|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$530.52 |
| Max. Negotiated Rate |
$1,469.65 |
| Rate for Payer: Aetna Commercial |
$710.90
|
| Rate for Payer: Aetna Medicare |
$551.74
|
| Rate for Payer: BCBS Complete |
$904.40
|
| Rate for Payer: BCBS MAPPO |
$530.52
|
| Rate for Payer: BCN Medicare Advantage |
$530.52
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$763.95
|
| Rate for Payer: Cofinity Commercial |
$710.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.05
|
| Rate for Payer: Nomi Health Commercial |
$636.62
|
| Rate for Payer: PACE SWMI |
$530.52
|
| Rate for Payer: PHP Medicare Advantage |
$530.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health Medicare |
$535.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$530.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.52
|
| Rate for Payer: UHC Exchange |
$530.52
|
| Rate for Payer: UHC Medicare Advantage |
$530.52
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$1,901.20 |
| Max. Negotiated Rate |
$3,132.84 |
| Rate for Payer: Aetna Commercial |
$2,915.28
|
| Rate for Payer: Aetna Medicare |
$2,262.60
|
| Rate for Payer: BCBS Complete |
$1,901.20
|
| Rate for Payer: BCBS MAPPO |
$2,175.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.58
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cofinity Commercial |
$3,132.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,284.36
|
| Rate for Payer: Nomi Health Commercial |
$2,610.70
|
| Rate for Payer: PACE SWMI |
$2,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health Medicare |
$2,197.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,175.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.58
|
| Rate for Payer: UHC Exchange |
$2,175.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,175.58
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$830.75 |
| Max. Negotiated Rate |
$2,310.75 |
| Rate for Payer: Aetna Commercial |
$1,113.20
|
| Rate for Payer: Aetna Medicare |
$863.98
|
| Rate for Payer: BCBS Complete |
$1,422.00
|
| Rate for Payer: BCBS MAPPO |
$830.75
|
| Rate for Payer: BCN Medicare Advantage |
$830.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,196.28
|
| Rate for Payer: Cofinity Commercial |
$1,113.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.29
|
| Rate for Payer: Nomi Health Commercial |
$996.90
|
| Rate for Payer: PACE SWMI |
$830.75
|
| Rate for Payer: PHP Medicare Advantage |
$830.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health Medicare |
$839.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$830.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.75
|
| Rate for Payer: UHC Exchange |
$830.75
|
| Rate for Payer: UHC Medicare Advantage |
$830.75
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,924.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$1,569.60 |
| Max. Negotiated Rate |
$2,550.60 |
| Rate for Payer: Aetna Commercial |
$2,281.78
|
| Rate for Payer: Aetna Medicare |
$1,770.93
|
| Rate for Payer: BCBS Complete |
$1,569.60
|
| Rate for Payer: BCBS MAPPO |
$1,702.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.82
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cofinity Commercial |
$2,452.06
|
| Rate for Payer: Cofinity Commercial |
$2,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.96
|
| Rate for Payer: Nomi Health Commercial |
$2,043.38
|
| Rate for Payer: PACE SWMI |
$1,702.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.60
|
| Rate for Payer: Priority Health Medicare |
$1,719.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.82
|
| Rate for Payer: UHC Exchange |
$1,702.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.82
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$887.44 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$622.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$451.60 |
| Max. Negotiated Rate |
$887.44 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: BCBS Complete |
$451.60
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health Medicare |
$622.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$616.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$616.28
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$733.85 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: BCBS Trust/PPO |
$921.60
|
| Rate for Payer: BCN Commercial |
$872.49
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$982.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.52
|
| Rate for Payer: UHC Core |
$942.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.75
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$268.14 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$293.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$352.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$352.81
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$282.25
|
| Rate for Payer: BCBS Trust/PPO |
$928.15
|
| Rate for Payer: BCN Commercial |
$877.80
|
| Rate for Payer: BCN Medicare Advantage |
$282.25
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.25
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.75
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.36
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$324.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$925.78
|
| Rate for Payer: PACE Senior Care Partners |
$268.14
|
| Rate for Payer: PACE SWMI |
$282.25
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: PHP Medicare Advantage |
$282.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO |
$982.23
|
| Rate for Payer: Priority Health Medicare |
$285.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$756.43
|
| Rate for Payer: Railroad Medicare Medicare |
$282.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$993.52
|
| Rate for Payer: UHC Core |
$942.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.25
|
| Rate for Payer: UHC Exchange |
$282.25
|
| Rate for Payer: UHC Medicare Advantage |
$282.25
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$282.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.75
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$812.40 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$569.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$561.60 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: BCBS Trust/PPO |
$705.28
|
| Rate for Payer: BCN Commercial |
$667.70
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: Nomi Health Commercial |
$708.48
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$751.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.32
|
| Rate for Payer: UHC Core |
$721.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.00
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Medicare |
$224.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$270.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$270.00
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$216.00
|
| Rate for Payer: BCBS Trust/PPO |
$710.29
|
| Rate for Payer: BCN Commercial |
$671.76
|
| Rate for Payer: BCN Medicare Advantage |
$216.00
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.00
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$648.00
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.80
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: Nomi Health Commercial |
$708.48
|
| Rate for Payer: PACE Senior Care Partners |
$205.20
|
| Rate for Payer: PACE SWMI |
$216.00
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: PHP Medicare Advantage |
$216.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO |
$751.68
|
| Rate for Payer: Priority Health Medicare |
$218.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.88
|
| Rate for Payer: Railroad Medicare Medicare |
$216.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.32
|
| Rate for Payer: UHC Core |
$721.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.00
|
| Rate for Payer: UHC Exchange |
$216.00
|
| Rate for Payer: UHC Medicare Advantage |
$216.00
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$216.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$648.00
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$812.40 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$569.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$564.17
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
|
|
PR RPR 1ST INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 49561
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Medicare |
$1,121.50
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$572.41 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$578.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Exchange |
$572.41
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$572.41 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$578.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Exchange |
$572.41
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.44 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna Medicare |
$432.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$520.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$520.31
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$416.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,368.80
|
| Rate for Payer: BCN Commercial |
$1,294.54
|
| Rate for Payer: BCN Medicare Advantage |
$416.25
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.25
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,248.75
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.06
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$478.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: PACE Senior Care Partners |
$395.44
|
| Rate for Payer: PACE SWMI |
$416.25
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: PHP Medicare Advantage |
$416.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,448.55
|
| Rate for Payer: Priority Health Medicare |
$420.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,115.55
|
| Rate for Payer: Railroad Medicare Medicare |
$416.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.20
|
| Rate for Payer: UHC Core |
$1,390.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$416.25
|
| Rate for Payer: UHC Exchange |
$416.25
|
| Rate for Payer: UHC Medicare Advantage |
$416.25
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$416.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,248.75
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.14
|
| Rate for Payer: BCN Commercial |
$1,286.71
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,248.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,448.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,115.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.20
|
| Rate for Payer: UHC Core |
$1,390.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,248.75
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$509.49 |
| Max. Negotiated Rate |
$1,097.20 |
| Rate for Payer: Aetna Commercial |
$682.72
|
| Rate for Payer: Aetna Medicare |
$529.87
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$509.49
|
| Rate for Payer: BCN Medicare Advantage |
$509.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$733.67
|
| Rate for Payer: Cofinity Commercial |
$682.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.96
|
| Rate for Payer: Nomi Health Commercial |
$611.39
|
| Rate for Payer: PACE SWMI |
$509.49
|
| Rate for Payer: PHP Medicare Advantage |
$509.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$514.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.49
|
| Rate for Payer: UHC Exchange |
$509.49
|
| Rate for Payer: UHC Medicare Advantage |
$509.49
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49505
|
| Min. Negotiated Rate |
$509.49 |
| Max. Negotiated Rate |
$1,097.20 |
| Rate for Payer: Aetna Commercial |
$682.72
|
| Rate for Payer: Aetna Medicare |
$529.87
|
| Rate for Payer: BCBS Complete |
$675.20
|
| Rate for Payer: BCBS MAPPO |
$509.49
|
| Rate for Payer: BCN Medicare Advantage |
$509.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$682.72
|
| Rate for Payer: Cofinity Commercial |
$733.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.96
|
| Rate for Payer: Nomi Health Commercial |
$611.39
|
| Rate for Payer: PACE SWMI |
$509.49
|
| Rate for Payer: PHP Medicare Advantage |
$509.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health Medicare |
$514.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.49
|
| Rate for Payer: UHC Exchange |
$509.49
|
| Rate for Payer: UHC Medicare Advantage |
$509.49
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,097.20 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,377.91
|
| Rate for Payer: BCN Commercial |
$1,304.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,266.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: Nomi Health Commercial |
$1,384.16
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,468.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,485.44
|
| Rate for Payer: UHC Core |
$1,409.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,266.00
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$400.90 |
| Max. Negotiated Rate |
$2,679.26 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: Aetna Medicare |
$438.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$527.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$527.50
|
| Rate for Payer: BCBS Complete |
$2,679.26
|
| Rate for Payer: BCBS MAPPO |
$422.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.70
|
| Rate for Payer: BCN Commercial |
$1,312.42
|
| Rate for Payer: BCN Medicare Advantage |
$422.00
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.00
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,266.00
|
| Rate for Payer: Mclaren Medicaid |
$2,551.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.10
|
| Rate for Payer: Meridian Medicaid |
$2,679.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$485.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: Nomi Health Commercial |
$1,384.16
|
| Rate for Payer: PACE Senior Care Partners |
$400.90
|
| Rate for Payer: PACE SWMI |
$422.00
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: PHP Medicare Advantage |
$422.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,551.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,468.56
|
| Rate for Payer: Priority Health Medicare |
$426.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,130.96
|
| Rate for Payer: Railroad Medicare Medicare |
$422.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,485.44
|
| Rate for Payer: UHC Core |
$1,409.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.00
|
| Rate for Payer: UHC Exchange |
$422.00
|
| Rate for Payer: UHC Medicare Advantage |
$422.00
|
| Rate for Payer: UHCCP Medicaid |
$2,551.51
|
| Rate for Payer: VA VA |
$422.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,266.00
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 49501
|
| Min. Negotiated Rate |
$592.06 |
| Max. Negotiated Rate |
$1,127.10 |
| Rate for Payer: Aetna Commercial |
$793.36
|
| Rate for Payer: Aetna Medicare |
$615.74
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$592.06
|
| Rate for Payer: BCN Medicare Advantage |
$592.06
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Commercial |
$793.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.66
|
| Rate for Payer: Nomi Health Commercial |
$710.47
|
| Rate for Payer: PACE SWMI |
$592.06
|
| Rate for Payer: PHP Medicare Advantage |
$592.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$597.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.06
|
| Rate for Payer: UHC Exchange |
$592.06
|
| Rate for Payer: UHC Medicare Advantage |
$592.06
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 49500
|
| Min. Negotiated Rate |
$404.10 |
| Max. Negotiated Rate |
$885.30 |
| Rate for Payer: Aetna Commercial |
$541.49
|
| Rate for Payer: Aetna Medicare |
$420.26
|
| Rate for Payer: BCBS Complete |
$544.80
|
| Rate for Payer: BCBS MAPPO |
$404.10
|
| Rate for Payer: BCN Medicare Advantage |
$404.10
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cofinity Commercial |
$581.90
|
| Rate for Payer: Cofinity Commercial |
$541.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.31
|
| Rate for Payer: Nomi Health Commercial |
$484.92
|
| Rate for Payer: PACE SWMI |
$404.10
|
| Rate for Payer: PHP Medicare Advantage |
$404.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health Medicare |
$408.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.10
|
| Rate for Payer: UHC Exchange |
$404.10
|
| Rate for Payer: UHC Medicare Advantage |
$404.10
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER
|
Professional
|
Both
|
$1,799.00
|
|
|
Service Code
|
HCPCS 49496
|
| Min. Negotiated Rate |
$600.19 |
| Max. Negotiated Rate |
$1,169.35 |
| Rate for Payer: Aetna Commercial |
$804.25
|
| Rate for Payer: Aetna Medicare |
$624.20
|
| Rate for Payer: BCBS Complete |
$719.60
|
| Rate for Payer: BCBS MAPPO |
$600.19
|
| Rate for Payer: BCN Medicare Advantage |
$600.19
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cofinity Commercial |
$864.27
|
| Rate for Payer: Cofinity Commercial |
$804.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.20
|
| Rate for Payer: Nomi Health Commercial |
$720.23
|
| Rate for Payer: PACE SWMI |
$600.19
|
| Rate for Payer: PHP Medicare Advantage |
$600.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.35
|
| Rate for Payer: Priority Health Medicare |
$606.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.19
|
| Rate for Payer: UHC Exchange |
$600.19
|
| Rate for Payer: UHC Medicare Advantage |
$600.19
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO RDC
|
Professional
|
Both
|
$1,514.00
|
|
|
Service Code
|
HCPCS 49495
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$984.10 |
| Rate for Payer: Aetna Commercial |
$534.66
|
| Rate for Payer: Aetna Medicare |
$414.96
|
| Rate for Payer: BCBS Complete |
$605.60
|
| Rate for Payer: BCBS MAPPO |
$399.00
|
| Rate for Payer: BCN Medicare Advantage |
$399.00
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Cash Price |
$1,211.20
|
| Rate for Payer: Cofinity Commercial |
$574.56
|
| Rate for Payer: Cofinity Commercial |
$534.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.95
|
| Rate for Payer: Nomi Health Commercial |
$478.80
|
| Rate for Payer: PACE SWMI |
$399.00
|
| Rate for Payer: PHP Medicare Advantage |
$399.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.10
|
| Rate for Payer: Priority Health Medicare |
$402.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.00
|
| Rate for Payer: UHC Exchange |
$399.00
|
| Rate for Payer: UHC Medicare Advantage |
$399.00
|
|
