|
PR LAPAROSCOPY SURG ABLATION RENAL CYSTS
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 50541
|
| Min. Negotiated Rate |
$581.28 |
| Max. Negotiated Rate |
$2,280.67 |
| Rate for Payer: Aetna Commercial |
$1,179.65
|
| Rate for Payer: BCBS Complete |
$610.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,280.67
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Meridian Medicaid |
$610.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$581.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,208.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,459.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.50
|
| Rate for Payer: Priority Health SBD |
$1,459.50
|
| Rate for Payer: UMR Bronson Commercial |
$794.42
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Facility
|
IP
|
$2,952.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
47562
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,298.88 |
| Max. Negotiated Rate |
$2,656.80 |
| Rate for Payer: Aetna American Axle |
$1,918.80
|
| Rate for Payer: Aetna Commercial |
$2,509.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,918.80
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cofinity Commercial |
$2,066.40
|
| Rate for Payer: Cofinity Commercial |
$2,538.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,361.60
|
| Rate for Payer: Healthscope Commercial |
$2,656.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,066.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,214.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,509.20
|
| Rate for Payer: PHP Commercial |
$2,509.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,066.40
|
| Rate for Payer: Priority Health SBD |
$1,859.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,298.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,214.00
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 47562
|
| Hospital Charge Code |
47562
|
| Min. Negotiated Rate |
$424.30 |
| Max. Negotiated Rate |
$2,066.40 |
| Rate for Payer: Aetna Commercial |
$890.52
|
| Rate for Payer: BCBS Complete |
$445.52
|
| Rate for Payer: BCBS Trust/PPO |
$481.23
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Meridian Medicaid |
$445.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,066.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.83
|
| Rate for Payer: Priority Health SBD |
$1,161.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.92
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Facility
|
OP
|
$2,952.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
47562
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$652.26 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$1,918.80
|
| Rate for Payer: Aetna Commercial |
$2,509.20
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,918.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$4,811.58
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cofinity Commercial |
$2,538.72
|
| Rate for Payer: Cofinity Commercial |
$2,066.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,361.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$2,656.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,066.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,214.00
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,509.20
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$2,509.20
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,066.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$1,859.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$652.26
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,092.24
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,214.00
|
|
|
PR LAPAROSCOPY SURG CHOLECYSTECTOMY
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 47562
|
| Min. Negotiated Rate |
$424.30 |
| Max. Negotiated Rate |
$2,066.40 |
| Rate for Payer: Aetna Commercial |
$890.52
|
| Rate for Payer: BCBS Complete |
$445.52
|
| Rate for Payer: BCBS Trust/PPO |
$481.23
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Meridian Medicaid |
$445.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,066.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.83
|
| Rate for Payer: Priority Health SBD |
$1,161.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,357.92
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Facility
|
OP
|
$2,708.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$1,001.96 |
| Max. Negotiated Rate |
$4,276.57 |
| Rate for Payer: Aetna American Axle |
$1,760.20
|
| Rate for Payer: Aetna Commercial |
$2,301.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,760.20
|
| Rate for Payer: BCBS Complete |
$1,083.20
|
| Rate for Payer: BCBS Trust/PPO |
$4,276.57
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Cofinity Commercial |
$1,895.60
|
| Rate for Payer: Cofinity Commercial |
$2,328.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,166.40
|
| Rate for Payer: Healthscope Commercial |
$2,437.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,895.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,031.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,301.80
|
| Rate for Payer: PHP Commercial |
$2,301.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.60
|
| Rate for Payer: Priority Health SBD |
$1,706.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,306.76
|
| Rate for Payer: UHC Exchange |
$1,187.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,031.00
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Facility
|
IP
|
$2,708.00
|
|
|
Service Code
|
CPT 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$1,191.52 |
| Max. Negotiated Rate |
$2,437.20 |
| Rate for Payer: Aetna American Axle |
$1,760.20
|
| Rate for Payer: Aetna Commercial |
$2,301.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,760.20
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Cofinity Commercial |
$1,895.60
|
| Rate for Payer: Cofinity Commercial |
$2,328.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,166.40
|
| Rate for Payer: Healthscope Commercial |
$2,437.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,895.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,031.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,301.80
|
| Rate for Payer: PHP Commercial |
$2,301.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.60
|
| Rate for Payer: Priority Health SBD |
$1,706.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,191.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,031.00
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,708.00
|
|
|
Service Code
|
HCPCS 44188
|
| Min. Negotiated Rate |
$772.76 |
| Max. Negotiated Rate |
$2,127.29 |
| Rate for Payer: Aetna Commercial |
$1,636.86
|
| Rate for Payer: BCBS Complete |
$811.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Meridian Medicaid |
$811.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,127.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,127.29
|
| Rate for Payer: Priority Health SBD |
$2,127.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,245.68
|
|
|
PR LAPAROSCOPY SURG COLOSTOMY/SKN LVL CECOSTOMY
|
Professional
|
Both
|
$2,708.00
|
|
|
Service Code
|
HCPCS 44188
|
| Hospital Charge Code |
44188
|
| Min. Negotiated Rate |
$772.76 |
| Max. Negotiated Rate |
$2,127.29 |
| Rate for Payer: Aetna Commercial |
$1,636.86
|
| Rate for Payer: BCBS Complete |
$811.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.13
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Cash Price |
$2,166.40
|
| Rate for Payer: Meridian Medicaid |
$811.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,895.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,127.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,127.29
|
| Rate for Payer: Priority Health SBD |
$2,127.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,245.68
|
|
|
PR LAPAROSCOPY SURGICAL JEJUNOSTOMY
|
Professional
|
Both
|
$1,959.00
|
|
|
Service Code
|
HCPCS 44186
|
| Min. Negotiated Rate |
$417.91 |
| Max. Negotiated Rate |
$1,371.30 |
| Rate for Payer: Aetna Commercial |
$878.77
|
| Rate for Payer: BCBS Complete |
$438.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.47
|
| Rate for Payer: Cash Price |
$1,567.20
|
| Rate for Payer: Cash Price |
$1,567.20
|
| Rate for Payer: Meridian Medicaid |
$438.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$417.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,145.37
|
| Rate for Payer: Priority Health SBD |
$1,145.37
|
| Rate for Payer: UMR Bronson Commercial |
$901.14
|
|
|
PR LAPAROSCOPY SURGICAL ORCHIECTOMY
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 54690
|
| Min. Negotiated Rate |
$417.48 |
| Max. Negotiated Rate |
$2,517.35 |
| Rate for Payer: Aetna Commercial |
$842.34
|
| Rate for Payer: BCBS Complete |
$438.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.35
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Meridian Medicaid |
$438.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$417.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,045.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,045.05
|
| Rate for Payer: Priority Health SBD |
$1,045.05
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR LAPAROSCOPY SURG ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,964.00
|
|
|
Service Code
|
HCPCS 44187
|
| Min. Negotiated Rate |
$693.95 |
| Max. Negotiated Rate |
$2,074.80 |
| Rate for Payer: Aetna Commercial |
$1,467.80
|
| Rate for Payer: BCBS Complete |
$728.65
|
| Rate for Payer: BCBS Trust/PPO |
$828.90
|
| Rate for Payer: Cash Price |
$2,371.20
|
| Rate for Payer: Cash Price |
$2,371.20
|
| Rate for Payer: Meridian Medicaid |
$728.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,910.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,910.33
|
| Rate for Payer: Priority Health SBD |
$1,910.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,363.44
|
|
|
PR LAPAROSCOPY SURG PARTIAL NEPHRECTOMY
|
Professional
|
Both
|
$2,796.00
|
|
|
Service Code
|
HCPCS 50543
|
| Min. Negotiated Rate |
$942.95 |
| Max. Negotiated Rate |
$3,176.67 |
| Rate for Payer: Aetna Commercial |
$1,912.33
|
| Rate for Payer: BCBS Complete |
$990.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,176.67
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Cash Price |
$2,236.80
|
| Rate for Payer: Meridian Medicaid |
$990.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$942.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,957.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,365.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,365.68
|
| Rate for Payer: Priority Health SBD |
$2,365.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,286.16
|
|
|
PR LAPAROSCOPY SURG PYELOPLASTY
|
Professional
|
Both
|
$2,350.00
|
|
|
Service Code
|
HCPCS 50544
|
| Min. Negotiated Rate |
$784.05 |
| Max. Negotiated Rate |
$2,666.86 |
| Rate for Payer: Aetna Commercial |
$1,596.98
|
| Rate for Payer: BCBS Complete |
$823.25
|
| Rate for Payer: BCBS Trust/PPO |
$2,666.86
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Cash Price |
$1,880.00
|
| Rate for Payer: Meridian Medicaid |
$823.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,645.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,970.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,970.69
|
| Rate for Payer: Priority Health SBD |
$1,970.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.00
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 49650
|
| Hospital Charge Code |
49650
|
| Min. Negotiated Rate |
$279.46 |
| Max. Negotiated Rate |
$4,463.08 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: BCBS Complete |
$293.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,463.08
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$293.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.36
|
| Rate for Payer: Priority Health Narrow Network |
$764.36
|
| Rate for Payer: Priority Health SBD |
$764.36
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 49650
|
| Min. Negotiated Rate |
$279.46 |
| Max. Negotiated Rate |
$4,463.08 |
| Rate for Payer: Aetna Commercial |
$580.39
|
| Rate for Payer: BCBS Complete |
$293.43
|
| Rate for Payer: BCBS Trust/PPO |
$4,463.08
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Meridian Medicaid |
$293.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$764.36
|
| Rate for Payer: Priority Health Narrow Network |
$764.36
|
| Rate for Payer: Priority Health SBD |
$764.36
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$673.20 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Aetna American Axle |
$994.50
|
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.50
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,071.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,071.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.50
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health SBD |
$963.90
|
| Rate for Payer: UMR Bronson Commercial |
$673.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.50
|
|
|
PR LAPAROSCOPY SURG RPR INITIAL INGUINAL HERNIA
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
CPT 49650
|
| Hospital Charge Code |
49650
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$429.60 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$994.50
|
| Rate for Payer: Aetna Commercial |
$1,300.50
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$5,317.02
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,315.80
|
| Rate for Payer: Cofinity Commercial |
$1,071.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,377.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,071.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.50
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,300.50
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,300.50
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,071.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$963.90
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$429.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$566.10
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.50
|
|
|
PR LAPAROSCOPY SURG W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
HCPCS 49321
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$1,478.18 |
| Rate for Payer: Aetna Commercial |
$463.87
|
| Rate for Payer: BCBS Complete |
$232.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,478.18
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,231.20
|
| Rate for Payer: Meridian Medicaid |
$232.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.21
|
| Rate for Payer: Priority Health Narrow Network |
$606.21
|
| Rate for Payer: Priority Health SBD |
$606.21
|
| Rate for Payer: UMR Bronson Commercial |
$707.94
|
|
|
PR LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM
|
Professional
|
Both
|
$2,912.00
|
|
|
Service Code
|
HCPCS 58572
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$2,038.40 |
| Rate for Payer: Aetna Commercial |
$1,237.81
|
| Rate for Payer: BCBS Complete |
$683.48
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Meridian Medicaid |
$683.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$650.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,038.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,472.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.35
|
| Rate for Payer: Priority Health SBD |
$1,472.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,339.52
|
|
|
PR LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR
|
Professional
|
Both
|
$3,397.00
|
|
|
Service Code
|
HCPCS 58573
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$2,377.90 |
| Rate for Payer: Aetna Commercial |
$1,450.88
|
| Rate for Payer: BCBS Complete |
$821.25
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: Cash Price |
$2,717.60
|
| Rate for Payer: Cash Price |
$2,717.60
|
| Rate for Payer: Meridian Medicaid |
$821.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$782.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,723.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,723.73
|
| Rate for Payer: Priority Health SBD |
$1,723.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,562.62
|
|
|
PR LAPAROSCOPY W/LYSIS OF ADHESIONS
|
Professional
|
Both
|
$2,634.00
|
|
|
Service Code
|
HCPCS 58660
|
| Min. Negotiated Rate |
$439.85 |
| Max. Negotiated Rate |
$1,843.80 |
| Rate for Payer: Aetna Commercial |
$813.78
|
| Rate for Payer: BCBS Complete |
$461.84
|
| Rate for Payer: BCBS Trust/PPO |
$540.45
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Cash Price |
$2,107.20
|
| Rate for Payer: Meridian Medicaid |
$461.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$439.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,843.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.15
|
| Rate for Payer: Priority Health Narrow Network |
$968.15
|
| Rate for Payer: Priority Health SBD |
$968.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.64
|
|
|
PR LAPAROSCOPY W/OMENTOPEXY
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 49326
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$1,426.41 |
| Rate for Payer: Aetna Commercial |
$255.96
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.41
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Meridian Medicaid |
$125.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.50
|
| Rate for Payer: Priority Health Narrow Network |
$327.50
|
| Rate for Payer: Priority Health SBD |
$327.50
|
| Rate for Payer: UMR Bronson Commercial |
$155.02
|
|
|
PR LAPAROSCOPY W/PLMT OCCLUSION DEVICE OVIDUCTS
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 58671
|
| Min. Negotiated Rate |
$48.39 |
| Max. Negotiated Rate |
$1,047.20 |
| Rate for Payer: Aetna Commercial |
$442.77
|
| Rate for Payer: BCBS Complete |
$251.61
|
| Rate for Payer: BCBS Trust/PPO |
$48.39
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Meridian Medicaid |
$251.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.29
|
| Rate for Payer: Priority Health Narrow Network |
$529.29
|
| Rate for Payer: Priority Health SBD |
$529.29
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
|
|
PR LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES
|
Professional
|
Both
|
$2,690.00
|
|
|
Service Code
|
HCPCS 58661
|
| Min. Negotiated Rate |
$183.85 |
| Max. Negotiated Rate |
$1,883.00 |
| Rate for Payer: Aetna Commercial |
$780.25
|
| Rate for Payer: BCBS Complete |
$439.48
|
| Rate for Payer: BCBS Trust/PPO |
$183.85
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Cash Price |
$2,152.00
|
| Rate for Payer: Meridian Medicaid |
$439.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,883.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$926.01
|
| Rate for Payer: Priority Health Narrow Network |
$926.01
|
| Rate for Payer: Priority Health SBD |
$926.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,237.40
|
|
