|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$782.18 |
| 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 Medicare |
$1,057.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.10
|
| Rate for Payer: BCBS Complete |
$845.60
|
| 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 |
$782.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,585.50
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
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 |
$1,006.11
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| 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 MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$233.20 |
| Max. Negotiated Rate |
$378.95 |
| Rate for Payer: Aetna Commercial |
$330.67
|
| Rate for Payer: Aetna Medicare |
$256.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.67
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$246.77
|
| Rate for Payer: BCN Medicare Advantage |
$246.77
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$355.35
|
| Rate for Payer: Cofinity Commercial |
$330.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.11
|
| Rate for Payer: Nomi Health Commercial |
$296.12
|
| Rate for Payer: PACE SWMI |
$246.77
|
| Rate for Payer: PHP Commercial |
$345.48
|
| Rate for Payer: PHP Medicare Advantage |
$246.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$246.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.77
|
| Rate for Payer: UHC Medicare Advantage |
$246.77
|
| Rate for Payer: UMR Bronson Commercial |
$268.18
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,905.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$392.33 |
| Max. Negotiated Rate |
$1,238.25 |
| Rate for Payer: Aetna Commercial |
$525.72
|
| Rate for Payer: Aetna Medicare |
$408.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.72
|
| Rate for Payer: BCBS Complete |
$762.00
|
| Rate for Payer: BCBS MAPPO |
$392.33
|
| Rate for Payer: BCN Medicare Advantage |
$392.33
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cash Price |
$1,524.00
|
| Rate for Payer: Cofinity Commercial |
$564.96
|
| Rate for Payer: Cofinity Commercial |
$525.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.95
|
| Rate for Payer: Nomi Health Commercial |
$470.80
|
| Rate for Payer: PACE SWMI |
$392.33
|
| Rate for Payer: PHP Commercial |
$549.26
|
| Rate for Payer: PHP Medicare Advantage |
$392.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,238.25
|
| Rate for Payer: Priority Health Medicare |
$392.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.33
|
| Rate for Payer: UHC Medicare Advantage |
$392.33
|
| Rate for Payer: UMR Bronson Commercial |
$876.30
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$801.20 |
| Max. Negotiated Rate |
$1,504.44 |
| Rate for Payer: Aetna Commercial |
$1,399.96
|
| Rate for Payer: Aetna Medicare |
$1,086.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,504.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.96
|
| Rate for Payer: BCBS Complete |
$801.20
|
| Rate for Payer: BCBS MAPPO |
$1,044.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,044.75
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cofinity Commercial |
$1,504.44
|
| Rate for Payer: Cofinity Commercial |
$1,399.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,044.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,096.99
|
| Rate for Payer: Nomi Health Commercial |
$1,253.70
|
| Rate for Payer: PACE SWMI |
$1,044.75
|
| Rate for Payer: PHP Commercial |
$1,462.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,044.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health Medicare |
$1,044.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,044.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,044.75
|
| Rate for Payer: UMR Bronson Commercial |
$921.38
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,381.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$830.55 |
| Max. Negotiated Rate |
$1,547.65 |
| Rate for Payer: Aetna Commercial |
$1,112.94
|
| Rate for Payer: Aetna Medicare |
$863.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,195.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.94
|
| Rate for Payer: BCBS Complete |
$952.40
|
| Rate for Payer: BCBS MAPPO |
$830.55
|
| Rate for Payer: BCN Medicare Advantage |
$830.55
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cash Price |
$1,904.80
|
| Rate for Payer: Cofinity Commercial |
$1,195.99
|
| Rate for Payer: Cofinity Commercial |
$1,112.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$996.66
|
| Rate for Payer: PACE SWMI |
$830.55
|
| Rate for Payer: PHP Commercial |
$1,162.77
|
| Rate for Payer: PHP Medicare Advantage |
$830.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.65
|
| Rate for Payer: Priority Health Medicare |
$830.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.55
|
| Rate for Payer: UHC Medicare Advantage |
$830.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,095.26
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$554.29
|
| Rate for Payer: Aetna Medicare |
$430.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.29
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$413.65
|
| Rate for Payer: BCN Medicare Advantage |
$413.65
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$595.66
|
| Rate for Payer: Cofinity Commercial |
$554.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.33
|
| Rate for Payer: Nomi Health Commercial |
$496.38
|
| Rate for Payer: PACE SWMI |
$413.65
|
| Rate for Payer: PHP Commercial |
$579.11
|
| Rate for Payer: PHP Medicare Advantage |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$413.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.65
|
| Rate for Payer: UHC Medicare Advantage |
$413.65
|
| Rate for Payer: UMR Bronson Commercial |
$560.28
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,259.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$818.35 |
| Rate for Payer: Aetna Commercial |
$518.42
|
| Rate for Payer: Aetna Medicare |
$402.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.42
|
| Rate for Payer: BCBS Complete |
$503.60
|
| Rate for Payer: BCBS MAPPO |
$386.88
|
| Rate for Payer: BCN Medicare Advantage |
$386.88
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cash Price |
$1,007.20
|
| Rate for Payer: Cofinity Commercial |
$557.11
|
| Rate for Payer: Cofinity Commercial |
$518.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.22
|
| Rate for Payer: Nomi Health Commercial |
$464.26
|
| Rate for Payer: PACE SWMI |
$386.88
|
| Rate for Payer: PHP Commercial |
$541.63
|
| Rate for Payer: PHP Medicare Advantage |
$386.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.35
|
| Rate for Payer: Priority Health Medicare |
$386.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$386.88
|
| Rate for Payer: UHC Medicare Advantage |
$386.88
|
| Rate for Payer: UMR Bronson Commercial |
$579.14
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Aetna Commercial |
$276.84
|
| Rate for Payer: Aetna Medicare |
$214.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.84
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$206.60
|
| Rate for Payer: BCN Medicare Advantage |
$206.60
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$297.50
|
| Rate for Payer: Cofinity Commercial |
$276.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.93
|
| Rate for Payer: Nomi Health Commercial |
$247.92
|
| Rate for Payer: PACE SWMI |
$206.60
|
| Rate for Payer: PHP Commercial |
$289.24
|
| Rate for Payer: PHP Medicare Advantage |
$206.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$206.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$206.60
|
| Rate for Payer: UHC Medicare Advantage |
$206.60
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,694.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$441.57 |
| Max. Negotiated Rate |
$1,101.10 |
| Rate for Payer: Aetna Commercial |
$591.70
|
| Rate for Payer: Aetna Medicare |
$459.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.70
|
| Rate for Payer: BCBS Complete |
$677.60
|
| Rate for Payer: BCBS MAPPO |
$441.57
|
| Rate for Payer: BCN Medicare Advantage |
$441.57
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cash Price |
$1,355.20
|
| Rate for Payer: Cofinity Commercial |
$635.86
|
| Rate for Payer: Cofinity Commercial |
$591.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$441.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$463.65
|
| Rate for Payer: Nomi Health Commercial |
$529.88
|
| Rate for Payer: PACE SWMI |
$441.57
|
| Rate for Payer: PHP Commercial |
$618.20
|
| Rate for Payer: PHP Medicare Advantage |
$441.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.10
|
| Rate for Payer: Priority Health Medicare |
$441.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$441.57
|
| Rate for Payer: UHC Medicare Advantage |
$441.57
|
| Rate for Payer: UMR Bronson Commercial |
$779.24
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,489.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$701.96 |
| Max. Negotiated Rate |
$1,617.85 |
| Rate for Payer: Aetna Commercial |
$940.63
|
| Rate for Payer: Aetna Medicare |
$730.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,010.82
|
| Rate for Payer: BCBS Complete |
$995.60
|
| Rate for Payer: BCBS MAPPO |
$701.96
|
| Rate for Payer: BCN Medicare Advantage |
$701.96
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cofinity Commercial |
$940.63
|
| Rate for Payer: Cofinity Commercial |
$1,010.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.06
|
| Rate for Payer: Nomi Health Commercial |
$842.35
|
| Rate for Payer: PACE SWMI |
$701.96
|
| Rate for Payer: PHP Commercial |
$982.74
|
| Rate for Payer: PHP Medicare Advantage |
$701.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,617.85
|
| Rate for Payer: Priority Health Medicare |
$701.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$701.96
|
| Rate for Payer: UHC Medicare Advantage |
$701.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.94
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,000.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$3,070.67 |
| Rate for Payer: Aetna Commercial |
$2,857.43
|
| Rate for Payer: Aetna Medicare |
$2,217.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,070.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,857.43
|
| Rate for Payer: BCBS Complete |
$1,600.00
|
| Rate for Payer: BCBS MAPPO |
$2,132.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,132.41
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cash Price |
$3,200.00
|
| Rate for Payer: Cofinity Commercial |
$3,070.67
|
| Rate for Payer: Cofinity Commercial |
$2,857.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,132.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,239.03
|
| Rate for Payer: Nomi Health Commercial |
$2,558.89
|
| Rate for Payer: PACE SWMI |
$2,132.41
|
| Rate for Payer: PHP Commercial |
$2,985.37
|
| Rate for Payer: PHP Medicare Advantage |
$2,132.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,600.00
|
| Rate for Payer: Priority Health Medicare |
$2,132.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,132.41
|
| Rate for Payer: UHC Medicare Advantage |
$2,132.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,840.00
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,787.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$714.80 |
| Max. Negotiated Rate |
$1,459.45 |
| Rate for Payer: Aetna Commercial |
$1,358.10
|
| Rate for Payer: Aetna Medicare |
$1,054.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,459.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.10
|
| Rate for Payer: BCBS Complete |
$714.80
|
| Rate for Payer: BCBS MAPPO |
$1,013.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,013.51
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cash Price |
$1,429.60
|
| Rate for Payer: Cofinity Commercial |
$1,459.45
|
| Rate for Payer: Cofinity Commercial |
$1,358.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,013.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,064.19
|
| Rate for Payer: Nomi Health Commercial |
$1,216.21
|
| Rate for Payer: PACE SWMI |
$1,013.51
|
| Rate for Payer: PHP Commercial |
$1,418.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,013.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,161.55
|
| Rate for Payer: Priority Health Medicare |
$1,013.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,013.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,013.51
|
| Rate for Payer: UMR Bronson Commercial |
$822.02
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$473.60 |
| Max. Negotiated Rate |
$866.82 |
| Rate for Payer: Aetna Commercial |
$806.63
|
| Rate for Payer: Aetna Medicare |
$626.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.63
|
| Rate for Payer: BCBS Complete |
$473.60
|
| Rate for Payer: BCBS MAPPO |
$601.96
|
| Rate for Payer: BCN Medicare Advantage |
$601.96
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$866.82
|
| Rate for Payer: Cofinity Commercial |
$806.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.06
|
| Rate for Payer: Nomi Health Commercial |
$722.35
|
| Rate for Payer: PACE SWMI |
$601.96
|
| Rate for Payer: PHP Commercial |
$842.74
|
| Rate for Payer: PHP Medicare Advantage |
$601.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health Medicare |
$601.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.96
|
| Rate for Payer: UHC Medicare Advantage |
$601.96
|
| Rate for Payer: UMR Bronson Commercial |
$544.64
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$812.80 |
| Max. Negotiated Rate |
$1,635.11 |
| Rate for Payer: Aetna Commercial |
$1,521.56
|
| Rate for Payer: Aetna Medicare |
$1,180.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,635.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,521.56
|
| Rate for Payer: BCBS Complete |
$812.80
|
| Rate for Payer: BCBS MAPPO |
$1,135.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,135.49
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,635.11
|
| Rate for Payer: Cofinity Commercial |
$1,521.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,135.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,192.26
|
| Rate for Payer: Nomi Health Commercial |
$1,362.59
|
| Rate for Payer: PACE SWMI |
$1,135.49
|
| Rate for Payer: PHP Commercial |
$1,589.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,135.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.80
|
| Rate for Payer: Priority Health Medicare |
$1,135.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,135.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,135.49
|
| Rate for Payer: UMR Bronson Commercial |
$934.72
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,703.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$1,081.20 |
| Max. Negotiated Rate |
$1,776.57 |
| Rate for Payer: Aetna Commercial |
$1,653.20
|
| Rate for Payer: Aetna Medicare |
$1,283.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,776.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,653.20
|
| Rate for Payer: BCBS Complete |
$1,081.20
|
| Rate for Payer: BCBS MAPPO |
$1,233.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,233.73
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cash Price |
$2,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,776.57
|
| Rate for Payer: Cofinity Commercial |
$1,653.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,233.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,295.42
|
| Rate for Payer: Nomi Health Commercial |
$1,480.48
|
| Rate for Payer: PACE SWMI |
$1,233.73
|
| Rate for Payer: PHP Commercial |
$1,727.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,233.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,756.95
|
| Rate for Payer: Priority Health Medicare |
$1,233.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,233.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,233.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,243.38
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,827.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$1,037.86 |
| Max. Negotiated Rate |
$1,837.55 |
| Rate for Payer: Aetna Commercial |
$1,390.73
|
| Rate for Payer: Aetna Medicare |
$1,079.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,390.73
|
| Rate for Payer: BCBS Complete |
$1,130.80
|
| Rate for Payer: BCBS MAPPO |
$1,037.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,037.86
|
| Rate for Payer: Cash Price |
$2,261.60
|
| Rate for Payer: Cash Price |
$2,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,494.52
|
| Rate for Payer: Cofinity Commercial |
$1,390.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,037.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,089.75
|
| Rate for Payer: Nomi Health Commercial |
$1,245.43
|
| Rate for Payer: PACE SWMI |
$1,037.86
|
| Rate for Payer: PHP Commercial |
$1,453.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,037.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,837.55
|
| Rate for Payer: Priority Health Medicare |
$1,037.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,037.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,300.42
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$753.20 |
| Max. Negotiated Rate |
$1,223.95 |
| Rate for Payer: Aetna Commercial |
$1,053.01
|
| Rate for Payer: Aetna Medicare |
$817.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,053.01
|
| Rate for Payer: BCBS Complete |
$753.20
|
| Rate for Payer: BCBS MAPPO |
$785.83
|
| Rate for Payer: BCN Medicare Advantage |
$785.83
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,131.60
|
| Rate for Payer: Cofinity Commercial |
$1,053.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$825.12
|
| Rate for Payer: Nomi Health Commercial |
$943.00
|
| Rate for Payer: PACE SWMI |
$785.83
|
| Rate for Payer: PHP Commercial |
$1,100.16
|
| Rate for Payer: PHP Medicare Advantage |
$785.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health Medicare |
$785.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$785.83
|
| Rate for Payer: UHC Medicare Advantage |
$785.83
|
| Rate for Payer: UMR Bronson Commercial |
$866.18
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$506.90 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna American Axle |
$890.50
|
| Rate for Payer: Aetna Commercial |
$1,164.50
|
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$959.00
|
| Rate for Payer: Cofinity Commercial |
$1,178.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Healthscope Commercial |
$1,233.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,027.50
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.50
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Commercial |
$1,164.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Priority Health SBD |
$863.10
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: UMR Bronson Commercial |
$506.90
|
| Rate for Payer: VA VA |
$2,674.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,027.50
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Aetna American Axle |
$890.50
|
| Rate for Payer: Aetna Commercial |
$1,164.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.50
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,178.20
|
| Rate for Payer: Cofinity Commercial |
$959.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$959.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.00
|
| Rate for Payer: Healthscope Commercial |
$1,233.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,027.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.50
|
| Rate for Payer: PHP Commercial |
$1,164.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health SBD |
$863.10
|
| Rate for Payer: UMR Bronson Commercial |
$602.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,027.50
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$890.50 |
| Rate for Payer: Aetna Commercial |
$787.65
|
| Rate for Payer: Aetna Medicare |
$611.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.65
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$587.80
|
| Rate for Payer: BCN Medicare Advantage |
$587.80
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$846.43
|
| Rate for Payer: Cofinity Commercial |
$787.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.19
|
| Rate for Payer: Nomi Health Commercial |
$705.36
|
| Rate for Payer: PACE SWMI |
$587.80
|
| Rate for Payer: PHP Commercial |
$822.92
|
| Rate for Payer: PHP Medicare Advantage |
$587.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$587.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.80
|
| Rate for Payer: UHC Medicare Advantage |
$587.80
|
| Rate for Payer: UMR Bronson Commercial |
$630.20
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$890.50 |
| Rate for Payer: Aetna Commercial |
$787.65
|
| Rate for Payer: Aetna Medicare |
$611.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.65
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$587.80
|
| Rate for Payer: BCN Medicare Advantage |
$587.80
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$787.65
|
| Rate for Payer: Cofinity Commercial |
$846.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.19
|
| Rate for Payer: Nomi Health Commercial |
$705.36
|
| Rate for Payer: PACE SWMI |
$587.80
|
| Rate for Payer: PHP Commercial |
$822.92
|
| Rate for Payer: PHP Medicare Advantage |
$587.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$587.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.80
|
| Rate for Payer: UHC Medicare Advantage |
$587.80
|
| Rate for Payer: UMR Bronson Commercial |
$630.20
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$836.80 |
| Max. Negotiated Rate |
$1,438.14 |
| Rate for Payer: Aetna Commercial |
$1,338.27
|
| Rate for Payer: Aetna Medicare |
$1,038.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,338.27
|
| Rate for Payer: BCBS Complete |
$836.80
|
| Rate for Payer: BCBS MAPPO |
$998.71
|
| Rate for Payer: BCN Medicare Advantage |
$998.71
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,438.14
|
| Rate for Payer: Cofinity Commercial |
$1,338.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$998.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,048.65
|
| Rate for Payer: Nomi Health Commercial |
$1,198.45
|
| Rate for Payer: PACE SWMI |
$998.71
|
| Rate for Payer: PHP Commercial |
$1,398.19
|
| Rate for Payer: PHP Medicare Advantage |
$998.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health Medicare |
$998.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$998.71
|
| Rate for Payer: UHC Medicare Advantage |
$998.71
|
| Rate for Payer: UMR Bronson Commercial |
$962.32
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$619.60 |
| Max. Negotiated Rate |
$1,230.91 |
| Rate for Payer: Aetna Commercial |
$1,145.43
|
| Rate for Payer: Aetna Medicare |
$888.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,145.43
|
| Rate for Payer: BCBS Complete |
$619.60
|
| Rate for Payer: BCBS MAPPO |
$854.80
|
| Rate for Payer: BCN Medicare Advantage |
$854.80
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cofinity Commercial |
$1,230.91
|
| Rate for Payer: Cofinity Commercial |
$1,145.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$897.54
|
| Rate for Payer: Nomi Health Commercial |
$1,025.76
|
| Rate for Payer: PACE SWMI |
$854.80
|
| Rate for Payer: PHP Commercial |
$1,196.72
|
| Rate for Payer: PHP Medicare Advantage |
$854.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health Medicare |
$854.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.80
|
| Rate for Payer: UHC Medicare Advantage |
$854.80
|
| Rate for Payer: UMR Bronson Commercial |
$712.54
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,107.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$842.80 |
| Max. Negotiated Rate |
$1,369.55 |
| Rate for Payer: Aetna Commercial |
$1,260.74
|
| Rate for Payer: Aetna Medicare |
$978.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,354.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,260.74
|
| Rate for Payer: BCBS Complete |
$842.80
|
| Rate for Payer: BCBS MAPPO |
$940.85
|
| Rate for Payer: BCN Medicare Advantage |
$940.85
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Cofinity Commercial |
$1,354.82
|
| Rate for Payer: Cofinity Commercial |
$1,260.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$940.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$987.89
|
| Rate for Payer: Nomi Health Commercial |
$1,129.02
|
| Rate for Payer: PACE SWMI |
$940.85
|
| Rate for Payer: PHP Commercial |
$1,317.19
|
| Rate for Payer: PHP Medicare Advantage |
$940.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.55
|
| Rate for Payer: Priority Health Medicare |
$940.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$940.85
|
| Rate for Payer: UHC Medicare Advantage |
$940.85
|
| Rate for Payer: UMR Bronson Commercial |
$969.22
|
|
