|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 55520
|
| Hospital Charge Code |
55520
|
| Min. Negotiated Rate |
$445.36 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$596.78
|
| Rate for Payer: Aetna Medicare |
$463.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.78
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$445.36
|
| Rate for Payer: BCN Medicare Advantage |
$445.36
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$596.78
|
| Rate for Payer: Cofinity Commercial |
$641.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.63
|
| Rate for Payer: Nomi Health Commercial |
$534.43
|
| Rate for Payer: PACE SWMI |
$445.36
|
| Rate for Payer: PHP Commercial |
$623.50
|
| Rate for Payer: PHP Medicare Advantage |
$445.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$445.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.36
|
| Rate for Payer: UHC Medicare Advantage |
$445.36
|
| Rate for Payer: UMR Bronson Commercial |
$584.20
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$390.72 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna American Axle |
$686.40
|
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$665.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: UMR Bronson Commercial |
$390.72
|
| Rate for Payer: VA VA |
$1,560.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$305.83 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: BCBS Complete |
$422.40
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$305.83 |
| Max. Negotiated Rate |
$686.40 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: BCBS Complete |
$422.40
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Commercial |
$428.16
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$464.64 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna American Axle |
$686.40
|
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$739.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$792.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health SBD |
$665.28
|
| Rate for Payer: UMR Bronson Commercial |
$464.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$792.00
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$295.72 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Commercial |
$414.01
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$295.72 |
| Max. Negotiated Rate |
$575.90 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: BCBS Complete |
$354.40
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Commercial |
$414.01
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UMR Bronson Commercial |
$407.56
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$389.84 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Aetna American Axle |
$575.90
|
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health SBD |
$558.18
|
| Rate for Payer: UMR Bronson Commercial |
$389.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$327.82 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna American Axle |
$575.90
|
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$620.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$664.50
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$558.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Exchange |
$2,982.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$836.62
|
| Rate for Payer: UMR Bronson Commercial |
$327.82
|
| Rate for Payer: VA VA |
$1,560.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$664.50
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$260.24 |
| Max. Negotiated Rate |
$538.85 |
| Rate for Payer: Aetna Commercial |
$348.72
|
| Rate for Payer: Aetna Medicare |
$270.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.72
|
| Rate for Payer: BCBS Complete |
$331.60
|
| Rate for Payer: BCBS MAPPO |
$260.24
|
| Rate for Payer: BCN Medicare Advantage |
$260.24
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$374.75
|
| Rate for Payer: Cofinity Commercial |
$348.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.25
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: PACE SWMI |
$260.24
|
| Rate for Payer: PHP Commercial |
$364.34
|
| Rate for Payer: PHP Medicare Advantage |
$260.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.85
|
| Rate for Payer: Priority Health Medicare |
$260.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.24
|
| Rate for Payer: UHC Medicare Advantage |
$260.24
|
| Rate for Payer: UMR Bronson Commercial |
$381.34
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$228.58 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Commercial |
$306.30
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.30
|
| Rate for Payer: BCBS Complete |
$237.20
|
| Rate for Payer: BCBS MAPPO |
$228.58
|
| Rate for Payer: BCN Medicare Advantage |
$228.58
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$329.16
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.01
|
| Rate for Payer: Nomi Health Commercial |
$274.30
|
| Rate for Payer: PACE SWMI |
$228.58
|
| Rate for Payer: PHP Commercial |
$320.01
|
| Rate for Payer: PHP Medicare Advantage |
$228.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: Priority Health Medicare |
$228.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.58
|
| Rate for Payer: UHC Medicare Advantage |
$228.58
|
| Rate for Payer: UMR Bronson Commercial |
$272.78
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$248.81 |
| Max. Negotiated Rate |
$492.05 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Aetna Medicare |
$258.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.41
|
| Rate for Payer: BCBS Complete |
$302.80
|
| Rate for Payer: BCBS MAPPO |
$248.81
|
| Rate for Payer: BCN Medicare Advantage |
$248.81
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cofinity Commercial |
$358.29
|
| Rate for Payer: Cofinity Commercial |
$333.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.25
|
| Rate for Payer: Nomi Health Commercial |
$298.57
|
| Rate for Payer: PACE SWMI |
$248.81
|
| Rate for Payer: PHP Commercial |
$348.33
|
| Rate for Payer: PHP Medicare Advantage |
$248.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.05
|
| Rate for Payer: Priority Health Medicare |
$248.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.81
|
| Rate for Payer: UHC Medicare Advantage |
$248.81
|
| Rate for Payer: UMR Bronson Commercial |
$348.22
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$847.81 |
| Rate for Payer: Aetna Commercial |
$788.94
|
| Rate for Payer: Aetna Medicare |
$612.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.94
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$588.76
|
| Rate for Payer: BCN Medicare Advantage |
$588.76
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$847.81
|
| Rate for Payer: Cofinity Commercial |
$788.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.20
|
| Rate for Payer: Nomi Health Commercial |
$706.51
|
| Rate for Payer: PACE SWMI |
$588.76
|
| Rate for Payer: PHP Commercial |
$824.26
|
| Rate for Payer: PHP Medicare Advantage |
$588.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$588.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.76
|
| Rate for Payer: UHC Medicare Advantage |
$588.76
|
| Rate for Payer: UMR Bronson Commercial |
$531.30
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$275.46 |
| Max. Negotiated Rate |
$462.15 |
| Rate for Payer: Aetna Commercial |
$369.12
|
| Rate for Payer: Aetna Medicare |
$286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.12
|
| Rate for Payer: BCBS Complete |
$284.40
|
| Rate for Payer: BCBS MAPPO |
$275.46
|
| Rate for Payer: BCN Medicare Advantage |
$275.46
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.23
|
| Rate for Payer: Nomi Health Commercial |
$330.55
|
| Rate for Payer: PACE SWMI |
$275.46
|
| Rate for Payer: PHP Commercial |
$385.64
|
| Rate for Payer: PHP Medicare Advantage |
$275.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health Medicare |
$275.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.46
|
| Rate for Payer: UHC Medicare Advantage |
$275.46
|
| Rate for Payer: UMR Bronson Commercial |
$327.06
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$114.45 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Medicare |
$119.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.36
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: BCBS MAPPO |
$114.45
|
| Rate for Payer: BCN Medicare Advantage |
$114.45
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Cofinity Commercial |
$153.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.17
|
| Rate for Payer: Nomi Health Commercial |
$137.34
|
| Rate for Payer: PACE SWMI |
$114.45
|
| Rate for Payer: PHP Commercial |
$160.23
|
| Rate for Payer: PHP Medicare Advantage |
$114.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health Medicare |
$114.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.45
|
| Rate for Payer: UHC Medicare Advantage |
$114.45
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$239.85 |
| Rate for Payer: Aetna Commercial |
$153.56
|
| Rate for Payer: Aetna Medicare |
$119.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: BCBS Complete |
$147.60
|
| Rate for Payer: BCBS MAPPO |
$114.60
|
| Rate for Payer: BCN Medicare Advantage |
$114.60
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$165.02
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.33
|
| Rate for Payer: Nomi Health Commercial |
$137.52
|
| Rate for Payer: PACE SWMI |
$114.60
|
| Rate for Payer: PHP Commercial |
$160.44
|
| Rate for Payer: PHP Medicare Advantage |
$114.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health Medicare |
$114.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.60
|
| Rate for Payer: UHC Medicare Advantage |
$114.60
|
| Rate for Payer: UMR Bronson Commercial |
$169.74
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$524.33 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Aetna Medicare |
$545.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.60
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$524.33
|
| Rate for Payer: BCN Medicare Advantage |
$524.33
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$755.04
|
| Rate for Payer: Cofinity Commercial |
$702.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.55
|
| Rate for Payer: Nomi Health Commercial |
$629.20
|
| Rate for Payer: PACE SWMI |
$524.33
|
| Rate for Payer: PHP Commercial |
$734.06
|
| Rate for Payer: PHP Medicare Advantage |
$524.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$524.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.33
|
| Rate for Payer: UHC Medicare Advantage |
$524.33
|
| Rate for Payer: UMR Bronson Commercial |
$912.18
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$479.10 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Aetna Medicare |
$346.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.83
|
| Rate for Payer: BCBS Complete |
$290.40
|
| Rate for Payer: BCBS MAPPO |
$332.71
|
| Rate for Payer: BCN Medicare Advantage |
$332.71
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Cofinity Commercial |
$445.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.35
|
| Rate for Payer: Nomi Health Commercial |
$399.25
|
| Rate for Payer: PACE SWMI |
$332.71
|
| Rate for Payer: PHP Commercial |
$465.79
|
| Rate for Payer: PHP Medicare Advantage |
$332.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health Medicare |
$332.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.71
|
| Rate for Payer: UHC Medicare Advantage |
$332.71
|
| Rate for Payer: UMR Bronson Commercial |
$333.96
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$341.59 |
| Max. Negotiated Rate |
$769.60 |
| Rate for Payer: Aetna Commercial |
$457.73
|
| Rate for Payer: Aetna Medicare |
$355.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.73
|
| Rate for Payer: BCBS Complete |
$473.60
|
| Rate for Payer: BCBS MAPPO |
$341.59
|
| Rate for Payer: BCN Medicare Advantage |
$341.59
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Cofinity Commercial |
$457.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.67
|
| Rate for Payer: Nomi Health Commercial |
$409.91
|
| Rate for Payer: PACE SWMI |
$341.59
|
| Rate for Payer: PHP Commercial |
$478.23
|
| Rate for Payer: PHP Medicare Advantage |
$341.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health Medicare |
$341.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.59
|
| Rate for Payer: UHC Medicare Advantage |
$341.59
|
| Rate for Payer: UMR Bronson Commercial |
$544.64
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$737.20 |
| Max. Negotiated Rate |
$1,717.60 |
| Rate for Payer: Aetna Commercial |
$1,598.33
|
| Rate for Payer: Aetna Medicare |
$1,240.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.33
|
| Rate for Payer: BCBS Complete |
$737.20
|
| Rate for Payer: BCBS MAPPO |
$1,192.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.78
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$1,598.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.42
|
| Rate for Payer: Nomi Health Commercial |
$1,431.34
|
| Rate for Payer: PACE SWMI |
$1,192.78
|
| Rate for Payer: PHP Commercial |
$1,669.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health Medicare |
$1,192.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.78
|
| Rate for Payer: UMR Bronson Commercial |
$847.78
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$948.51 |
| Max. Negotiated Rate |
$2,053.35 |
| Rate for Payer: Aetna Commercial |
$1,271.00
|
| Rate for Payer: Aetna Medicare |
$986.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,271.00
|
| Rate for Payer: BCBS Complete |
$1,263.60
|
| Rate for Payer: BCBS MAPPO |
$948.51
|
| Rate for Payer: BCN Medicare Advantage |
$948.51
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,365.85
|
| Rate for Payer: Cofinity Commercial |
$1,271.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.94
|
| Rate for Payer: Nomi Health Commercial |
$1,138.21
|
| Rate for Payer: PACE SWMI |
$948.51
|
| Rate for Payer: PHP Commercial |
$1,327.91
|
| Rate for Payer: PHP Medicare Advantage |
$948.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.35
|
| Rate for Payer: Priority Health Medicare |
$948.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.51
|
| Rate for Payer: UHC Medicare Advantage |
$948.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,453.14
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$116.80 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$166.90
|
| Rate for Payer: Aetna Medicare |
$129.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.90
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$124.55
|
| Rate for Payer: BCN Medicare Advantage |
$124.55
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$166.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.78
|
| Rate for Payer: Nomi Health Commercial |
$149.46
|
| Rate for Payer: PACE SWMI |
$124.55
|
| Rate for Payer: PHP Commercial |
$174.37
|
| Rate for Payer: PHP Medicare Advantage |
$124.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$124.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.55
|
| Rate for Payer: UHC Medicare Advantage |
$124.55
|
| Rate for Payer: UMR Bronson Commercial |
$134.32
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$1,444.44 |
| Rate for Payer: Aetna Commercial |
$1,344.13
|
| Rate for Payer: Aetna Medicare |
$1,043.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.13
|
| Rate for Payer: BCBS Complete |
$849.60
|
| Rate for Payer: BCBS MAPPO |
$1,003.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.08
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,444.44
|
| Rate for Payer: Cofinity Commercial |
$1,344.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.23
|
| Rate for Payer: Nomi Health Commercial |
$1,203.70
|
| Rate for Payer: PACE SWMI |
$1,003.08
|
| Rate for Payer: PHP Commercial |
$1,404.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.60
|
| Rate for Payer: Priority Health Medicare |
$1,003.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.08
|
| Rate for Payer: UMR Bronson Commercial |
$977.04
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Min. Negotiated Rate |
$750.83 |
| Max. Negotiated Rate |
$1,374.10 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$780.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.11
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Commercial |
$1,051.16
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UMR Bronson Commercial |
$972.44
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
IP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$930.16 |
| Max. Negotiated Rate |
$1,902.60 |
| Rate for Payer: Aetna American Axle |
$1,374.10
|
| Rate for Payer: Aetna Commercial |
$1,796.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.10
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,479.80
|
| Rate for Payer: Cofinity Commercial |
$1,818.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$1,902.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,479.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,585.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: PHP Commercial |
$1,796.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health SBD |
$1,331.82
|
| Rate for Payer: UMR Bronson Commercial |
$930.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.50
|
|
