|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Professional
|
Both
|
$1,002.00
|
|
|
Service Code
|
HCPCS 23076
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$835.93 |
| Rate for Payer: Aetna Commercial |
$722.71
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS Trust/PPO |
$93.51
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$701.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.93
|
| Rate for Payer: Priority Health Narrow Network |
$835.93
|
| Rate for Payer: Priority Health SBD |
$835.93
|
| Rate for Payer: UMR Bronson Commercial |
$460.92
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
IP
|
$1,002.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
23076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$440.88 |
| Max. Negotiated Rate |
$901.80 |
| Rate for Payer: Aetna American Axle |
$651.30
|
| Rate for Payer: Aetna Commercial |
$851.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.30
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cofinity Commercial |
$701.40
|
| Rate for Payer: Cofinity Commercial |
$861.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.60
|
| Rate for Payer: Healthscope Commercial |
$901.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$851.70
|
| Rate for Payer: PHP Commercial |
$851.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$701.40
|
| Rate for Payer: Priority Health SBD |
$631.26
|
| Rate for Payer: UMR Bronson Commercial |
$440.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.50
|
|
|
PR EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM
|
Facility
|
OP
|
$1,002.00
|
|
|
Service Code
|
CPT 23076
|
| Hospital Charge Code |
23076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$370.74 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$651.30
|
| Rate for Payer: Aetna Commercial |
$851.70
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.30
|
| 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 |
$1,531.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cash Price |
$801.60
|
| Rate for Payer: Cofinity Commercial |
$701.40
|
| Rate for Payer: Cofinity Commercial |
$861.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$801.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$901.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$701.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$751.50
|
| 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 |
$851.70
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$851.70
|
| 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 |
$701.40
|
| 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 |
$631.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$540.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$370.74
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$751.50
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 22900
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$867.59 |
| Rate for Payer: Aetna Commercial |
$757.16
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS Trust/PPO |
$232.20
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.59
|
| Rate for Payer: Priority Health Narrow Network |
$867.59
|
| Rate for Payer: Priority Health SBD |
$867.59
|
| Rate for Payer: UMR Bronson Commercial |
$523.48
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
22900
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$500.72 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Aetna American Axle |
$739.70
|
| Rate for Payer: Aetna Commercial |
$967.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.70
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cofinity Commercial |
$796.60
|
| Rate for Payer: Cofinity Commercial |
$978.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.40
|
| Rate for Payer: Healthscope Commercial |
$1,024.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$967.30
|
| Rate for Payer: PHP Commercial |
$967.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.60
|
| Rate for Payer: Priority Health SBD |
$716.94
|
| Rate for Payer: UMR Bronson Commercial |
$500.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.50
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
HCPCS 22900
|
| Hospital Charge Code |
22900
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$867.59 |
| Rate for Payer: Aetna Commercial |
$757.16
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS Trust/PPO |
$232.20
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.59
|
| Rate for Payer: Priority Health Narrow Network |
$867.59
|
| Rate for Payer: Priority Health SBD |
$867.59
|
| Rate for Payer: UMR Bronson Commercial |
$523.48
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 22900
|
| Hospital Charge Code |
22900
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$421.06 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$739.70
|
| Rate for Payer: Aetna Commercial |
$967.30
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.70
|
| 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 |
$1,531.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cash Price |
$910.40
|
| Rate for Payer: Cofinity Commercial |
$796.60
|
| Rate for Payer: Cofinity Commercial |
$978.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$1,024.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.50
|
| 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 |
$967.30
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$967.30
|
| 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 |
$796.60
|
| 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 |
$716.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$617.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$561.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$421.06
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.50
|
|
|
PR EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/>
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 22901
|
| Min. Negotiated Rate |
$132.44 |
| Max. Negotiated Rate |
$1,020.28 |
| Rate for Payer: Aetna Commercial |
$895.18
|
| Rate for Payer: BCBS Complete |
$450.66
|
| Rate for Payer: BCBS Trust/PPO |
$132.44
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Meridian Medicaid |
$450.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,020.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,020.28
|
| Rate for Payer: Priority Health SBD |
$1,020.28
|
| Rate for Payer: UMR Bronson Commercial |
$542.34
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 22903
|
| Hospital Charge Code |
22903
|
| Min. Negotiated Rate |
$165.89 |
| Max. Negotiated Rate |
$676.11 |
| Rate for Payer: Aetna Commercial |
$589.34
|
| Rate for Payer: BCBS Complete |
$298.58
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Meridian Medicaid |
$298.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.11
|
| Rate for Payer: Priority Health Narrow Network |
$676.11
|
| Rate for Payer: Priority Health SBD |
$676.11
|
| Rate for Payer: UMR Bronson Commercial |
$322.00
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
22903
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$455.00
|
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| 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 |
$2,525.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| 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 |
$595.00
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$595.00
|
| 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 |
$490.00
|
| 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 |
$441.00
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$437.14
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$259.00
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 22903
|
| Min. Negotiated Rate |
$165.89 |
| Max. Negotiated Rate |
$676.11 |
| Rate for Payer: Aetna Commercial |
$589.34
|
| Rate for Payer: BCBS Complete |
$298.58
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Meridian Medicaid |
$298.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.11
|
| Rate for Payer: Priority Health Narrow Network |
$676.11
|
| Rate for Payer: Priority Health SBD |
$676.11
|
| Rate for Payer: UMR Bronson Commercial |
$322.00
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/>
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 22903
|
| Hospital Charge Code |
22903
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna American Axle |
$455.00
|
| Rate for Payer: Aetna Commercial |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$490.00
|
| Rate for Payer: Cofinity Commercial |
$602.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$560.00
|
| Rate for Payer: Healthscope Commercial |
$630.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$490.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$525.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$595.00
|
| Rate for Payer: PHP Commercial |
$595.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health SBD |
$441.00
|
| Rate for Payer: UMR Bronson Commercial |
$308.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$525.00
|
|
|
PR EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 22902
|
| Min. Negotiated Rate |
$216.41 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna Commercial |
$444.06
|
| Rate for Payer: BCBS Complete |
$227.23
|
| Rate for Payer: BCBS Trust/PPO |
$216.50
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Meridian Medicaid |
$227.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$542.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.18
|
| Rate for Payer: Priority Health Narrow Network |
$512.18
|
| Rate for Payer: Priority Health SBD |
$512.18
|
| Rate for Payer: UMR Bronson Commercial |
$356.50
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 28041
|
| Hospital Charge Code |
28041
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna Commercial |
$597.23
|
| Rate for Payer: BCBS Complete |
$304.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.54
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Meridian Medicaid |
$304.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.31
|
| Rate for Payer: Priority Health Narrow Network |
$686.31
|
| Rate for Payer: Priority Health SBD |
$686.31
|
| Rate for Payer: UMR Bronson Commercial |
$543.72
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Facility
|
OP
|
$1,182.00
|
|
|
Service Code
|
CPT 28041
|
| Hospital Charge Code |
28041
|
| Min. Negotiated Rate |
$437.34 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$768.30
|
| Rate for Payer: Aetna Commercial |
$1,004.70
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.30
|
| 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 |
$1,531.74
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$1,016.52
|
| Rate for Payer: Cofinity Commercial |
$827.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$1,063.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.50
|
| 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 |
$1,004.70
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$1,004.70
|
| 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 |
$827.40
|
| 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 |
$744.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$446.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$437.34
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.50
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 28041
|
| Min. Negotiated Rate |
$290.32 |
| Max. Negotiated Rate |
$1,055.54 |
| Rate for Payer: Aetna Commercial |
$597.23
|
| Rate for Payer: BCBS Complete |
$304.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.54
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Meridian Medicaid |
$304.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.31
|
| Rate for Payer: Priority Health Narrow Network |
$686.31
|
| Rate for Payer: Priority Health SBD |
$686.31
|
| Rate for Payer: UMR Bronson Commercial |
$543.72
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>
|
Facility
|
IP
|
$1,182.00
|
|
|
Service Code
|
CPT 28041
|
| Hospital Charge Code |
28041
|
| Min. Negotiated Rate |
$520.08 |
| Max. Negotiated Rate |
$1,063.80 |
| Rate for Payer: Aetna American Axle |
$768.30
|
| Rate for Payer: Aetna Commercial |
$1,004.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.30
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$1,016.52
|
| Rate for Payer: Cofinity Commercial |
$827.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$945.60
|
| Rate for Payer: Healthscope Commercial |
$1,063.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$827.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$886.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,004.70
|
| Rate for Payer: PHP Commercial |
$1,004.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$827.40
|
| Rate for Payer: Priority Health SBD |
$744.66
|
| Rate for Payer: UMR Bronson Commercial |
$520.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$886.50
|
|
|
PR EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 28045
|
| Min. Negotiated Rate |
$223.65 |
| Max. Negotiated Rate |
$699.47 |
| Rate for Payer: Aetna Commercial |
$458.34
|
| Rate for Payer: BCBS Complete |
$234.83
|
| Rate for Payer: BCBS Trust/PPO |
$699.47
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Meridian Medicaid |
$234.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.54
|
| Rate for Payer: Priority Health Narrow Network |
$529.54
|
| Rate for Payer: Priority Health SBD |
$529.54
|
| Rate for Payer: UMR Bronson Commercial |
$397.44
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
25075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$506.88 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Aetna American Axle |
$748.80
|
| Rate for Payer: Aetna Commercial |
$979.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.80
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cofinity Commercial |
$806.40
|
| Rate for Payer: Cofinity Commercial |
$990.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.60
|
| Rate for Payer: Healthscope Commercial |
$1,036.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$979.20
|
| Rate for Payer: PHP Commercial |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health SBD |
$725.76
|
| Rate for Payer: UMR Bronson Commercial |
$506.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.00
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25075
|
| Min. Negotiated Rate |
$205.55 |
| Max. Negotiated Rate |
$1,151.69 |
| Rate for Payer: Aetna Commercial |
$418.59
|
| Rate for Payer: BCBS Complete |
$215.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.69
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Meridian Medicaid |
$215.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.67
|
| Rate for Payer: Priority Health Narrow Network |
$487.67
|
| Rate for Payer: Priority Health SBD |
$487.67
|
| Rate for Payer: UMR Bronson Commercial |
$529.92
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 25075
|
| Hospital Charge Code |
25075
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.98 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$748.80
|
| Rate for Payer: Aetna Commercial |
$979.20
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,801.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,801.41
|
| Rate for Payer: BCBS Complete |
$827.79
|
| Rate for Payer: BCBS MAPPO |
$1,441.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,919.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cofinity Commercial |
$806.40
|
| Rate for Payer: Cofinity Commercial |
$990.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$921.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$1,036.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$806.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$864.00
|
| Rate for Payer: Mclaren Medicaid |
$788.30
|
| Rate for Payer: Mclaren Medicare |
$1,441.13
|
| Rate for Payer: Meridian Medicaid |
$827.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,513.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,657.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$979.20
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$979.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,441.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,536.73
|
| Rate for Payer: Priority Health Medicare |
$1,441.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,629.38
|
| Rate for Payer: Priority Health SBD |
$725.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.58
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$315.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$426.24
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$864.00
|
|
|
PR EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
HCPCS 25075
|
| Hospital Charge Code |
25075
|
| Min. Negotiated Rate |
$205.55 |
| Max. Negotiated Rate |
$1,151.69 |
| Rate for Payer: Aetna Commercial |
$418.59
|
| Rate for Payer: BCBS Complete |
$215.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,151.69
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Cash Price |
$921.60
|
| Rate for Payer: Meridian Medicaid |
$215.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.67
|
| Rate for Payer: Priority Health Narrow Network |
$487.67
|
| Rate for Payer: Priority Health SBD |
$487.67
|
| Rate for Payer: UMR Bronson Commercial |
$529.92
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASC 5 CM/>
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 27634
|
| Min. Negotiated Rate |
$433.24 |
| Max. Negotiated Rate |
$1,636.60 |
| Rate for Payer: Aetna Commercial |
$906.06
|
| Rate for Payer: BCBS Complete |
$454.90
|
| Rate for Payer: BCBS Trust/PPO |
$745.43
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Meridian Medicaid |
$454.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,636.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,036.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,036.62
|
| Rate for Payer: Priority Health SBD |
$1,036.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,075.48
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM
|
Professional
|
Both
|
$1,223.00
|
|
|
Service Code
|
HCPCS 27619
|
| Min. Negotiated Rate |
$304.38 |
| Max. Negotiated Rate |
$1,538.94 |
| Rate for Payer: Aetna Commercial |
$613.97
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,538.94
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Cash Price |
$978.40
|
| Rate for Payer: Meridian Medicaid |
$319.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$717.97
|
| Rate for Payer: Priority Health Narrow Network |
$717.97
|
| Rate for Payer: Priority Health SBD |
$717.97
|
| Rate for Payer: UMR Bronson Commercial |
$562.58
|
|
|
PR EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 27618
|
| Hospital Charge Code |
27618
|
| Min. Negotiated Rate |
$467.72 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Aetna American Axle |
$690.95
|
| Rate for Payer: Aetna Commercial |
$903.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.95
|
| Rate for Payer: Cash Price |
$850.40
|
| Rate for Payer: Cofinity Commercial |
$744.10
|
| Rate for Payer: Cofinity Commercial |
$914.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$850.40
|
| Rate for Payer: Healthscope Commercial |
$956.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$744.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$797.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$903.55
|
| Rate for Payer: PHP Commercial |
$903.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.10
|
| Rate for Payer: Priority Health SBD |
$669.69
|
| Rate for Payer: UMR Bronson Commercial |
$467.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$797.25
|
|
