
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$762.39 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$550.62
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$534.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Exchange |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$334.95
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$325.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Exchange |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$334.95
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$325.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Exchange |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$258.64 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$283.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$340.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$340.31
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$272.25
|
| Rate for Payer: BCBS Trust/PPO |
$895.27
|
| Rate for Payer: BCN Commercial |
$846.70
|
| Rate for Payer: BCN Medicare Advantage |
$272.25
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.25
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.86
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$313.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PACE Senior Care Partners |
$258.64
|
| Rate for Payer: PACE SWMI |
$272.25
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: PHP Medicare Advantage |
$272.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO |
$947.43
|
| Rate for Payer: Priority Health Medicare |
$274.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.63
|
| Rate for Payer: Railroad Medicare Medicare |
$272.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.32
|
| Rate for Payer: UHC Core |
$909.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$272.25
|
| Rate for Payer: UHC Exchange |
$272.25
|
| Rate for Payer: UHC Medicare Advantage |
$272.25
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$272.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$707.85 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: BCBS Trust/PPO |
$888.95
|
| Rate for Payer: BCN Commercial |
$841.58
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$816.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: Nomi Health Commercial |
$892.98
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health HMO/PPO |
$947.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$729.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.32
|
| Rate for Payer: UHC Core |
$909.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$816.75
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$681.97
|
| Rate for Payer: Aetna Medicare |
$529.29
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$508.93
|
| Rate for Payer: BCN Medicare Advantage |
$508.93
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$732.86
|
| Rate for Payer: Cofinity Commercial |
$681.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.38
|
| Rate for Payer: Nomi Health Commercial |
$610.72
|
| Rate for Payer: PACE SWMI |
$508.93
|
| Rate for Payer: PHP Medicare Advantage |
$508.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$514.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$508.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.93
|
| Rate for Payer: UHC Exchange |
$508.93
|
| Rate for Payer: UHC Medicare Advantage |
$508.93
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,537.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$610.21 |
| Max. Negotiated Rate |
$3,599.05 |
| Rate for Payer: Aetna Commercial |
$817.68
|
| Rate for Payer: Aetna Medicare |
$634.62
|
| Rate for Payer: BCBS Complete |
$2,214.80
|
| Rate for Payer: BCBS MAPPO |
$610.21
|
| Rate for Payer: BCN Medicare Advantage |
$610.21
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cofinity Commercial |
$878.70
|
| Rate for Payer: Cofinity Commercial |
$817.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$610.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$640.72
|
| Rate for Payer: Nomi Health Commercial |
$732.25
|
| Rate for Payer: PACE SWMI |
$610.21
|
| Rate for Payer: PHP Medicare Advantage |
$610.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,599.05
|
| Rate for Payer: Priority Health Medicare |
$616.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$610.21
|
| Rate for Payer: UHC Exchange |
$610.21
|
| Rate for Payer: UHC Medicare Advantage |
$610.21
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,149.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$841.38 |
| Rate for Payer: Aetna Commercial |
$782.95
|
| Rate for Payer: Aetna Medicare |
$607.66
|
| Rate for Payer: BCBS Complete |
$459.60
|
| Rate for Payer: BCBS MAPPO |
$584.29
|
| Rate for Payer: BCN Medicare Advantage |
$584.29
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cofinity Commercial |
$841.38
|
| Rate for Payer: Cofinity Commercial |
$782.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$584.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$613.50
|
| Rate for Payer: Nomi Health Commercial |
$701.15
|
| Rate for Payer: PACE SWMI |
$584.29
|
| Rate for Payer: PHP Medicare Advantage |
$584.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.85
|
| Rate for Payer: Priority Health Medicare |
$590.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$584.29
|
| Rate for Payer: UHC Exchange |
$584.29
|
| Rate for Payer: UHC Medicare Advantage |
$584.29
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$411.95 |
| Max. Negotiated Rate |
$1,392.95 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna Medicare |
$428.43
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$411.95
|
| Rate for Payer: BCN Medicare Advantage |
$411.95
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$593.21
|
| Rate for Payer: Cofinity Commercial |
$552.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.55
|
| Rate for Payer: Nomi Health Commercial |
$494.34
|
| Rate for Payer: PACE SWMI |
$411.95
|
| Rate for Payer: PHP Medicare Advantage |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$416.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.95
|
| Rate for Payer: UHC Exchange |
$411.95
|
| Rate for Payer: UHC Medicare Advantage |
$411.95
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$485.70 |
| Rate for Payer: Aetna Commercial |
$451.97
|
| Rate for Payer: Aetna Medicare |
$350.78
|
| Rate for Payer: BCBS Complete |
$262.00
|
| Rate for Payer: BCBS MAPPO |
$337.29
|
| Rate for Payer: BCN Medicare Advantage |
$337.29
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cofinity Commercial |
$485.70
|
| Rate for Payer: Cofinity Commercial |
$451.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.15
|
| Rate for Payer: Nomi Health Commercial |
$404.75
|
| Rate for Payer: PACE SWMI |
$337.29
|
| Rate for Payer: PHP Medicare Advantage |
$337.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health Medicare |
$340.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.29
|
| Rate for Payer: UHC Exchange |
$337.29
|
| Rate for Payer: UHC Medicare Advantage |
$337.29
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$778.38 |
| Rate for Payer: Aetna Commercial |
$724.32
|
| Rate for Payer: Aetna Medicare |
$562.16
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$540.54
|
| Rate for Payer: BCN Medicare Advantage |
$540.54
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$778.38
|
| Rate for Payer: Cofinity Commercial |
$724.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.57
|
| Rate for Payer: Nomi Health Commercial |
$648.65
|
| Rate for Payer: PACE SWMI |
$540.54
|
| Rate for Payer: PHP Medicare Advantage |
$540.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$545.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.54
|
| Rate for Payer: UHC Exchange |
$540.54
|
| Rate for Payer: UHC Medicare Advantage |
$540.54
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$743.10 |
| Rate for Payer: Aetna Commercial |
$691.49
|
| Rate for Payer: Aetna Medicare |
$536.68
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$516.04
|
| Rate for Payer: BCN Medicare Advantage |
$516.04
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$743.10
|
| Rate for Payer: Cofinity Commercial |
$691.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.84
|
| Rate for Payer: Nomi Health Commercial |
$619.25
|
| Rate for Payer: PACE SWMI |
$516.04
|
| Rate for Payer: PHP Medicare Advantage |
$516.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$521.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.04
|
| Rate for Payer: UHC Exchange |
$516.04
|
| Rate for Payer: UHC Medicare Advantage |
$516.04
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$767.00
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$499.08 |
| Rate for Payer: Aetna Commercial |
$464.42
|
| Rate for Payer: Aetna Medicare |
$360.44
|
| Rate for Payer: BCBS Complete |
$306.80
|
| Rate for Payer: BCBS MAPPO |
$346.58
|
| Rate for Payer: BCN Medicare Advantage |
$346.58
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cofinity Commercial |
$499.08
|
| Rate for Payer: Cofinity Commercial |
$464.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.91
|
| Rate for Payer: Nomi Health Commercial |
$415.90
|
| Rate for Payer: PACE SWMI |
$346.58
|
| Rate for Payer: PHP Medicare Advantage |
$346.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.55
|
| Rate for Payer: Priority Health Medicare |
$350.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.58
|
| Rate for Payer: UHC Exchange |
$346.58
|
| Rate for Payer: UHC Medicare Advantage |
$346.58
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$2,902.00
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,886.30 |
| Rate for Payer: Aetna Commercial |
$1,375.31
|
| Rate for Payer: Aetna Medicare |
$1,067.40
|
| Rate for Payer: BCBS Complete |
$1,160.80
|
| Rate for Payer: BCBS MAPPO |
$1,026.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.35
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.94
|
| Rate for Payer: Cofinity Commercial |
$1,375.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.67
|
| Rate for Payer: Nomi Health Commercial |
$1,231.62
|
| Rate for Payer: PACE SWMI |
$1,026.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.30
|
| Rate for Payer: Priority Health Medicare |
$1,036.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,026.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.35
|
| Rate for Payer: UHC Exchange |
$1,026.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.35
|
|
