|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$239.67 |
| Rate for Payer: Aetna Commercial |
$223.03
|
| Rate for Payer: Aetna Medicare |
$173.10
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$166.44
|
| Rate for Payer: BCN Medicare Advantage |
$166.44
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$223.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.76
|
| Rate for Payer: Nomi Health Commercial |
$199.73
|
| Rate for Payer: PACE SWMI |
$166.44
|
| Rate for Payer: PHP Medicare Advantage |
$166.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Medicare |
$168.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.44
|
| Rate for Payer: UHC Exchange |
$166.44
|
| Rate for Payer: UHC Medicare Advantage |
$166.44
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$92.47
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$89.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Exchange |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$534.17 |
| Rate for Payer: Aetna Commercial |
$204.85
|
| Rate for Payer: Aetna Medicare |
$62.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.31
|
| Rate for Payer: BCBS Complete |
$534.17
|
| Rate for Payer: BCBS MAPPO |
$60.25
|
| Rate for Payer: BCBS Trust/PPO |
$198.13
|
| Rate for Payer: BCN Commercial |
$187.38
|
| Rate for Payer: BCN Medicare Advantage |
$60.25
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$207.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.25
|
| Rate for Payer: Healthscope Commercial |
$216.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.75
|
| Rate for Payer: Mclaren Medicaid |
$508.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.26
|
| Rate for Payer: Meridian Medicaid |
$534.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: Nomi Health Commercial |
$197.62
|
| Rate for Payer: PACE Senior Care Partners |
$57.24
|
| Rate for Payer: PACE SWMI |
$60.25
|
| Rate for Payer: PHP Commercial |
$204.85
|
| Rate for Payer: PHP Medicare Advantage |
$60.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO |
$209.67
|
| Rate for Payer: Priority Health Medicare |
$60.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.47
|
| Rate for Payer: Railroad Medicare Medicare |
$60.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.08
|
| Rate for Payer: UHC Core |
$201.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.25
|
| Rate for Payer: UHC Exchange |
$60.25
|
| Rate for Payer: UHC Medicare Advantage |
$60.25
|
| Rate for Payer: UHCCP Medicaid |
$508.70
|
| Rate for Payer: VA VA |
$60.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.75
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$92.47
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$89.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Exchange |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.65 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna Commercial |
$204.85
|
| Rate for Payer: BCBS Trust/PPO |
$196.73
|
| Rate for Payer: BCN Commercial |
$186.24
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$207.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Healthscope Commercial |
$216.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: Nomi Health Commercial |
$197.62
|
| Rate for Payer: PHP Commercial |
$204.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO |
$209.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.08
|
| Rate for Payer: UHC Core |
$201.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.75
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$292.59 |
| Rate for Payer: Aetna Commercial |
$272.27
|
| Rate for Payer: Aetna Medicare |
$211.32
|
| Rate for Payer: BCBS Complete |
$175.20
|
| Rate for Payer: BCBS MAPPO |
$203.19
|
| Rate for Payer: BCN Medicare Advantage |
$203.19
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$292.59
|
| Rate for Payer: Cofinity Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$243.83
|
| Rate for Payer: PACE SWMI |
$203.19
|
| Rate for Payer: PHP Medicare Advantage |
$203.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health Medicare |
$205.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.19
|
| Rate for Payer: UHC Exchange |
$203.19
|
| Rate for Payer: UHC Medicare Advantage |
$203.19
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$705.25 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$922.25
|
| Rate for Payer: BCBS Trust/PPO |
$885.69
|
| Rate for Payer: BCN Commercial |
$838.49
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$933.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Healthscope Commercial |
$976.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$813.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.25
|
| Rate for Payer: Nomi Health Commercial |
$889.70
|
| Rate for Payer: PHP Commercial |
$922.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health HMO/PPO |
$943.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$726.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$954.80
|
| Rate for Payer: UHC Core |
$905.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$813.75
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$705.25 |
| Rate for Payer: Aetna Commercial |
$540.11
|
| Rate for Payer: Aetna Medicare |
$419.19
|
| Rate for Payer: BCBS Complete |
$434.00
|
| Rate for Payer: BCBS MAPPO |
$403.07
|
| Rate for Payer: BCN Medicare Advantage |
$403.07
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$540.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.22
|
| Rate for Payer: Nomi Health Commercial |
$483.68
|
| Rate for Payer: PACE SWMI |
$403.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$407.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.07
|
| Rate for Payer: UHC Exchange |
$403.07
|
| Rate for Payer: UHC Medicare Advantage |
$403.07
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$705.25 |
| Rate for Payer: Aetna Commercial |
$540.11
|
| Rate for Payer: Aetna Medicare |
$419.19
|
| Rate for Payer: BCBS Complete |
$434.00
|
| Rate for Payer: BCBS MAPPO |
$403.07
|
| Rate for Payer: BCN Medicare Advantage |
$403.07
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$540.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.22
|
| Rate for Payer: Nomi Health Commercial |
$483.68
|
| Rate for Payer: PACE SWMI |
$403.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$407.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.07
|
| Rate for Payer: UHC Exchange |
$403.07
|
| Rate for Payer: UHC Medicare Advantage |
$403.07
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$257.69 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: Aetna Commercial |
$922.25
|
| Rate for Payer: Aetna Medicare |
$282.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$339.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$339.06
|
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: BCBS MAPPO |
$271.25
|
| Rate for Payer: BCBS Trust/PPO |
$891.98
|
| Rate for Payer: BCN Commercial |
$843.59
|
| Rate for Payer: BCN Medicare Advantage |
$271.25
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$933.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.25
|
| Rate for Payer: Healthscope Commercial |
$976.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$813.75
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$284.81
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.25
|
| Rate for Payer: Nomi Health Commercial |
$889.70
|
| Rate for Payer: PACE Senior Care Partners |
$257.69
|
| Rate for Payer: PACE SWMI |
$271.25
|
| Rate for Payer: PHP Commercial |
$922.25
|
| Rate for Payer: PHP Medicare Advantage |
$271.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health HMO/PPO |
$943.95
|
| Rate for Payer: Priority Health Medicare |
$273.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$726.95
|
| Rate for Payer: Railroad Medicare Medicare |
$271.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$954.80
|
| Rate for Payer: UHC Core |
$905.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.25
|
| Rate for Payer: UHC Exchange |
$271.25
|
| Rate for Payer: UHC Medicare Advantage |
$271.25
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
| Rate for Payer: VA VA |
$271.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$813.75
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$303.54 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Aetna Commercial |
$406.74
|
| Rate for Payer: Aetna Medicare |
$315.68
|
| Rate for Payer: BCBS Complete |
$333.20
|
| Rate for Payer: BCBS MAPPO |
$303.54
|
| Rate for Payer: BCN Medicare Advantage |
$303.54
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$437.10
|
| Rate for Payer: Cofinity Commercial |
$406.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.72
|
| Rate for Payer: Nomi Health Commercial |
$364.25
|
| Rate for Payer: PACE SWMI |
$303.54
|
| Rate for Payer: PHP Medicare Advantage |
$303.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health Medicare |
$306.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.54
|
| Rate for Payer: UHC Exchange |
$303.54
|
| Rate for Payer: UHC Medicare Advantage |
$303.54
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,044.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$338.64 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna Commercial |
$453.78
|
| Rate for Payer: Aetna Medicare |
$352.19
|
| Rate for Payer: BCBS Complete |
$417.60
|
| Rate for Payer: BCBS MAPPO |
$338.64
|
| Rate for Payer: BCN Medicare Advantage |
$338.64
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cofinity Commercial |
$487.64
|
| Rate for Payer: Cofinity Commercial |
$453.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.57
|
| Rate for Payer: Nomi Health Commercial |
$406.37
|
| Rate for Payer: PACE SWMI |
$338.64
|
| Rate for Payer: PHP Medicare Advantage |
$338.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.60
|
| Rate for Payer: Priority Health Medicare |
$342.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.64
|
| Rate for Payer: UHC Exchange |
$338.64
|
| Rate for Payer: UHC Medicare Advantage |
$338.64
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$137.77 |
| Max. Negotiated Rate |
$597.35 |
| Rate for Payer: Aetna Commercial |
$184.61
|
| Rate for Payer: Aetna Medicare |
$143.28
|
| Rate for Payer: BCBS Complete |
$367.60
|
| Rate for Payer: BCBS MAPPO |
$137.77
|
| Rate for Payer: BCN Medicare Advantage |
$137.77
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$198.39
|
| Rate for Payer: Cofinity Commercial |
$184.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.66
|
| Rate for Payer: Nomi Health Commercial |
$165.32
|
| Rate for Payer: PACE SWMI |
$137.77
|
| Rate for Payer: PHP Medicare Advantage |
$137.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$139.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.77
|
| Rate for Payer: UHC Exchange |
$137.77
|
| Rate for Payer: UHC Medicare Advantage |
$137.77
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$218.26 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$781.15
|
| Rate for Payer: Aetna Medicare |
$238.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.19
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$229.75
|
| Rate for Payer: BCBS Trust/PPO |
$755.51
|
| Rate for Payer: BCN Commercial |
$714.52
|
| Rate for Payer: BCN Medicare Advantage |
$229.75
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$790.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.75
|
| Rate for Payer: Healthscope Commercial |
$827.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.25
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.24
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.15
|
| Rate for Payer: Nomi Health Commercial |
$753.58
|
| Rate for Payer: PACE Senior Care Partners |
$218.26
|
| Rate for Payer: PACE SWMI |
$229.75
|
| Rate for Payer: PHP Commercial |
$781.15
|
| Rate for Payer: PHP Medicare Advantage |
$229.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO |
$799.53
|
| Rate for Payer: Priority Health Medicare |
$232.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.73
|
| Rate for Payer: Railroad Medicare Medicare |
$229.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.72
|
| Rate for Payer: UHC Core |
$767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.75
|
| Rate for Payer: UHC Exchange |
$229.75
|
| Rate for Payer: UHC Medicare Advantage |
$229.75
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$229.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.25
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$137.77 |
| Max. Negotiated Rate |
$597.35 |
| Rate for Payer: Aetna Commercial |
$184.61
|
| Rate for Payer: Aetna Medicare |
$143.28
|
| Rate for Payer: BCBS Complete |
$367.60
|
| Rate for Payer: BCBS MAPPO |
$137.77
|
| Rate for Payer: BCN Medicare Advantage |
$137.77
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$198.39
|
| Rate for Payer: Cofinity Commercial |
$184.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.66
|
| Rate for Payer: Nomi Health Commercial |
$165.32
|
| Rate for Payer: PACE SWMI |
$137.77
|
| Rate for Payer: PHP Medicare Advantage |
$137.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$139.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.77
|
| Rate for Payer: UHC Exchange |
$137.77
|
| Rate for Payer: UHC Medicare Advantage |
$137.77
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$597.35 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Aetna Commercial |
$781.15
|
| Rate for Payer: BCBS Trust/PPO |
$750.18
|
| Rate for Payer: BCN Commercial |
$710.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$790.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Healthscope Commercial |
$827.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$689.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.15
|
| Rate for Payer: Nomi Health Commercial |
$753.58
|
| Rate for Payer: PHP Commercial |
$781.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health HMO/PPO |
$799.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$808.72
|
| Rate for Payer: UHC Core |
$767.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$689.25
|
|
|
PR REMOVAL INDWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 50384
|
| Min. Negotiated Rate |
$214.55 |
| Max. Negotiated Rate |
$1,101.75 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: Aetna Medicare |
$223.13
|
| Rate for Payer: BCBS Complete |
$678.00
|
| Rate for Payer: BCBS MAPPO |
$214.55
|
| Rate for Payer: BCN Medicare Advantage |
$214.55
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$308.95
|
| Rate for Payer: Cofinity Commercial |
$287.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.28
|
| Rate for Payer: Nomi Health Commercial |
$257.46
|
| Rate for Payer: PACE SWMI |
$214.55
|
| Rate for Payer: PHP Medicare Advantage |
$214.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.75
|
| Rate for Payer: Priority Health Medicare |
$216.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.55
|
| Rate for Payer: UHC Exchange |
$214.55
|
| Rate for Payer: UHC Medicare Advantage |
$214.55
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$531.46 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$712.16
|
| Rate for Payer: Aetna Medicare |
$552.72
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$531.46
|
| Rate for Payer: BCN Medicare Advantage |
$531.46
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$765.30
|
| Rate for Payer: Cofinity Commercial |
$712.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.03
|
| Rate for Payer: Nomi Health Commercial |
$637.75
|
| Rate for Payer: PACE SWMI |
$531.46
|
| Rate for Payer: PHP Medicare Advantage |
$531.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$536.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.46
|
| Rate for Payer: UHC Exchange |
$531.46
|
| Rate for Payer: UHC Medicare Advantage |
$531.46
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Medicare |
$33.88
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$32.58
|
| Rate for Payer: BCN Medicare Advantage |
$32.58
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$43.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.21
|
| Rate for Payer: Nomi Health Commercial |
$39.10
|
| Rate for Payer: PACE SWMI |
$32.58
|
| Rate for Payer: PHP Medicare Advantage |
$32.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health Medicare |
$32.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.58
|
| Rate for Payer: UHC Exchange |
$32.58
|
| Rate for Payer: UHC Medicare Advantage |
$32.58
|
|
|
PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 20705
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$172.14 |
| Rate for Payer: Aetna Commercial |
$160.18
|
| Rate for Payer: Aetna Medicare |
$124.32
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS MAPPO |
$119.54
|
| Rate for Payer: BCN Medicare Advantage |
$119.54
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$160.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.52
|
| Rate for Payer: Nomi Health Commercial |
$143.45
|
| Rate for Payer: PACE SWMI |
$119.54
|
| Rate for Payer: PHP Medicare Advantage |
$119.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health Medicare |
$120.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.54
|
| Rate for Payer: UHC Exchange |
$119.54
|
| Rate for Payer: UHC Medicare Advantage |
$119.54
|
|
|
PR REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 58301
|
| Min. Negotiated Rate |
$63.78 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$85.47
|
| Rate for Payer: Aetna Medicare |
$66.33
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$63.78
|
| Rate for Payer: BCN Medicare Advantage |
$63.78
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$91.84
|
| Rate for Payer: Cofinity Commercial |
$85.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.97
|
| Rate for Payer: Nomi Health Commercial |
$76.54
|
| Rate for Payer: PACE SWMI |
$63.78
|
| Rate for Payer: PHP Medicare Advantage |
$63.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$64.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.78
|
| Rate for Payer: UHC Exchange |
$63.78
|
| Rate for Payer: UHC Medicare Advantage |
$63.78
|
|
|
PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA
|
Professional
|
Both
|
$6,102.00
|
|
|
Service Code
|
HCPCS 32442
|
| Min. Negotiated Rate |
$2,440.80 |
| Max. Negotiated Rate |
$4,222.48 |
| Rate for Payer: Aetna Commercial |
$3,929.26
|
| Rate for Payer: Aetna Medicare |
$3,049.57
|
| Rate for Payer: BCBS Complete |
$2,440.80
|
| Rate for Payer: BCBS MAPPO |
$2,932.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,932.28
|
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cash Price |
$4,881.60
|
| Rate for Payer: Cofinity Commercial |
$4,222.48
|
| Rate for Payer: Cofinity Commercial |
$3,929.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,932.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,078.89
|
| Rate for Payer: Nomi Health Commercial |
$3,518.74
|
| Rate for Payer: PACE SWMI |
$2,932.28
|
| Rate for Payer: PHP Medicare Advantage |
$2,932.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,966.30
|
| Rate for Payer: Priority Health Medicare |
$2,961.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,932.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,932.28
|
| Rate for Payer: UHC Exchange |
$2,932.28
|
| Rate for Payer: UHC Medicare Advantage |
$2,932.28
|
|
|
PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 11982
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$165.10 |
| Rate for Payer: Aetna Commercial |
$93.87
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$70.05
|
| Rate for Payer: BCN Medicare Advantage |
$70.05
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$93.87
|
| Rate for Payer: Cofinity Commercial |
$100.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.55
|
| Rate for Payer: Nomi Health Commercial |
$84.06
|
| Rate for Payer: PACE SWMI |
$70.05
|
| Rate for Payer: PHP Medicare Advantage |
$70.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.10
|
| Rate for Payer: Priority Health Medicare |
$70.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.05
|
| Rate for Payer: UHC Exchange |
$70.05
|
| Rate for Payer: UHC Medicare Advantage |
$70.05
|
|
|
PR REMOVAL OF LUNG PNEUMONECTOMY
|
Professional
|
Both
|
$5,503.00
|
|
|
Service Code
|
HCPCS 32440
|
| Min. Negotiated Rate |
$1,507.49 |
| Max. Negotiated Rate |
$3,576.95 |
| Rate for Payer: Aetna Commercial |
$2,020.04
|
| Rate for Payer: Aetna Medicare |
$1,567.79
|
| Rate for Payer: BCBS Complete |
$2,201.20
|
| Rate for Payer: BCBS MAPPO |
$1,507.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,507.49
|
| Rate for Payer: Cash Price |
$4,402.40
|
| Rate for Payer: Cash Price |
$4,402.40
|
| Rate for Payer: Cofinity Commercial |
$2,170.79
|
| Rate for Payer: Cofinity Commercial |
$2,020.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,507.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,582.86
|
| Rate for Payer: Nomi Health Commercial |
$1,808.99
|
| Rate for Payer: PACE SWMI |
$1,507.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,507.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,576.95
|
| Rate for Payer: Priority Health Medicare |
$1,522.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,507.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,507.49
|
| Rate for Payer: UHC Exchange |
$1,507.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,507.49
|
|
|
PR REMOVAL OF SUTURES
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS S0630
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
