|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$3,922.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$3,845.34 |
| Rate for Payer: Aetna Commercial |
$2,988.87
|
| Rate for Payer: BCBS Complete |
$1,485.71
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: Cash Price |
$3,137.60
|
| Rate for Payer: Cash Price |
$3,137.60
|
| Rate for Payer: Meridian Medicaid |
$1,485.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,745.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,845.34
|
| Rate for Payer: Priority Health Narrow Network |
$3,845.34
|
| Rate for Payer: Priority Health SBD |
$3,845.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,804.12
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$1,866.23 |
| Rate for Payer: Aetna Commercial |
$1,398.85
|
| Rate for Payer: BCBS Complete |
$713.44
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Meridian Medicaid |
$713.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,226.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,866.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,866.23
|
| Rate for Payer: Priority Health SBD |
$1,866.23
|
| Rate for Payer: UMR Bronson Commercial |
$805.92
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Aetna Commercial |
$830.54
|
| Rate for Payer: BCBS Complete |
$426.06
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Meridian Medicaid |
$426.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,114.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,114.20
|
| Rate for Payer: Priority Health SBD |
$1,114.20
|
| Rate for Payer: UMR Bronson Commercial |
$534.06
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,992.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$279.47 |
| Max. Negotiated Rate |
$2,090.24 |
| Rate for Payer: Aetna Commercial |
$1,570.77
|
| Rate for Payer: BCBS Complete |
$797.76
|
| Rate for Payer: BCBS Trust/PPO |
$279.47
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Cash Price |
$1,593.60
|
| Rate for Payer: Meridian Medicaid |
$797.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,090.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,090.24
|
| Rate for Payer: Priority Health SBD |
$2,090.24
|
| Rate for Payer: UMR Bronson Commercial |
$916.32
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,650.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$823.25 |
| Max. Negotiated Rate |
$2,260.16 |
| Rate for Payer: Aetna Commercial |
$1,721.13
|
| Rate for Payer: BCBS Complete |
$864.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,920.90
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Cash Price |
$2,120.00
|
| Rate for Payer: Meridian Medicaid |
$864.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$823.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,260.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,260.16
|
| Rate for Payer: Priority Health SBD |
$2,260.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.00
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,772.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$689.27 |
| Max. Negotiated Rate |
$2,249.50 |
| Rate for Payer: Aetna Commercial |
$1,446.17
|
| Rate for Payer: BCBS Complete |
$723.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,249.50
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Meridian Medicaid |
$723.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,940.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,893.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,893.87
|
| Rate for Payer: Priority Health SBD |
$1,893.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,275.12
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$478.64 |
| Max. Negotiated Rate |
$1,447.58 |
| Rate for Payer: Aetna Commercial |
$1,102.79
|
| Rate for Payer: BCBS Complete |
$553.54
|
| Rate for Payer: BCBS Trust/PPO |
$478.64
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Meridian Medicaid |
$553.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$527.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,447.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,447.58
|
| Rate for Payer: Priority Health SBD |
$1,447.58
|
| Rate for Payer: UMR Bronson Commercial |
$849.16
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$496.91 |
| Max. Negotiated Rate |
$7,856.86 |
| Rate for Payer: Aetna American Axle |
$872.95
|
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna Medicare |
$2,595.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,119.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,119.72
|
| Rate for Payer: BCBS Complete |
$1,433.58
|
| Rate for Payer: BCBS MAPPO |
$2,495.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,725.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,495.78
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,495.78
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,007.25
|
| Rate for Payer: Mclaren Medicaid |
$1,365.19
|
| Rate for Payer: Mclaren Medicare |
$2,495.78
|
| Rate for Payer: Meridian Medicaid |
$1,433.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,620.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.55
|
| Rate for Payer: PACE Medicare |
$2,370.99
|
| Rate for Payer: PACE SWMI |
$2,495.78
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,495.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,365.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,856.86
|
| Rate for Payer: Priority Health Medicare |
$2,495.78
|
| Rate for Payer: Priority Health Narrow Network |
$6,285.49
|
| Rate for Payer: Priority Health SBD |
$846.09
|
| Rate for Payer: Railroad Medicare Medicare |
$2,495.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$669.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,495.78
|
| Rate for Payer: UHC Exchange |
$608.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,570.65
|
| Rate for Payer: UMR Bronson Commercial |
$496.91
|
| Rate for Payer: VA VA |
$2,495.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,007.25
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.92
|
| Rate for Payer: Priority Health SBD |
$1,088.92
|
| Rate for Payer: UMR Bronson Commercial |
$617.78
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,088.92
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.92
|
| Rate for Payer: Priority Health SBD |
$1,088.92
|
| Rate for Payer: UMR Bronson Commercial |
$617.78
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$590.92 |
| Max. Negotiated Rate |
$1,208.70 |
| Rate for Payer: Aetna American Axle |
$872.95
|
| Rate for Payer: Aetna Commercial |
$1,141.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.95
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.98
|
| Rate for Payer: Cofinity Commercial |
$940.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,074.40
|
| Rate for Payer: Healthscope Commercial |
$1,208.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$940.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,007.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,141.55
|
| Rate for Payer: PHP Commercial |
$1,141.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health SBD |
$846.09
|
| Rate for Payer: UMR Bronson Commercial |
$590.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,007.25
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,051.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$658.17 |
| Max. Negotiated Rate |
$1,805.67 |
| Rate for Payer: Aetna Commercial |
$1,385.01
|
| Rate for Payer: BCBS Complete |
$691.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Cash Price |
$1,640.80
|
| Rate for Payer: Meridian Medicaid |
$691.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$658.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,435.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,805.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,805.67
|
| Rate for Payer: Priority Health SBD |
$1,805.67
|
| Rate for Payer: UMR Bronson Commercial |
$943.46
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$575.31 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$982.56
|
| Rate for Payer: BCBS Complete |
$604.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Meridian Medicaid |
$604.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.21
|
| Rate for Payer: Priority Health SBD |
$1,110.21
|
| Rate for Payer: UMR Bronson Commercial |
$698.74
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,066.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$663.50 |
| Max. Negotiated Rate |
$1,446.20 |
| Rate for Payer: Aetna Commercial |
$1,133.75
|
| Rate for Payer: BCBS Complete |
$696.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,266.07
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Cash Price |
$1,652.80
|
| Rate for Payer: Meridian Medicaid |
$696.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,446.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.90
|
| Rate for Payer: Priority Health SBD |
$1,284.90
|
| Rate for Payer: UMR Bronson Commercial |
$950.36
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$613.84 |
| Rate for Payer: Aetna Commercial |
$459.09
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS Trust/PPO |
$229.28
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.84
|
| Rate for Payer: Priority Health Narrow Network |
$613.84
|
| Rate for Payer: Priority Health SBD |
$613.84
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$349.53 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: BCBS Complete |
$367.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Meridian Medicaid |
$367.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.81
|
| Rate for Payer: Priority Health Narrow Network |
$829.81
|
| Rate for Payer: Priority Health SBD |
$829.81
|
| Rate for Payer: UMR Bronson Commercial |
$812.82
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
OP
|
$1,767.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$537.33 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$1,148.55
|
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.55
|
| 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 |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Cofinity Commercial |
$1,236.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,236.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.25
|
| 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 |
$1,501.95
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| 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 |
$1,236.90
|
| 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 |
$1,113.21
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$537.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$653.79
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.25
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,767.00
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$349.53 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: BCBS Complete |
$367.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Meridian Medicaid |
$367.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$829.81
|
| Rate for Payer: Priority Health Narrow Network |
$829.81
|
| Rate for Payer: Priority Health SBD |
$829.81
|
| Rate for Payer: UMR Bronson Commercial |
$812.82
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
IP
|
$1,767.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$777.48 |
| Max. Negotiated Rate |
$1,590.30 |
| Rate for Payer: Aetna American Axle |
$1,148.55
|
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.55
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cofinity Commercial |
$1,236.90
|
| Rate for Payer: Cofinity Commercial |
$1,519.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.60
|
| Rate for Payer: Healthscope Commercial |
$1,590.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,236.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,501.95
|
| Rate for Payer: PHP Commercial |
$1,501.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.90
|
| Rate for Payer: Priority Health SBD |
$1,113.21
|
| Rate for Payer: UMR Bronson Commercial |
$777.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.25
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$73.06 |
| Max. Negotiated Rate |
$2,226.78 |
| Rate for Payer: Aetna Commercial |
$150.24
|
| Rate for Payer: BCBS Complete |
$76.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.78
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Meridian Medicaid |
$76.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.74
|
| Rate for Payer: Priority Health Narrow Network |
$198.74
|
| Rate for Payer: Priority Health SBD |
$198.74
|
| Rate for Payer: UMR Bronson Commercial |
$160.08
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$409.17 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$662.98
|
| Rate for Payer: BCBS Complete |
$429.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Meridian Medicaid |
$429.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$822.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$785.49
|
| Rate for Payer: Priority Health Narrow Network |
$785.49
|
| Rate for Payer: Priority Health SBD |
$785.49
|
| Rate for Payer: UMR Bronson Commercial |
$540.50
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$1,431.65 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: BCBS Complete |
$797.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Cash Price |
$1,564.80
|
| Rate for Payer: Meridian Medicaid |
$797.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$759.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,431.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,431.65
|
| Rate for Payer: Priority Health SBD |
$1,431.65
|
| Rate for Payer: UMR Bronson Commercial |
$899.76
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.25
|
| Rate for Payer: Priority Health Narrow Network |
$827.25
|
| Rate for Payer: Priority Health SBD |
$827.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,004.64
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$534.71 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$1,419.60
|
| Rate for Payer: Aetna Commercial |
$1,856.40
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,419.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,787.02
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cofinity Commercial |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$1,878.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$1,965.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,528.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,638.00
|
| Rate for Payer: Mclaren Medicaid |
$1,381.58
|
| Rate for Payer: Mclaren Medicare |
$2,525.74
|
| Rate for Payer: Meridian Medicaid |
$1,450.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,652.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,904.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,856.40
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$1,856.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Priority Health SBD |
$1,375.92
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$534.71
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$808.08
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,638.00
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,184.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,528.80 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Cash Price |
$1,747.20
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$827.25
|
| Rate for Payer: Priority Health Narrow Network |
$827.25
|
| Rate for Payer: Priority Health SBD |
$827.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,004.64
|
|
