|
PR RADICAL RESECTION TUMOR RADIUS OR ULNA
|
Professional
|
Both
|
$2,544.00
|
|
|
Service Code
|
HCPCS 25170
|
| Min. Negotiated Rate |
$542.04 |
| Max. Negotiated Rate |
$2,239.71 |
| Rate for Payer: Aetna Commercial |
$1,965.45
|
| Rate for Payer: BCBS Complete |
$987.19
|
| Rate for Payer: BCBS Trust/PPO |
$542.04
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Cash Price |
$2,035.20
|
| Rate for Payer: Meridian Medicaid |
$987.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$940.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,239.71
|
| Rate for Payer: Priority Health Narrow Network |
$2,239.71
|
| Rate for Payer: Priority Health SBD |
$2,239.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,170.24
|
|
|
PR RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,269.00
|
|
|
Service Code
|
HCPCS 24150
|
| Min. Negotiated Rate |
$145.81 |
| Max. Negotiated Rate |
$2,355.12 |
| Rate for Payer: Aetna Commercial |
$2,068.51
|
| Rate for Payer: BCBS Complete |
$1,038.41
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Cash Price |
$1,815.20
|
| Rate for Payer: Meridian Medicaid |
$1,038.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,355.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,355.12
|
| Rate for Payer: Priority Health SBD |
$2,355.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.74
|
|
|
PR RADICAL STYLOIDECTOMY SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 25230
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$1,572.75 |
| Rate for Payer: Aetna Commercial |
$574.91
|
| Rate for Payer: BCBS Complete |
$297.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,572.75
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Meridian Medicaid |
$297.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$283.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$671.51
|
| Rate for Payer: Priority Health Narrow Network |
$671.51
|
| Rate for Payer: Priority Health SBD |
$671.51
|
| Rate for Payer: UMR Bronson Commercial |
$694.14
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$5,402.75 |
| Rate for Payer: Aetna American Axle |
$595.40
|
| Rate for Payer: Aetna Commercial |
$778.60
|
| Rate for Payer: Aetna Medicare |
$1,784.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,145.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,145.29
|
| Rate for Payer: BCBS Complete |
$985.80
|
| Rate for Payer: BCBS MAPPO |
$1,716.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,716.23
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$641.20
|
| Rate for Payer: Cofinity Commercial |
$787.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,716.23
|
| Rate for Payer: Healthscope Commercial |
$824.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.00
|
| Rate for Payer: Mclaren Medicaid |
$938.78
|
| Rate for Payer: Mclaren Medicare |
$1,716.23
|
| Rate for Payer: Meridian Medicaid |
$985.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,802.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,973.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.60
|
| Rate for Payer: PACE Medicare |
$1,630.42
|
| Rate for Payer: PACE SWMI |
$1,716.23
|
| Rate for Payer: PHP Commercial |
$778.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,716.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$938.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,402.75
|
| Rate for Payer: Priority Health Medicare |
$1,716.23
|
| Rate for Payer: Priority Health Narrow Network |
$4,322.20
|
| Rate for Payer: Priority Health SBD |
$577.08
|
| Rate for Payer: Railroad Medicare Medicare |
$1,716.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,716.23
|
| Rate for Payer: UHC Exchange |
$191.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.72
|
| Rate for Payer: UMR Bronson Commercial |
$338.92
|
| Rate for Payer: VA VA |
$1,716.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.00
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Aetna Commercial |
$248.15
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.22
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.58
|
| Rate for Payer: Priority Health Narrow Network |
$325.58
|
| Rate for Payer: Priority Health SBD |
$325.58
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
64625
|
| Min. Negotiated Rate |
$403.04 |
| Max. Negotiated Rate |
$824.40 |
| Rate for Payer: Aetna American Axle |
$595.40
|
| Rate for Payer: Aetna Commercial |
$778.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.40
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$641.20
|
| Rate for Payer: Cofinity Commercial |
$787.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$732.80
|
| Rate for Payer: Healthscope Commercial |
$824.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$641.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$687.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$778.60
|
| Rate for Payer: PHP Commercial |
$778.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health SBD |
$577.08
|
| Rate for Payer: UMR Bronson Commercial |
$403.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$687.00
|
|
|
PR RADIOFREQUENCY ABLTJ NRV NRVTG SI JT W/IMG GDN
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 64625
|
| Min. Negotiated Rate |
$124.39 |
| Max. Negotiated Rate |
$1,208.22 |
| Rate for Payer: Aetna Commercial |
$248.15
|
| Rate for Payer: BCBS Complete |
$130.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,208.22
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Meridian Medicaid |
$130.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$641.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.58
|
| Rate for Payer: Priority Health Narrow Network |
$325.58
|
| Rate for Payer: Priority Health SBD |
$325.58
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
|
|
PR RAD RESCJ CAPSL TISS&HTRTPC B1 ELBW CONTRCT RLS
|
Professional
|
Both
|
$2,616.00
|
|
|
Service Code
|
HCPCS 24149
|
| Min. Negotiated Rate |
$762.11 |
| Max. Negotiated Rate |
$1,831.20 |
| Rate for Payer: Aetna Commercial |
$1,566.80
|
| Rate for Payer: BCBS Complete |
$800.22
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Cash Price |
$2,092.80
|
| Rate for Payer: Meridian Medicaid |
$800.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,831.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,810.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,810.76
|
| Rate for Payer: Priority Health SBD |
$1,810.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,203.36
|
|
|
PR RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW <5CM
|
Professional
|
Both
|
$1,811.00
|
|
|
Service Code
|
HCPCS 24077
|
| Min. Negotiated Rate |
$659.87 |
| Max. Negotiated Rate |
$1,580.46 |
| Rate for Payer: Aetna Commercial |
$1,376.78
|
| Rate for Payer: BCBS Complete |
$692.86
|
| Rate for Payer: BCBS Trust/PPO |
$712.15
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Cash Price |
$1,448.80
|
| Rate for Payer: Meridian Medicaid |
$692.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,267.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,580.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,580.46
|
| Rate for Payer: Priority Health SBD |
$1,580.46
|
| Rate for Payer: UMR Bronson Commercial |
$833.06
|
|
|
PR RAD RESCJ TUMOR SOFT TISS UPPER ARM/ELBOW 5CM+
|
Professional
|
Both
|
$3,056.00
|
|
|
Service Code
|
HCPCS 24079
|
| Min. Negotiated Rate |
$849.66 |
| Max. Negotiated Rate |
$2,139.20 |
| Rate for Payer: Aetna Commercial |
$1,771.40
|
| Rate for Payer: BCBS Complete |
$892.14
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Cash Price |
$2,444.80
|
| Rate for Payer: Meridian Medicaid |
$892.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$849.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,022.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,022.68
|
| Rate for Payer: Priority Health SBD |
$2,022.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,405.76
|
|
|
PR RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>
|
Professional
|
Both
|
$3,863.00
|
|
|
Service Code
|
HCPCS 25078
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$2,704.10 |
| Rate for Payer: Aetna Commercial |
$1,555.32
|
| Rate for Payer: BCBS Complete |
$786.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,058.71
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Cash Price |
$3,090.40
|
| Rate for Payer: Meridian Medicaid |
$786.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$748.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,704.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,783.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,783.70
|
| Rate for Payer: Priority Health SBD |
$1,783.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,776.98
|
|
|
PR RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>
|
Professional
|
Both
|
$3,440.00
|
|
|
Service Code
|
HCPCS 26118
|
| Min. Negotiated Rate |
$213.95 |
| Max. Negotiated Rate |
$2,408.00 |
| Rate for Payer: Aetna Commercial |
$1,403.39
|
| Rate for Payer: BCBS Complete |
$709.19
|
| Rate for Payer: BCBS Trust/PPO |
$213.95
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Cash Price |
$2,752.00
|
| Rate for Payer: Meridian Medicaid |
$709.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,617.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,617.23
|
| Rate for Payer: Priority Health SBD |
$1,617.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,582.40
|
|
|
PR RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL
|
Professional
|
Both
|
$4,187.00
|
|
|
Service Code
|
HCPCS 27075
|
| Min. Negotiated Rate |
$572.15 |
| Max. Negotiated Rate |
$3,168.07 |
| Rate for Payer: Aetna Commercial |
$2,792.00
|
| Rate for Payer: BCBS Complete |
$1,395.12
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: Cash Price |
$3,349.60
|
| Rate for Payer: Cash Price |
$3,349.60
|
| Rate for Payer: Meridian Medicaid |
$1,395.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,328.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,930.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,168.07
|
| Rate for Payer: Priority Health Narrow Network |
$3,168.07
|
| Rate for Payer: Priority Health SBD |
$3,168.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,926.02
|
|
|
PR RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER
|
Professional
|
Both
|
$1,614.00
|
|
|
Service Code
|
HCPCS 26260
|
| Min. Negotiated Rate |
$278.41 |
| Max. Negotiated Rate |
$1,224.55 |
| Rate for Payer: Aetna Commercial |
$1,064.51
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS Trust/PPO |
$278.41
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Cash Price |
$1,291.20
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,224.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,224.55
|
| Rate for Payer: Priority Health SBD |
$1,224.55
|
| Rate for Payer: UMR Bronson Commercial |
$742.44
|
|
|
PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/>
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
HCPCS 21016
|
| Min. Negotiated Rate |
$87.70 |
| Max. Negotiated Rate |
$1,541.15 |
| Rate for Payer: Aetna Commercial |
$1,337.87
|
| Rate for Payer: BCBS Complete |
$677.66
|
| Rate for Payer: BCBS Trust/PPO |
$87.70
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Meridian Medicaid |
$677.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,206.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,541.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,541.15
|
| Rate for Payer: Priority Health SBD |
$1,541.15
|
| Rate for Payer: UMR Bronson Commercial |
$792.58
|
|
|
PR RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM
|
Professional
|
Both
|
$878.00
|
|
|
Service Code
|
HCPCS 21015
|
| Min. Negotiated Rate |
$403.88 |
| Max. Negotiated Rate |
$6,178.65 |
| Rate for Payer: Aetna Commercial |
$930.36
|
| Rate for Payer: BCBS Complete |
$470.56
|
| Rate for Payer: BCBS Trust/PPO |
$6,178.65
|
| Rate for Payer: Cash Price |
$702.40
|
| Rate for Payer: Cash Price |
$702.40
|
| Rate for Payer: Meridian Medicaid |
$470.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$614.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,069.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.30
|
| Rate for Payer: Priority Health SBD |
$1,069.30
|
| Rate for Payer: UMR Bronson Commercial |
$403.88
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/>
|
Professional
|
Both
|
$2,373.00
|
|
|
Service Code
|
HCPCS 22905
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$2,023.19 |
| Rate for Payer: Aetna Commercial |
$1,775.84
|
| Rate for Payer: BCBS Complete |
$893.71
|
| Rate for Payer: BCBS Trust/PPO |
$149.00
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Meridian Medicaid |
$893.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$851.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,023.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,023.19
|
| Rate for Payer: Priority Health SBD |
$2,023.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,091.58
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 22904
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$1,602.93 |
| Rate for Payer: Aetna Commercial |
$1,401.18
|
| Rate for Payer: BCBS Complete |
$705.62
|
| Rate for Payer: BCBS Trust/PPO |
$288.98
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Meridian Medicaid |
$705.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,464.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,602.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,602.93
|
| Rate for Payer: Priority Health SBD |
$1,602.93
|
| Rate for Payer: UMR Bronson Commercial |
$962.32
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM
|
Professional
|
Both
|
$2,882.00
|
|
|
Service Code
|
HCPCS 21935
|
| Min. Negotiated Rate |
$124.38 |
| Max. Negotiated Rate |
$2,017.40 |
| Rate for Payer: Aetna Commercial |
$1,374.99
|
| Rate for Payer: BCBS Complete |
$688.39
|
| Rate for Payer: BCBS Trust/PPO |
$124.38
|
| Rate for Payer: Cash Price |
$2,305.60
|
| Rate for Payer: Cash Price |
$2,305.60
|
| Rate for Payer: Meridian Medicaid |
$688.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$655.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,017.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.51
|
| Rate for Payer: Priority Health SBD |
$1,558.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,325.72
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>
|
Professional
|
Both
|
$2,547.00
|
|
|
Service Code
|
HCPCS 21936
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$2,156.99 |
| Rate for Payer: Aetna Commercial |
$1,897.26
|
| Rate for Payer: BCBS Complete |
$951.40
|
| Rate for Payer: BCBS Trust/PPO |
$38.98
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Cash Price |
$2,037.60
|
| Rate for Payer: Meridian Medicaid |
$951.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$906.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,782.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,156.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,156.99
|
| Rate for Payer: Priority Health SBD |
$2,156.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,171.62
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>
|
Professional
|
Both
|
$2,268.00
|
|
|
Service Code
|
HCPCS 27616
|
| Min. Negotiated Rate |
$807.06 |
| Max. Negotiated Rate |
$1,936.38 |
| Rate for Payer: Aetna Commercial |
$1,701.80
|
| Rate for Payer: BCBS Complete |
$847.41
|
| Rate for Payer: BCBS Trust/PPO |
$928.75
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Meridian Medicaid |
$847.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$807.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,936.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,936.38
|
| Rate for Payer: Priority Health SBD |
$1,936.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.28
|
|
|
PR RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM
|
Professional
|
Both
|
$2,011.00
|
|
|
Service Code
|
HCPCS 23077
|
| Min. Negotiated Rate |
$240.38 |
| Max. Negotiated Rate |
$1,724.46 |
| Rate for Payer: Aetna Commercial |
$1,518.73
|
| Rate for Payer: BCBS Complete |
$761.53
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: Cash Price |
$1,608.80
|
| Rate for Payer: Cash Price |
$1,608.80
|
| Rate for Payer: Meridian Medicaid |
$761.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,407.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,724.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,724.46
|
| Rate for Payer: Priority Health SBD |
$1,724.46
|
| Rate for Payer: UMR Bronson Commercial |
$925.06
|
|
|
PR RAD RESECTION TUMOR SOFT TIS THIGH/KNEE 5 CM/>
|
Professional
|
Both
|
$6,526.00
|
|
|
Service Code
|
HCPCS 27364
|
| Min. Negotiated Rate |
$1,000.46 |
| Max. Negotiated Rate |
$4,568.20 |
| Rate for Payer: Aetna Commercial |
$2,093.77
|
| Rate for Payer: BCBS Complete |
$1,050.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,166.03
|
| Rate for Payer: Cash Price |
$5,220.80
|
| Rate for Payer: Cash Price |
$5,220.80
|
| Rate for Payer: Meridian Medicaid |
$1,050.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,568.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,386.27
|
| Rate for Payer: Priority Health SBD |
$2,386.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,001.96
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Facility
|
IP
|
$2,820.00
|
|
|
Service Code
|
CPT 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$1,240.80 |
| Max. Negotiated Rate |
$2,538.00 |
| Rate for Payer: Aetna American Axle |
$1,833.00
|
| Rate for Payer: Aetna Commercial |
$2,397.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,833.00
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cofinity Commercial |
$1,974.00
|
| Rate for Payer: Cofinity Commercial |
$2,425.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,256.00
|
| Rate for Payer: Healthscope Commercial |
$2,538.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,974.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,115.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,397.00
|
| Rate for Payer: PHP Commercial |
$2,397.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.00
|
| Rate for Payer: Priority Health SBD |
$1,776.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,240.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,115.00
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Professional
|
Both
|
$2,820.00
|
|
|
Service Code
|
HCPCS 25077
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$1,974.00 |
| Rate for Payer: Aetna Commercial |
$1,186.63
|
| Rate for Payer: BCBS Complete |
$580.60
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Meridian Medicaid |
$580.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,974.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,358.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,358.84
|
| Rate for Payer: Priority Health SBD |
$1,358.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,297.20
|
|
