|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
HCPCS 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$835.39 |
| Max. Negotiated Rate |
$1,869.40 |
| Rate for Payer: Aetna Commercial |
$1,119.42
|
| Rate for Payer: Aetna Medicare |
$868.81
|
| Rate for Payer: BCBS Complete |
$1,150.40
|
| Rate for Payer: BCBS MAPPO |
$835.39
|
| Rate for Payer: BCN Medicare Advantage |
$835.39
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,202.96
|
| Rate for Payer: Cofinity Commercial |
$1,119.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.16
|
| Rate for Payer: Nomi Health Commercial |
$1,002.47
|
| Rate for Payer: PACE SWMI |
$835.39
|
| Rate for Payer: PHP Medicare Advantage |
$835.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: Priority Health Medicare |
$843.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$835.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.39
|
| Rate for Payer: UHC Exchange |
$835.39
|
| Rate for Payer: UHC Medicare Advantage |
$835.39
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 21557
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna Commercial |
$1,231.12
|
| Rate for Payer: Aetna Medicare |
$955.50
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$918.75
|
| Rate for Payer: BCN Medicare Advantage |
$918.75
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$1,323.00
|
| Rate for Payer: Cofinity Commercial |
$1,231.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.69
|
| Rate for Payer: Nomi Health Commercial |
$1,102.50
|
| Rate for Payer: PACE SWMI |
$918.75
|
| Rate for Payer: PHP Medicare Advantage |
$918.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$927.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.75
|
| Rate for Payer: UHC Exchange |
$918.75
|
| Rate for Payer: UHC Medicare Advantage |
$918.75
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>
|
Professional
|
Both
|
$3,418.00
|
|
|
Service Code
|
HCPCS 21558
|
| Min. Negotiated Rate |
$1,292.74 |
| Max. Negotiated Rate |
$2,221.70 |
| Rate for Payer: Aetna Commercial |
$1,732.27
|
| Rate for Payer: Aetna Medicare |
$1,344.45
|
| Rate for Payer: BCBS Complete |
$1,367.20
|
| Rate for Payer: BCBS MAPPO |
$1,292.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,292.74
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cofinity Commercial |
$1,861.55
|
| Rate for Payer: Cofinity Commercial |
$1,732.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,292.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,357.38
|
| Rate for Payer: Nomi Health Commercial |
$1,551.29
|
| Rate for Payer: PACE SWMI |
$1,292.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,292.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.70
|
| Rate for Payer: Priority Health Medicare |
$1,305.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,292.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,292.74
|
| Rate for Payer: UHC Exchange |
$1,292.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,292.74
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26117
|
| Min. Negotiated Rate |
$721.43 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$966.72
|
| Rate for Payer: Aetna Medicare |
$750.29
|
| Rate for Payer: BCBS Complete |
$944.40
|
| Rate for Payer: BCBS MAPPO |
$721.43
|
| Rate for Payer: BCN Medicare Advantage |
$721.43
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$966.72
|
| Rate for Payer: Cofinity Commercial |
$1,038.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.50
|
| Rate for Payer: Nomi Health Commercial |
$865.72
|
| Rate for Payer: PACE SWMI |
$721.43
|
| Rate for Payer: PHP Medicare Advantage |
$721.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health Medicare |
$728.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.43
|
| Rate for Payer: UHC Exchange |
$721.43
|
| Rate for Payer: UHC Medicare Advantage |
$721.43
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 27049
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,839.71
|
| Rate for Payer: Aetna Medicare |
$1,427.84
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: BCBS MAPPO |
$1,372.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.92
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$1,977.00
|
| Rate for Payer: Cofinity Commercial |
$1,839.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,441.57
|
| Rate for Payer: Nomi Health Commercial |
$1,647.50
|
| Rate for Payer: PACE SWMI |
$1,372.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health Medicare |
$1,386.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,372.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,372.92
|
| Rate for Payer: UHC Exchange |
$1,372.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.92
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 27329
|
| Min. Negotiated Rate |
$1,006.86 |
| Max. Negotiated Rate |
$2,195.70 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Aetna Medicare |
$1,047.13
|
| Rate for Payer: BCBS Complete |
$1,351.20
|
| Rate for Payer: BCBS MAPPO |
$1,006.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,006.86
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cofinity Commercial |
$1,449.88
|
| Rate for Payer: Cofinity Commercial |
$1,349.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,006.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,057.20
|
| Rate for Payer: Nomi Health Commercial |
$1,208.23
|
| Rate for Payer: PACE SWMI |
$1,006.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,006.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.70
|
| Rate for Payer: Priority Health Medicare |
$1,016.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,006.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,006.86
|
| Rate for Payer: UHC Exchange |
$1,006.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,006.86
|
|
|
PR RAPID DESENSITIZATION PROCEDURE EACH HOUR
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 95180
|
| Min. Negotiated Rate |
$96.26 |
| Max. Negotiated Rate |
$164.45 |
| Rate for Payer: Aetna Commercial |
$128.99
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$96.26
|
| Rate for Payer: BCN Medicare Advantage |
$96.26
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$138.61
|
| Rate for Payer: Cofinity Commercial |
$128.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.07
|
| Rate for Payer: Nomi Health Commercial |
$115.51
|
| Rate for Payer: PACE SWMI |
$96.26
|
| Rate for Payer: PHP Medicare Advantage |
$96.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$97.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.26
|
| Rate for Payer: UHC Exchange |
$96.26
|
| Rate for Payer: UHC Medicare Advantage |
$96.26
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$467.98
|
| Rate for Payer: Aetna Medicare |
$363.21
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$349.24
|
| Rate for Payer: BCN Medicare Advantage |
$349.24
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$502.91
|
| Rate for Payer: Cofinity Commercial |
$467.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.70
|
| Rate for Payer: Nomi Health Commercial |
$419.09
|
| Rate for Payer: PACE SWMI |
$349.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$352.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.24
|
| Rate for Payer: UHC Exchange |
$349.24
|
| Rate for Payer: UHC Medicare Advantage |
$349.24
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$553.15 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Aetna Commercial |
$723.35
|
| Rate for Payer: BCBS Trust/PPO |
$694.67
|
| Rate for Payer: BCN Commercial |
$657.65
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$731.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Healthscope Commercial |
$765.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: PHP Commercial |
$723.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO |
$740.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.88
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.25
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$202.11 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: Aetna Commercial |
$723.35
|
| Rate for Payer: Aetna Medicare |
$221.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$265.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$265.94
|
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: BCBS MAPPO |
$212.75
|
| Rate for Payer: BCBS Trust/PPO |
$699.61
|
| Rate for Payer: BCN Commercial |
$661.65
|
| Rate for Payer: BCN Medicare Advantage |
$212.75
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$731.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.75
|
| Rate for Payer: Healthscope Commercial |
$765.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$638.25
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.39
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$244.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$697.82
|
| Rate for Payer: PACE Senior Care Partners |
$202.11
|
| Rate for Payer: PACE SWMI |
$212.75
|
| Rate for Payer: PHP Commercial |
$723.35
|
| Rate for Payer: PHP Medicare Advantage |
$212.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO |
$740.37
|
| Rate for Payer: Priority Health Medicare |
$214.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.17
|
| Rate for Payer: Railroad Medicare Medicare |
$212.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$748.88
|
| Rate for Payer: UHC Core |
$710.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.75
|
| Rate for Payer: UHC Exchange |
$212.75
|
| Rate for Payer: UHC Medicare Advantage |
$212.75
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
| Rate for Payer: VA VA |
$212.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$638.25
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$467.98
|
| Rate for Payer: Aetna Medicare |
$363.21
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$349.24
|
| Rate for Payer: BCN Medicare Advantage |
$349.24
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$502.91
|
| Rate for Payer: Cofinity Commercial |
$467.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.70
|
| Rate for Payer: Nomi Health Commercial |
$419.09
|
| Rate for Payer: PACE SWMI |
$349.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$352.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.24
|
| Rate for Payer: UHC Exchange |
$349.24
|
| Rate for Payer: UHC Medicare Advantage |
$349.24
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$2,106.19 |
| Max. Negotiated Rate |
$4,677.40 |
| Rate for Payer: Aetna Commercial |
$2,822.29
|
| Rate for Payer: Aetna Medicare |
$2,190.44
|
| Rate for Payer: BCBS Complete |
$2,878.40
|
| Rate for Payer: BCBS MAPPO |
$2,106.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,106.19
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,032.91
|
| Rate for Payer: Cofinity Commercial |
$2,822.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,106.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,211.50
|
| Rate for Payer: Nomi Health Commercial |
$2,527.43
|
| Rate for Payer: PACE SWMI |
$2,106.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,106.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,677.40
|
| Rate for Payer: Priority Health Medicare |
$2,127.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,106.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,106.19
|
| Rate for Payer: UHC Exchange |
$2,106.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,106.19
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$988.76 |
| Rate for Payer: Aetna Commercial |
$920.10
|
| Rate for Payer: Aetna Medicare |
$714.11
|
| Rate for Payer: BCBS Complete |
$486.40
|
| Rate for Payer: BCBS MAPPO |
$686.64
|
| Rate for Payer: BCN Medicare Advantage |
$686.64
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cofinity Commercial |
$988.76
|
| Rate for Payer: Cofinity Commercial |
$920.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.97
|
| Rate for Payer: Nomi Health Commercial |
$823.97
|
| Rate for Payer: PACE SWMI |
$686.64
|
| Rate for Payer: PHP Medicare Advantage |
$686.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health Medicare |
$693.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$686.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.64
|
| Rate for Payer: UHC Exchange |
$686.64
|
| Rate for Payer: UHC Medicare Advantage |
$686.64
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$676.96 |
| Max. Negotiated Rate |
$2,317.90 |
| Rate for Payer: Aetna Commercial |
$907.13
|
| Rate for Payer: Aetna Medicare |
$704.04
|
| Rate for Payer: BCBS Complete |
$1,426.40
|
| Rate for Payer: BCBS MAPPO |
$676.96
|
| Rate for Payer: BCN Medicare Advantage |
$676.96
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cofinity Commercial |
$974.82
|
| Rate for Payer: Cofinity Commercial |
$907.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.81
|
| Rate for Payer: Nomi Health Commercial |
$812.35
|
| Rate for Payer: PACE SWMI |
$676.96
|
| Rate for Payer: PHP Medicare Advantage |
$676.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,317.90
|
| Rate for Payer: Priority Health Medicare |
$683.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.96
|
| Rate for Payer: UHC Exchange |
$676.96
|
| Rate for Payer: UHC Medicare Advantage |
$676.96
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$787.45 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,055.18
|
| Rate for Payer: Aetna Medicare |
$818.95
|
| Rate for Payer: BCBS Complete |
$952.00
|
| Rate for Payer: BCBS MAPPO |
$787.45
|
| Rate for Payer: BCN Medicare Advantage |
$787.45
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.93
|
| Rate for Payer: Cofinity Commercial |
$1,055.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.82
|
| Rate for Payer: Nomi Health Commercial |
$944.94
|
| Rate for Payer: PACE SWMI |
$787.45
|
| Rate for Payer: PHP Medicare Advantage |
$787.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health Medicare |
$795.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$787.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.45
|
| Rate for Payer: UHC Exchange |
$787.45
|
| Rate for Payer: UHC Medicare Advantage |
$787.45
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$1,044.17 |
| Rate for Payer: Aetna Commercial |
$971.66
|
| Rate for Payer: Aetna Medicare |
$754.12
|
| Rate for Payer: BCBS Complete |
$607.60
|
| Rate for Payer: BCBS MAPPO |
$725.12
|
| Rate for Payer: BCN Medicare Advantage |
$725.12
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cofinity Commercial |
$971.66
|
| Rate for Payer: Cofinity Commercial |
$1,044.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.38
|
| Rate for Payer: Nomi Health Commercial |
$870.14
|
| Rate for Payer: PACE SWMI |
$725.12
|
| Rate for Payer: PHP Medicare Advantage |
$725.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.35
|
| Rate for Payer: Priority Health Medicare |
$732.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$725.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.12
|
| Rate for Payer: UHC Exchange |
$725.12
|
| Rate for Payer: UHC Medicare Advantage |
$725.12
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,503.45 |
| Max. Negotiated Rate |
$2,081.70 |
| Rate for Payer: Aetna Commercial |
$1,966.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,888.10
|
| Rate for Payer: BCN Commercial |
$1,787.49
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,989.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Healthscope Commercial |
$2,081.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,734.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: Nomi Health Commercial |
$1,896.66
|
| Rate for Payer: PHP Commercial |
$1,966.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,012.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,549.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,035.44
|
| Rate for Payer: UHC Core |
$1,931.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,734.75
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| Min. Negotiated Rate |
$719.01 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$747.77
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$726.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Exchange |
$719.01
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$719.01 |
| Max. Negotiated Rate |
$1,503.45 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$747.77
|
| Rate for Payer: BCBS Complete |
$925.20
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health Medicare |
$726.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Exchange |
$719.01
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$549.34 |
| Max. Negotiated Rate |
$5,423.52 |
| Rate for Payer: Aetna Commercial |
$1,966.05
|
| Rate for Payer: Aetna Medicare |
$601.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$722.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$722.81
|
| Rate for Payer: BCBS Complete |
$5,423.52
|
| Rate for Payer: BCBS MAPPO |
$578.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.52
|
| Rate for Payer: BCN Commercial |
$1,798.36
|
| Rate for Payer: BCN Medicare Advantage |
$578.25
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,989.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.25
|
| Rate for Payer: Healthscope Commercial |
$2,081.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,734.75
|
| Rate for Payer: Mclaren Medicaid |
$5,164.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$607.16
|
| Rate for Payer: Meridian Medicaid |
$5,423.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$664.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: Nomi Health Commercial |
$1,896.66
|
| Rate for Payer: PACE Senior Care Partners |
$549.34
|
| Rate for Payer: PACE SWMI |
$578.25
|
| Rate for Payer: PHP Commercial |
$1,966.05
|
| Rate for Payer: PHP Medicare Advantage |
$578.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,164.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,012.31
|
| Rate for Payer: Priority Health Medicare |
$584.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,549.71
|
| Rate for Payer: Railroad Medicare Medicare |
$578.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,035.44
|
| Rate for Payer: UHC Core |
$1,931.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$578.25
|
| Rate for Payer: UHC Exchange |
$578.25
|
| Rate for Payer: UHC Medicare Advantage |
$578.25
|
| Rate for Payer: UHCCP Medicaid |
$5,164.92
|
| Rate for Payer: VA VA |
$578.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,734.75
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$721.72 |
| Max. Negotiated Rate |
$1,517.75 |
| Rate for Payer: Aetna Commercial |
$967.10
|
| Rate for Payer: Aetna Medicare |
$750.59
|
| Rate for Payer: BCBS Complete |
$934.00
|
| Rate for Payer: BCBS MAPPO |
$721.72
|
| Rate for Payer: BCN Medicare Advantage |
$721.72
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cofinity Commercial |
$967.10
|
| Rate for Payer: Cofinity Commercial |
$1,039.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.81
|
| Rate for Payer: Nomi Health Commercial |
$866.06
|
| Rate for Payer: PACE SWMI |
$721.72
|
| Rate for Payer: PHP Medicare Advantage |
$721.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health Medicare |
$728.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.72
|
| Rate for Payer: UHC Exchange |
$721.72
|
| Rate for Payer: UHC Medicare Advantage |
$721.72
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$1,065.56 |
| Max. Negotiated Rate |
$1,963.00 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,108.18
|
| Rate for Payer: BCBS Complete |
$1,208.00
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.00
|
| Rate for Payer: Priority Health Medicare |
$1,076.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Exchange |
$1,065.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,335.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$1,065.56 |
| Max. Negotiated Rate |
$2,167.75 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,108.18
|
| Rate for Payer: BCBS Complete |
$1,334.00
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.75
|
| Rate for Payer: Priority Health Medicare |
$1,076.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Exchange |
$1,065.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,461.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$1,342.34 |
| Max. Negotiated Rate |
$4,199.65 |
| Rate for Payer: Aetna Commercial |
$1,798.74
|
| Rate for Payer: Aetna Medicare |
$1,396.03
|
| Rate for Payer: BCBS Complete |
$2,584.40
|
| Rate for Payer: BCBS MAPPO |
$1,342.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.34
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.97
|
| Rate for Payer: Cofinity Commercial |
$1,798.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.46
|
| Rate for Payer: Nomi Health Commercial |
$1,610.81
|
| Rate for Payer: PACE SWMI |
$1,342.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.65
|
| Rate for Payer: Priority Health Medicare |
$1,355.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,342.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.34
|
| Rate for Payer: UHC Exchange |
$1,342.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.34
|
|
|
PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE
|
Professional
|
Both
|
$3,509.00
|
|
|
Service Code
|
HCPCS 21244
|
| Min. Negotiated Rate |
$945.86 |
| Max. Negotiated Rate |
$2,280.85 |
| Rate for Payer: Aetna Commercial |
$1,267.45
|
| Rate for Payer: Aetna Medicare |
$983.69
|
| Rate for Payer: BCBS Complete |
$1,403.60
|
| Rate for Payer: BCBS MAPPO |
$945.86
|
| Rate for Payer: BCN Medicare Advantage |
$945.86
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Cash Price |
$2,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.04
|
| Rate for Payer: Cofinity Commercial |
$1,267.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.15
|
| Rate for Payer: Nomi Health Commercial |
$1,135.03
|
| Rate for Payer: PACE SWMI |
$945.86
|
| Rate for Payer: PHP Medicare Advantage |
$945.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,280.85
|
| Rate for Payer: Priority Health Medicare |
$955.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.86
|
| Rate for Payer: UHC Exchange |
$945.86
|
| Rate for Payer: UHC Medicare Advantage |
$945.86
|
|
