|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna Medicare |
$29.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.54
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS MAPPO |
$28.43
|
| Rate for Payer: BCBS Trust/PPO |
$93.49
|
| Rate for Payer: BCN Commercial |
$88.42
|
| Rate for Payer: BCN Medicare Advantage |
$28.43
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.43
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: PACE Senior Care Partners |
$27.01
|
| Rate for Payer: PACE SWMI |
$28.43
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: PHP Medicare Advantage |
$28.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health HMO/PPO |
$98.94
|
| Rate for Payer: Priority Health Medicare |
$28.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.19
|
| Rate for Payer: Railroad Medicare Medicare |
$28.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.07
|
| Rate for Payer: UHC Core |
$94.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.43
|
| Rate for Payer: UHC Exchange |
$28.43
|
| Rate for Payer: UHC Medicare Advantage |
$28.43
|
| Rate for Payer: VA VA |
$28.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: BCBS Trust/PPO |
$79.71
|
| Rate for Payer: BCN Commercial |
$75.46
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health HMO/PPO |
$84.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.93
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.19 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$25.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.52
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS MAPPO |
$24.41
|
| Rate for Payer: BCBS Trust/PPO |
$80.28
|
| Rate for Payer: BCN Commercial |
$75.92
|
| Rate for Payer: BCN Medicare Advantage |
$24.41
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: PACE Senior Care Partners |
$23.19
|
| Rate for Payer: PACE SWMI |
$24.41
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: PHP Medicare Advantage |
$24.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health HMO/PPO |
$84.96
|
| Rate for Payer: Priority Health Medicare |
$24.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.43
|
| Rate for Payer: Railroad Medicare Medicare |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.93
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.41
|
| Rate for Payer: UHC Exchange |
$24.41
|
| Rate for Payer: UHC Medicare Advantage |
$24.41
|
| Rate for Payer: VA VA |
$24.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: BCBS Trust/PPO |
$92.83
|
| Rate for Payer: BCN Commercial |
$87.88
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health HMO/PPO |
$98.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.07
|
| Rate for Payer: UHC Core |
$94.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,527.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$1,010.80 |
| Max. Negotiated Rate |
$1,668.84 |
| Rate for Payer: Aetna Commercial |
$1,552.95
|
| Rate for Payer: Aetna Medicare |
$1,205.28
|
| Rate for Payer: BCBS Complete |
$1,010.80
|
| Rate for Payer: BCBS MAPPO |
$1,158.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,158.92
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,668.84
|
| Rate for Payer: Cofinity Commercial |
$1,552.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,158.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,216.87
|
| Rate for Payer: Nomi Health Commercial |
$1,390.70
|
| Rate for Payer: PACE SWMI |
$1,158.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,158.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,642.55
|
| Rate for Payer: Priority Health Medicare |
$1,170.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,158.92
|
| Rate for Payer: UHC Exchange |
$1,158.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,158.92
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$450.77
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$437.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Exchange |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$213.99 |
| Max. Negotiated Rate |
$2,907.19 |
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: Aetna Medicare |
$234.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$281.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$281.56
|
| Rate for Payer: BCBS Complete |
$2,907.19
|
| Rate for Payer: BCBS MAPPO |
$225.25
|
| Rate for Payer: BCBS Trust/PPO |
$740.71
|
| Rate for Payer: BCN Commercial |
$700.53
|
| Rate for Payer: BCN Medicare Advantage |
$225.25
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.25
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| Rate for Payer: Mclaren Medicaid |
$2,768.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.51
|
| Rate for Payer: Meridian Medicaid |
$2,907.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: PACE Senior Care Partners |
$213.99
|
| Rate for Payer: PACE SWMI |
$225.25
|
| Rate for Payer: PHP Commercial |
$765.85
|
| Rate for Payer: PHP Medicare Advantage |
$225.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,768.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO |
$783.87
|
| Rate for Payer: Priority Health Medicare |
$227.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$603.67
|
| Rate for Payer: Railroad Medicare Medicare |
$225.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.88
|
| Rate for Payer: UHC Core |
$752.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.25
|
| Rate for Payer: UHC Exchange |
$225.25
|
| Rate for Payer: UHC Medicare Advantage |
$225.25
|
| Rate for Payer: UHCCP Medicaid |
$2,768.57
|
| Rate for Payer: VA VA |
$225.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$585.65 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: BCBS Trust/PPO |
$735.49
|
| Rate for Payer: BCN Commercial |
$696.29
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: Nomi Health Commercial |
$738.82
|
| Rate for Payer: PHP Commercial |
$765.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health HMO/PPO |
$783.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$603.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.88
|
| Rate for Payer: UHC Core |
$752.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$450.77
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$437.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Exchange |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,782.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,912.80 |
| Max. Negotiated Rate |
$3,872.69 |
| Rate for Payer: Aetna Commercial |
$3,603.76
|
| Rate for Payer: Aetna Medicare |
$2,796.94
|
| Rate for Payer: BCBS Complete |
$1,912.80
|
| Rate for Payer: BCBS MAPPO |
$2,689.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,689.37
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cofinity Commercial |
$3,872.69
|
| Rate for Payer: Cofinity Commercial |
$3,603.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,689.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,823.84
|
| Rate for Payer: Nomi Health Commercial |
$3,227.24
|
| Rate for Payer: PACE SWMI |
$2,689.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,689.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,108.30
|
| Rate for Payer: Priority Health Medicare |
$2,716.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,689.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,689.37
|
| Rate for Payer: UHC Exchange |
$2,689.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,689.37
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,070.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,628.00 |
| Max. Negotiated Rate |
$2,791.57 |
| Rate for Payer: Aetna Commercial |
$2,597.71
|
| Rate for Payer: Aetna Medicare |
$2,016.13
|
| Rate for Payer: BCBS Complete |
$1,628.00
|
| Rate for Payer: BCBS MAPPO |
$1,938.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,938.59
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cofinity Commercial |
$2,791.57
|
| Rate for Payer: Cofinity Commercial |
$2,597.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,938.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,035.52
|
| Rate for Payer: Nomi Health Commercial |
$2,326.31
|
| Rate for Payer: PACE SWMI |
$1,938.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,938.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,645.50
|
| Rate for Payer: Priority Health Medicare |
$1,957.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,938.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,938.59
|
| Rate for Payer: UHC Exchange |
$1,938.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,938.59
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,694.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$1,077.60 |
| Max. Negotiated Rate |
$1,821.02 |
| Rate for Payer: Aetna Commercial |
$1,694.56
|
| Rate for Payer: Aetna Medicare |
$1,315.18
|
| Rate for Payer: BCBS Complete |
$1,077.60
|
| Rate for Payer: BCBS MAPPO |
$1,264.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.60
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cofinity Commercial |
$1,821.02
|
| Rate for Payer: Cofinity Commercial |
$1,694.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.83
|
| Rate for Payer: Nomi Health Commercial |
$1,517.52
|
| Rate for Payer: PACE SWMI |
$1,264.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.10
|
| Rate for Payer: Priority Health Medicare |
$1,277.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,264.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,264.60
|
| Rate for Payer: UHC Exchange |
$1,264.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,264.60
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$178.14 |
| Max. Negotiated Rate |
$836.55 |
| Rate for Payer: Aetna Commercial |
$238.71
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: BCBS Complete |
$514.80
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$238.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: Nomi Health Commercial |
$213.77
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.55
|
| Rate for Payer: Priority Health Medicare |
$179.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Exchange |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$178.14
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$582.74 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$780.87
|
| Rate for Payer: Aetna Medicare |
$606.05
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$582.74
|
| Rate for Payer: BCN Medicare Advantage |
$582.74
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$839.15
|
| Rate for Payer: Cofinity Commercial |
$780.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$582.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$611.88
|
| Rate for Payer: Nomi Health Commercial |
$699.29
|
| Rate for Payer: PACE SWMI |
$582.74
|
| Rate for Payer: PHP Medicare Advantage |
$582.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$588.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$582.74
|
| Rate for Payer: UHC Exchange |
$582.74
|
| Rate for Payer: UHC Medicare Advantage |
$582.74
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$300.08 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$402.11
|
| Rate for Payer: Aetna Medicare |
$312.08
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS MAPPO |
$300.08
|
| Rate for Payer: BCN Medicare Advantage |
$300.08
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$432.12
|
| Rate for Payer: Cofinity Commercial |
$402.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.08
|
| Rate for Payer: Nomi Health Commercial |
$360.10
|
| Rate for Payer: PACE SWMI |
$300.08
|
| Rate for Payer: PHP Medicare Advantage |
$300.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$303.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.08
|
| Rate for Payer: UHC Exchange |
$300.08
|
| Rate for Payer: UHC Medicare Advantage |
$300.08
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$606.80 |
| Max. Negotiated Rate |
$986.05 |
| Rate for Payer: Aetna Commercial |
$844.82
|
| Rate for Payer: Aetna Medicare |
$655.68
|
| Rate for Payer: BCBS Complete |
$606.80
|
| Rate for Payer: BCBS MAPPO |
$630.46
|
| Rate for Payer: BCN Medicare Advantage |
$630.46
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cofinity Commercial |
$907.86
|
| Rate for Payer: Cofinity Commercial |
$844.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.98
|
| Rate for Payer: Nomi Health Commercial |
$756.55
|
| Rate for Payer: PACE SWMI |
$630.46
|
| Rate for Payer: PHP Medicare Advantage |
$630.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.05
|
| Rate for Payer: Priority Health Medicare |
$636.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.46
|
| Rate for Payer: UHC Exchange |
$630.46
|
| Rate for Payer: UHC Medicare Advantage |
$630.46
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,152.86 |
| Rate for Payer: Aetna Commercial |
$1,072.80
|
| Rate for Payer: Aetna Medicare |
$832.62
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$800.60
|
| Rate for Payer: BCN Medicare Advantage |
$800.60
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,152.86
|
| Rate for Payer: Cofinity Commercial |
$1,072.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.63
|
| Rate for Payer: Nomi Health Commercial |
$960.72
|
| Rate for Payer: PACE SWMI |
$800.60
|
| Rate for Payer: PHP Medicare Advantage |
$800.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$808.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$800.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.60
|
| Rate for Payer: UHC Exchange |
$800.60
|
| Rate for Payer: UHC Medicare Advantage |
$800.60
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$143.88 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$192.80
|
| Rate for Payer: Aetna Medicare |
$149.64
|
| Rate for Payer: BCBS Complete |
$256.00
|
| Rate for Payer: BCBS MAPPO |
$143.88
|
| Rate for Payer: BCN Medicare Advantage |
$143.88
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Cofinity Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.07
|
| Rate for Payer: Nomi Health Commercial |
$172.66
|
| Rate for Payer: PACE SWMI |
$143.88
|
| Rate for Payer: PHP Medicare Advantage |
$143.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.00
|
| Rate for Payer: Priority Health Medicare |
$145.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$143.88
|
| Rate for Payer: UHC Exchange |
$143.88
|
| Rate for Payer: UHC Medicare Advantage |
$143.88
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$202.10 |
| Max. Negotiated Rate |
$330.20 |
| Rate for Payer: Aetna Commercial |
$270.81
|
| Rate for Payer: Aetna Medicare |
$210.18
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$202.10
|
| Rate for Payer: BCN Medicare Advantage |
$202.10
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.21
|
| Rate for Payer: Nomi Health Commercial |
$242.52
|
| Rate for Payer: PACE SWMI |
$202.10
|
| Rate for Payer: PHP Medicare Advantage |
$202.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health Medicare |
$204.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.10
|
| Rate for Payer: UHC Exchange |
$202.10
|
| Rate for Payer: UHC Medicare Advantage |
$202.10
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$1,211.00
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$421.00 |
| Max. Negotiated Rate |
$787.15 |
| Rate for Payer: Aetna Commercial |
$564.14
|
| Rate for Payer: Aetna Medicare |
$437.84
|
| Rate for Payer: BCBS Complete |
$484.40
|
| Rate for Payer: BCBS MAPPO |
$421.00
|
| Rate for Payer: BCN Medicare Advantage |
$421.00
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Cash Price |
$968.80
|
| Rate for Payer: Cofinity Commercial |
$606.24
|
| Rate for Payer: Cofinity Commercial |
$564.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.05
|
| Rate for Payer: Nomi Health Commercial |
$505.20
|
| Rate for Payer: PACE SWMI |
$421.00
|
| Rate for Payer: PHP Medicare Advantage |
$421.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$787.15
|
| Rate for Payer: Priority Health Medicare |
$425.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.00
|
| Rate for Payer: UHC Exchange |
$421.00
|
| Rate for Payer: UHC Medicare Advantage |
$421.00
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$292.01 |
| Max. Negotiated Rate |
$835.25 |
| Rate for Payer: Aetna Commercial |
$391.29
|
| Rate for Payer: Aetna Medicare |
$303.69
|
| Rate for Payer: BCBS Complete |
$514.00
|
| Rate for Payer: BCBS MAPPO |
$292.01
|
| Rate for Payer: BCN Medicare Advantage |
$292.01
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$420.49
|
| Rate for Payer: Cofinity Commercial |
$391.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.61
|
| Rate for Payer: Nomi Health Commercial |
$350.41
|
| Rate for Payer: PACE SWMI |
$292.01
|
| Rate for Payer: PHP Medicare Advantage |
$292.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health Medicare |
$294.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.01
|
| Rate for Payer: UHC Exchange |
$292.01
|
| Rate for Payer: UHC Medicare Advantage |
$292.01
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$790.61 |
| Max. Negotiated Rate |
$1,700.40 |
| Rate for Payer: Aetna Commercial |
$1,059.42
|
| Rate for Payer: Aetna Medicare |
$822.23
|
| Rate for Payer: BCBS Complete |
$1,046.40
|
| Rate for Payer: BCBS MAPPO |
$790.61
|
| Rate for Payer: BCN Medicare Advantage |
$790.61
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cofinity Commercial |
$1,138.48
|
| Rate for Payer: Cofinity Commercial |
$1,059.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.14
|
| Rate for Payer: Nomi Health Commercial |
$948.73
|
| Rate for Payer: PACE SWMI |
$790.61
|
| Rate for Payer: PHP Medicare Advantage |
$790.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,700.40
|
| Rate for Payer: Priority Health Medicare |
$798.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$790.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.61
|
| Rate for Payer: UHC Exchange |
$790.61
|
| Rate for Payer: UHC Medicare Advantage |
$790.61
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$3,119.00
|
|
|
Service Code
|
HCPCS 23412
|
| Min. Negotiated Rate |
$822.15 |
| Max. Negotiated Rate |
$2,027.35 |
| Rate for Payer: Aetna Commercial |
$1,101.68
|
| Rate for Payer: Aetna Medicare |
$855.04
|
| Rate for Payer: BCBS Complete |
$1,247.60
|
| Rate for Payer: BCBS MAPPO |
$822.15
|
| Rate for Payer: BCN Medicare Advantage |
$822.15
|
| Rate for Payer: Cash Price |
$2,495.20
|
| Rate for Payer: Cash Price |
$2,495.20
|
| Rate for Payer: Cofinity Commercial |
$1,183.90
|
| Rate for Payer: Cofinity Commercial |
$1,101.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$822.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$863.26
|
| Rate for Payer: Nomi Health Commercial |
$986.58
|
| Rate for Payer: PACE SWMI |
$822.15
|
| Rate for Payer: PHP Medicare Advantage |
$822.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,027.35
|
| Rate for Payer: Priority Health Medicare |
$830.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$822.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$822.15
|
| Rate for Payer: UHC Exchange |
$822.15
|
| Rate for Payer: UHC Medicare Advantage |
$822.15
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Facility
|
IP
|
$3,005.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
27814
|
| Min. Negotiated Rate |
$1,953.25 |
| Max. Negotiated Rate |
$2,704.50 |
| Rate for Payer: Aetna Commercial |
$2,554.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,452.98
|
| Rate for Payer: BCN Commercial |
$2,322.26
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$2,584.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,404.00
|
| Rate for Payer: Healthscope Commercial |
$2,704.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,253.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,554.25
|
| Rate for Payer: Nomi Health Commercial |
$2,464.10
|
| Rate for Payer: PHP Commercial |
$2,554.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,614.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,013.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,644.40
|
| Rate for Payer: UHC Core |
$2,509.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,253.75
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27814
|
| Min. Negotiated Rate |
$735.00 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$984.90
|
| Rate for Payer: Aetna Medicare |
$764.40
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$735.00
|
| Rate for Payer: BCN Medicare Advantage |
$735.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$984.90
|
| Rate for Payer: Cofinity Commercial |
$1,058.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.75
|
| Rate for Payer: Nomi Health Commercial |
$882.00
|
| Rate for Payer: PACE SWMI |
$735.00
|
| Rate for Payer: PHP Medicare Advantage |
$735.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$742.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.00
|
| Rate for Payer: UHC Exchange |
$735.00
|
| Rate for Payer: UHC Medicare Advantage |
$735.00
|
|
