|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,127.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$1,098.19 |
| Max. Negotiated Rate |
$3,332.55 |
| Rate for Payer: Aetna Commercial |
$1,471.57
|
| Rate for Payer: Aetna Medicare |
$1,142.12
|
| Rate for Payer: BCBS Complete |
$2,050.80
|
| Rate for Payer: BCBS MAPPO |
$1,098.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.19
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,581.39
|
| Rate for Payer: Cofinity Commercial |
$1,471.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.10
|
| Rate for Payer: Nomi Health Commercial |
$1,317.83
|
| Rate for Payer: PACE SWMI |
$1,098.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.55
|
| Rate for Payer: Priority Health Medicare |
$1,109.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.19
|
| Rate for Payer: UHC Exchange |
$1,098.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.19
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$189.19 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: Aetna Medicare |
$196.76
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$189.19
|
| Rate for Payer: BCN Medicare Advantage |
$189.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.65
|
| Rate for Payer: Nomi Health Commercial |
$227.03
|
| Rate for Payer: PACE SWMI |
$189.19
|
| Rate for Payer: PHP Medicare Advantage |
$189.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$191.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.19
|
| Rate for Payer: UHC Exchange |
$189.19
|
| Rate for Payer: UHC Medicare Advantage |
$189.19
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$148.70
|
| Rate for Payer: Aetna Medicare |
$115.41
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$110.97
|
| Rate for Payer: BCN Medicare Advantage |
$110.97
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$148.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.52
|
| Rate for Payer: Nomi Health Commercial |
$133.16
|
| Rate for Payer: PACE SWMI |
$110.97
|
| Rate for Payer: PHP Medicare Advantage |
$110.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$112.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.97
|
| Rate for Payer: UHC Exchange |
$110.97
|
| Rate for Payer: UHC Medicare Advantage |
$110.97
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$604.43 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$809.94
|
| Rate for Payer: Aetna Medicare |
$628.61
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$604.43
|
| Rate for Payer: BCN Medicare Advantage |
$604.43
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$870.38
|
| Rate for Payer: Cofinity Commercial |
$809.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.65
|
| Rate for Payer: Nomi Health Commercial |
$725.32
|
| Rate for Payer: PACE SWMI |
$604.43
|
| Rate for Payer: PHP Medicare Advantage |
$604.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$610.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.43
|
| Rate for Payer: UHC Exchange |
$604.43
|
| Rate for Payer: UHC Medicare Advantage |
$604.43
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$128.75 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Medicare |
$92.99
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$89.41
|
| Rate for Payer: BCN Medicare Advantage |
$89.41
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Cofinity Commercial |
$119.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.88
|
| Rate for Payer: Nomi Health Commercial |
$107.29
|
| Rate for Payer: PACE SWMI |
$89.41
|
| Rate for Payer: PHP Medicare Advantage |
$89.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$90.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.41
|
| Rate for Payer: UHC Exchange |
$89.41
|
| Rate for Payer: UHC Medicare Advantage |
$89.41
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$45.67
|
| Rate for Payer: BCN Medicare Advantage |
$45.67
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$65.76
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.95
|
| Rate for Payer: Nomi Health Commercial |
$54.80
|
| Rate for Payer: PACE SWMI |
$45.67
|
| Rate for Payer: PHP Medicare Advantage |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$46.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.67
|
| Rate for Payer: UHC Exchange |
$45.67
|
| Rate for Payer: UHC Medicare Advantage |
$45.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$40.22
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$38.67
|
| Rate for Payer: BCN Medicare Advantage |
$38.67
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Nomi Health Commercial |
$46.40
|
| Rate for Payer: PACE SWMI |
$38.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$39.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.67
|
| Rate for Payer: UHC Exchange |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$38.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$62.14
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$46.37
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$66.77
|
| Rate for Payer: Cofinity Commercial |
$62.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.69
|
| Rate for Payer: Nomi Health Commercial |
$55.64
|
| Rate for Payer: PACE SWMI |
$46.37
|
| Rate for Payer: PHP Medicare Advantage |
$46.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$46.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.37
|
| Rate for Payer: UHC Exchange |
$46.37
|
| Rate for Payer: UHC Medicare Advantage |
$46.37
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Aetna Medicare |
$34.88
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$33.54
|
| Rate for Payer: BCN Medicare Advantage |
$33.54
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.22
|
| Rate for Payer: Nomi Health Commercial |
$40.25
|
| Rate for Payer: PACE SWMI |
$33.54
|
| Rate for Payer: PHP Medicare Advantage |
$33.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.54
|
| Rate for Payer: UHC Exchange |
$33.54
|
| Rate for Payer: UHC Medicare Advantage |
$33.54
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$219.66 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Aetna Commercial |
$294.34
|
| Rate for Payer: Aetna Medicare |
$228.45
|
| Rate for Payer: BCBS Complete |
$245.20
|
| Rate for Payer: BCBS MAPPO |
$219.66
|
| Rate for Payer: BCN Medicare Advantage |
$219.66
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cofinity Commercial |
$316.31
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.64
|
| Rate for Payer: Nomi Health Commercial |
$263.59
|
| Rate for Payer: PACE SWMI |
$219.66
|
| Rate for Payer: PHP Medicare Advantage |
$219.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health Medicare |
$221.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.66
|
| Rate for Payer: UHC Exchange |
$219.66
|
| Rate for Payer: UHC Medicare Advantage |
$219.66
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$2,172.87 |
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: Aetna Medicare |
$199.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$240.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$240.00
|
| Rate for Payer: BCBS Complete |
$2,172.87
|
| Rate for Payer: BCBS MAPPO |
$192.00
|
| Rate for Payer: BCBS Trust/PPO |
$631.37
|
| Rate for Payer: BCN Commercial |
$597.12
|
| Rate for Payer: BCN Medicare Advantage |
$192.00
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.00
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.00
|
| Rate for Payer: Mclaren Medicaid |
$2,069.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.60
|
| Rate for Payer: Meridian Medicaid |
$2,172.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$220.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: PACE Senior Care Partners |
$182.40
|
| Rate for Payer: PACE SWMI |
$192.00
|
| Rate for Payer: PHP Commercial |
$652.80
|
| Rate for Payer: PHP Medicare Advantage |
$192.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,069.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO |
$668.16
|
| Rate for Payer: Priority Health Medicare |
$193.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$514.56
|
| Rate for Payer: Railroad Medicare Medicare |
$192.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$675.84
|
| Rate for Payer: UHC Core |
$641.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.00
|
| Rate for Payer: UHC Exchange |
$192.00
|
| Rate for Payer: UHC Medicare Advantage |
$192.00
|
| Rate for Payer: UHCCP Medicaid |
$2,069.26
|
| Rate for Payer: VA VA |
$192.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.00
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$240.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Exchange |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: BCBS Trust/PPO |
$626.92
|
| Rate for Payer: BCN Commercial |
$593.51
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$629.76
|
| Rate for Payer: PHP Commercial |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO |
$668.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$514.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$675.84
|
| Rate for Payer: UHC Core |
$641.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.00
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$240.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Exchange |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$263.90 |
| Rate for Payer: Aetna Commercial |
$216.77
|
| Rate for Payer: Aetna Medicare |
$168.24
|
| Rate for Payer: BCBS Complete |
$162.40
|
| Rate for Payer: BCBS MAPPO |
$161.77
|
| Rate for Payer: BCN Medicare Advantage |
$161.77
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Cofinity Commercial |
$216.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.86
|
| Rate for Payer: Nomi Health Commercial |
$194.12
|
| Rate for Payer: PACE SWMI |
$161.77
|
| Rate for Payer: PHP Medicare Advantage |
$161.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Medicare |
$163.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.77
|
| Rate for Payer: UHC Exchange |
$161.77
|
| Rate for Payer: UHC Medicare Advantage |
$161.77
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$77.90 |
| Max. Negotiated Rate |
$1,230.09 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$85.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$102.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$102.50
|
| Rate for Payer: BCBS Complete |
$1,230.09
|
| Rate for Payer: BCBS MAPPO |
$82.00
|
| Rate for Payer: BCBS Trust/PPO |
$269.65
|
| Rate for Payer: BCN Commercial |
$255.02
|
| Rate for Payer: BCN Medicare Advantage |
$82.00
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.00
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Mclaren Medicaid |
$1,171.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.10
|
| Rate for Payer: Meridian Medicaid |
$1,230.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$94.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PACE Senior Care Partners |
$77.90
|
| Rate for Payer: PACE SWMI |
$82.00
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$82.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO |
$285.36
|
| Rate for Payer: Priority Health Medicare |
$82.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.76
|
| Rate for Payer: Railroad Medicare Medicare |
$82.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.64
|
| Rate for Payer: UHC Core |
$273.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.00
|
| Rate for Payer: UHC Exchange |
$82.00
|
| Rate for Payer: UHC Medicare Advantage |
$82.00
|
| Rate for Payer: UHCCP Medicaid |
$1,171.43
|
| Rate for Payer: VA VA |
$82.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$138.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Exchange |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$138.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Exchange |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$213.20 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: BCBS Trust/PPO |
$267.75
|
| Rate for Payer: BCN Commercial |
$253.48
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$268.96
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO |
$285.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$288.64
|
| Rate for Payer: UHC Core |
$273.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$1,316.80 |
| Max. Negotiated Rate |
$2,208.15 |
| Rate for Payer: Aetna Commercial |
$2,054.81
|
| Rate for Payer: Aetna Medicare |
$1,594.78
|
| Rate for Payer: BCBS Complete |
$1,316.80
|
| Rate for Payer: BCBS MAPPO |
$1,533.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,533.44
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cofinity Commercial |
$2,208.15
|
| Rate for Payer: Cofinity Commercial |
$2,054.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,533.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,610.11
|
| Rate for Payer: Nomi Health Commercial |
$1,840.13
|
| Rate for Payer: PACE SWMI |
$1,533.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,533.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health Medicare |
$1,548.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,533.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,533.44
|
| Rate for Payer: UHC Exchange |
$1,533.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,533.44
|
|
|
PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 33971
|
| Min. Negotiated Rate |
$676.18 |
| Max. Negotiated Rate |
$1,706.25 |
| Rate for Payer: Aetna Commercial |
$906.08
|
| Rate for Payer: Aetna Medicare |
$703.23
|
| Rate for Payer: BCBS Complete |
$1,050.00
|
| Rate for Payer: BCBS MAPPO |
$676.18
|
| Rate for Payer: BCN Medicare Advantage |
$676.18
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cofinity Commercial |
$973.70
|
| Rate for Payer: Cofinity Commercial |
$906.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.99
|
| Rate for Payer: Nomi Health Commercial |
$811.42
|
| Rate for Payer: PACE SWMI |
$676.18
|
| Rate for Payer: PHP Medicare Advantage |
$676.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.25
|
| Rate for Payer: Priority Health Medicare |
$682.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$676.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.18
|
| Rate for Payer: UHC Exchange |
$676.18
|
| Rate for Payer: UHC Medicare Advantage |
$676.18
|
|
|
PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 33284
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$268.40 |
| Max. Negotiated Rate |
$507.57 |
| Rate for Payer: Aetna Commercial |
$472.32
|
| Rate for Payer: Aetna Medicare |
$366.58
|
| Rate for Payer: BCBS Complete |
$268.40
|
| Rate for Payer: BCBS MAPPO |
$352.48
|
| Rate for Payer: BCN Medicare Advantage |
$352.48
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$507.57
|
| Rate for Payer: Cofinity Commercial |
$472.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.10
|
| Rate for Payer: Nomi Health Commercial |
$422.98
|
| Rate for Payer: PACE SWMI |
$352.48
|
| Rate for Payer: PHP Medicare Advantage |
$352.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.15
|
| Rate for Payer: Priority Health Medicare |
$356.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.48
|
| Rate for Payer: UHC Exchange |
$352.48
|
| Rate for Payer: UHC Medicare Advantage |
$352.48
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$314.80 |
| Max. Negotiated Rate |
$528.34 |
| Rate for Payer: Aetna Commercial |
$491.65
|
| Rate for Payer: Aetna Medicare |
$381.58
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCBS MAPPO |
$366.90
|
| Rate for Payer: BCN Medicare Advantage |
$366.90
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$528.34
|
| Rate for Payer: Cofinity Commercial |
$491.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.25
|
| Rate for Payer: Nomi Health Commercial |
$440.28
|
| Rate for Payer: PACE SWMI |
$366.90
|
| Rate for Payer: PHP Medicare Advantage |
$366.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health Medicare |
$370.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.90
|
| Rate for Payer: UHC Exchange |
$366.90
|
| Rate for Payer: UHC Medicare Advantage |
$366.90
|
|
