|
PR EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 21048
|
| Min. Negotiated Rate |
$635.38 |
| Max. Negotiated Rate |
$3,701.02 |
| Rate for Payer: Aetna Commercial |
$1,361.18
|
| Rate for Payer: BCBS Complete |
$667.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,701.02
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Meridian Medicaid |
$667.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$635.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,586.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.66
|
| Rate for Payer: Priority Health SBD |
$1,517.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,042.36
|
|
|
PR EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 21030
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$998.90 |
| Rate for Payer: Aetna Commercial |
$488.49
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS Trust/PPO |
$998.90
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$702.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$549.98
|
| Rate for Payer: Priority Health Narrow Network |
$549.98
|
| Rate for Payer: Priority Health SBD |
$549.98
|
| Rate for Payer: UMR Bronson Commercial |
$461.84
|
|
|
PR EXC BRANCHIAL CLEFT CYST BELOW SUBQ TISS&/PHRYNX
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 42815
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,136.10 |
| Rate for Payer: Aetna Commercial |
$718.44
|
| Rate for Payer: BCBS Complete |
$364.33
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Meridian Medicaid |
$364.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$958.39
|
| Rate for Payer: Priority Health Narrow Network |
$958.39
|
| Rate for Payer: Priority Health SBD |
$958.39
|
| Rate for Payer: UMR Bronson Commercial |
$746.58
|
|
|
PR EXC BRANCHIAL CLEFT CYST CONFINED SKN&SUBQ TIS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 42810
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Aetna Commercial |
$370.11
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS Trust/PPO |
$196.53
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$500.36
|
| Rate for Payer: Priority Health Narrow Network |
$500.36
|
| Rate for Payer: Priority Health SBD |
$500.36
|
| Rate for Payer: UMR Bronson Commercial |
$391.00
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Hospital Charge Code |
19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Narrow Network |
$570.12
|
| Rate for Payer: Priority Health SBD |
$570.12
|
| Rate for Payer: UMR Bronson Commercial |
$569.48
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$458.06 |
| Max. Negotiated Rate |
$10,666.11 |
| Rate for Payer: Aetna American Axle |
$804.70
|
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: Aetna Medicare |
$3,523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,235.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,235.21
|
| Rate for Payer: BCBS Complete |
$1,946.16
|
| Rate for Payer: BCBS MAPPO |
$3,388.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,587.20
|
| Rate for Payer: BCCCP Commercial |
$618.15
|
| Rate for Payer: BCN Medicare Advantage |
$3,388.17
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,064.68
|
| Rate for Payer: Cofinity Commercial |
$866.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,388.17
|
| Rate for Payer: Healthscope Commercial |
$1,114.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.50
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,388.17
|
| Rate for Payer: Meridian Medicaid |
$1,946.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,557.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,896.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: PACE Medicare |
$3,218.76
|
| Rate for Payer: PACE SWMI |
$3,388.17
|
| Rate for Payer: PHP Commercial |
$1,052.30
|
| Rate for Payer: PHP Medicare Advantage |
$3,388.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,666.11
|
| Rate for Payer: Priority Health Medicare |
$3,388.17
|
| Rate for Payer: Priority Health Narrow Network |
$8,532.89
|
| Rate for Payer: Priority Health SBD |
$779.94
|
| Rate for Payer: Railroad Medicare Medicare |
$3,388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,388.17
|
| Rate for Payer: UHC Exchange |
$458.42
|
| Rate for Payer: UHC Medicare Advantage |
$3,489.82
|
| Rate for Payer: UMR Bronson Commercial |
$458.06
|
| Rate for Payer: VA VA |
$3,388.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.50
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 19125
|
| Hospital Charge Code |
19125
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.72 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Aetna American Axle |
$804.70
|
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.70
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$1,064.68
|
| Rate for Payer: Cofinity Commercial |
$866.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$990.40
|
| Rate for Payer: Healthscope Commercial |
$1,114.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$866.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$928.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,052.30
|
| Rate for Payer: PHP Commercial |
$1,052.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health SBD |
$779.94
|
| Rate for Payer: UMR Bronson Commercial |
$544.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$928.50
|
|
|
PR EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 19125
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$866.60 |
| Rate for Payer: Aetna Commercial |
$503.32
|
| Rate for Payer: BCBS Complete |
$313.11
|
| Rate for Payer: BCBS Trust/PPO |
$13.80
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Meridian Medicaid |
$313.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$866.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.12
|
| Rate for Payer: Priority Health Narrow Network |
$570.12
|
| Rate for Payer: Priority Health SBD |
$570.12
|
| Rate for Payer: UMR Bronson Commercial |
$569.48
|
|
|
PR EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 19126
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$195.24 |
| Rate for Payer: Aetna Commercial |
$177.60
|
| Rate for Payer: BCBS Complete |
$106.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Meridian Medicaid |
$106.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.24
|
| Rate for Payer: Priority Health Narrow Network |
$195.24
|
| Rate for Payer: Priority Health SBD |
$195.24
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR EXC CAROTID BODY TUMOR W/O EXC CAROTID ARTERY
|
Professional
|
Both
|
$2,711.00
|
|
|
Service Code
|
HCPCS 60600
|
| Min. Negotiated Rate |
$529.36 |
| Max. Negotiated Rate |
$1,914.80 |
| Rate for Payer: Aetna Commercial |
$1,763.47
|
| Rate for Payer: BCBS Complete |
$909.14
|
| Rate for Payer: BCBS Trust/PPO |
$529.36
|
| Rate for Payer: Cash Price |
$2,168.80
|
| Rate for Payer: Cash Price |
$2,168.80
|
| Rate for Payer: Meridian Medicaid |
$909.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$865.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,914.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,914.80
|
| Rate for Payer: Priority Health SBD |
$1,914.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,247.06
|
|
|
PR EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 26596
|
| Min. Negotiated Rate |
$72.17 |
| Max. Negotiated Rate |
$1,267.95 |
| Rate for Payer: Aetna Commercial |
$1,076.67
|
| Rate for Payer: BCBS Complete |
$556.22
|
| Rate for Payer: BCBS Trust/PPO |
$72.17
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Meridian Medicaid |
$556.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,267.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,267.95
|
| Rate for Payer: Priority Health SBD |
$1,267.95
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR EXC CRV STUMP VAG APPR W/RPR NTRCL
|
Professional
|
Both
|
$1,257.00
|
|
|
Service Code
|
HCPCS 57556
|
| Min. Negotiated Rate |
$378.50 |
| Max. Negotiated Rate |
$1,301.73 |
| Rate for Payer: Aetna Commercial |
$698.98
|
| Rate for Payer: BCBS Complete |
$397.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,301.73
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Cash Price |
$1,005.60
|
| Rate for Payer: Meridian Medicaid |
$397.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$378.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.96
|
| Rate for Payer: Priority Health Narrow Network |
$837.96
|
| Rate for Payer: Priority Health SBD |
$837.96
|
| Rate for Payer: UMR Bronson Commercial |
$578.22
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/DP NEUROVASC DSJ
|
Professional
|
Both
|
$4,123.00
|
|
|
Service Code
|
HCPCS 38555
|
| Min. Negotiated Rate |
$556.83 |
| Max. Negotiated Rate |
$2,886.10 |
| Rate for Payer: Aetna Commercial |
$1,274.21
|
| Rate for Payer: BCBS Complete |
$691.30
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Cash Price |
$3,298.40
|
| Rate for Payer: Meridian Medicaid |
$691.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,886.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,225.89
|
| Rate for Payer: Priority Health Narrow Network |
$2,225.89
|
| Rate for Payer: Priority Health SBD |
$2,225.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,896.58
|
|
|
PR EXC CSTIC HYGROMA AX/CRV W/O DP NEUROVASC DSJ
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 38550
|
| Min. Negotiated Rate |
$337.18 |
| Max. Negotiated Rate |
$1,135.76 |
| Rate for Payer: Aetna Commercial |
$643.88
|
| Rate for Payer: BCBS Complete |
$354.04
|
| Rate for Payer: BCBS Trust/PPO |
$608.07
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Meridian Medicaid |
$354.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,135.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,135.76
|
| Rate for Payer: Priority Health SBD |
$1,135.76
|
| Rate for Payer: UMR Bronson Commercial |
$711.16
|
|
|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$1,620.50 |
| Rate for Payer: Aetna Commercial |
$808.63
|
| Rate for Payer: BCBS Complete |
$413.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.23
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Meridian Medicaid |
$413.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.51
|
| Rate for Payer: Priority Health Narrow Network |
$935.51
|
| Rate for Payer: Priority Health SBD |
$935.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,064.90
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$1,747.00
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$1,222.90 |
| Rate for Payer: Aetna Commercial |
$756.96
|
| Rate for Payer: BCBS Complete |
$388.48
|
| Rate for Payer: BCBS Trust/PPO |
$119.40
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Cash Price |
$1,397.60
|
| Rate for Payer: Meridian Medicaid |
$388.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$878.83
|
| Rate for Payer: Priority Health Narrow Network |
$878.83
|
| Rate for Payer: Priority Health SBD |
$878.83
|
| Rate for Payer: UMR Bronson Commercial |
$803.62
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 27637
|
| Min. Negotiated Rate |
$483.08 |
| Max. Negotiated Rate |
$1,904.70 |
| Rate for Payer: Aetna Commercial |
$989.60
|
| Rate for Payer: BCBS Complete |
$507.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.18
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Meridian Medicaid |
$507.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$483.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,904.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,138.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,138.25
|
| Rate for Payer: Priority Health SBD |
$1,138.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,251.66
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 27638
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$1,612.37 |
| Rate for Payer: Aetna Commercial |
$1,011.80
|
| Rate for Payer: BCBS Complete |
$502.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,612.37
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Meridian Medicaid |
$502.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,146.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,146.41
|
| Rate for Payer: Priority Health SBD |
$1,146.41
|
| Rate for Payer: UMR Bronson Commercial |
$998.20
|
|
|
PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 28104
|
| Min. Negotiated Rate |
$228.98 |
| Max. Negotiated Rate |
$1,143.77 |
| Rate for Payer: Aetna Commercial |
$469.02
|
| Rate for Payer: BCBS Complete |
$240.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,143.77
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Meridian Medicaid |
$240.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.22
|
| Rate for Payer: Priority Health Narrow Network |
$538.22
|
| Rate for Payer: Priority Health SBD |
$538.22
|
| Rate for Payer: UMR Bronson Commercial |
$437.00
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 24116
|
| Min. Negotiated Rate |
$82.41 |
| Max. Negotiated Rate |
$1,321.56 |
| Rate for Payer: Aetna Commercial |
$1,149.88
|
| Rate for Payer: BCBS Complete |
$583.51
|
| Rate for Payer: BCBS Trust/PPO |
$82.41
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Meridian Medicaid |
$583.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,321.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,321.56
|
| Rate for Payer: Priority Health SBD |
$1,321.56
|
| Rate for Payer: UMR Bronson Commercial |
$782.00
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 23140
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$858.91 |
| Rate for Payer: Aetna Commercial |
$740.39
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS Trust/PPO |
$27.17
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$858.91
|
| Rate for Payer: Priority Health Narrow Network |
$858.91
|
| Rate for Payer: Priority Health SBD |
$858.91
|
| Rate for Payer: UMR Bronson Commercial |
$424.58
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$859.60 |
| Rate for Payer: Aetna Commercial |
$709.53
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.64
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Meridian Medicaid |
$364.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.19
|
| Rate for Payer: Priority Health Narrow Network |
$824.19
|
| Rate for Payer: Priority Health SBD |
$824.19
|
| Rate for Payer: UMR Bronson Commercial |
$564.88
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,228.00
|
|
|
Service Code
|
HCPCS 24120
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$859.60 |
| Rate for Payer: Aetna Commercial |
$709.53
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.64
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Meridian Medicaid |
$364.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.19
|
| Rate for Payer: Priority Health Narrow Network |
$824.19
|
| Rate for Payer: Priority Health SBD |
$824.19
|
| Rate for Payer: UMR Bronson Commercial |
$564.88
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$454.36 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$798.20
|
| Rate for Payer: Aetna Commercial |
$1,043.80
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,596.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,596.44
|
| Rate for Payer: BCBS Complete |
$1,652.63
|
| Rate for Payer: BCBS MAPPO |
$2,877.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,810.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,877.15
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cofinity Commercial |
$1,056.08
|
| Rate for Payer: Cofinity Commercial |
$859.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,105.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$859.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.00
|
| Rate for Payer: Mclaren Medicaid |
$1,573.80
|
| Rate for Payer: Mclaren Medicare |
$2,877.15
|
| Rate for Payer: Meridian Medicaid |
$1,652.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,021.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,308.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,043.80
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$1,043.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,877.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,573.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,057.42
|
| Rate for Payer: Priority Health Medicare |
$2,877.15
|
| Rate for Payer: Priority Health Narrow Network |
$7,245.94
|
| Rate for Payer: Priority Health SBD |
$773.64
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$587.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$534.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$454.36
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.00
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$540.32 |
| Max. Negotiated Rate |
$1,105.20 |
| Rate for Payer: Aetna American Axle |
$798.20
|
| Rate for Payer: Aetna Commercial |
$1,043.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.20
|
| Rate for Payer: Cash Price |
$982.40
|
| Rate for Payer: Cofinity Commercial |
$1,056.08
|
| Rate for Payer: Cofinity Commercial |
$859.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$982.40
|
| Rate for Payer: Healthscope Commercial |
$1,105.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$859.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$921.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,043.80
|
| Rate for Payer: PHP Commercial |
$1,043.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.60
|
| Rate for Payer: Priority Health SBD |
$773.64
|
| Rate for Payer: UMR Bronson Commercial |
$540.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$921.00
|
|
