|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Facility
|
OP
|
$2,820.00
|
|
|
Service Code
|
CPT 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$850.04 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$1,833.00
|
| Rate for Payer: Aetna Commercial |
$2,397.00
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,833.00
|
| 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 |
$1,055.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cash Price |
$2,256.00
|
| Rate for Payer: Cofinity Commercial |
$2,425.20
|
| Rate for Payer: Cofinity Commercial |
$1,974.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,256.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| 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: 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 |
$2,397.00
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$2,397.00
|
| 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 |
$1,974.00
|
| 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 |
$1,776.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$935.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$850.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.40
|
| Rate for Payer: VA VA |
$2,525.74
|
| 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
|
| Hospital Charge Code |
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
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 21557
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$1,459.44 |
| Rate for Payer: Aetna Commercial |
$1,274.88
|
| Rate for Payer: BCBS Complete |
$645.90
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Meridian Medicaid |
$645.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,459.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,459.44
|
| Rate for Payer: Priority Health SBD |
$1,459.44
|
| Rate for Payer: UMR Bronson Commercial |
$756.24
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>
|
Professional
|
Both
|
$3,351.00
|
|
|
Service Code
|
HCPCS 21558
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$2,345.70 |
| Rate for Payer: Aetna Commercial |
$1,800.42
|
| Rate for Payer: BCBS Complete |
$900.20
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: Cash Price |
$2,680.80
|
| Rate for Payer: Cash Price |
$2,680.80
|
| Rate for Payer: Meridian Medicaid |
$900.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$857.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,345.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,050.77
|
| Rate for Payer: Priority Health Narrow Network |
$2,050.77
|
| Rate for Payer: Priority Health SBD |
$2,050.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,541.46
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 26117
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$1,620.50 |
| Rate for Payer: Aetna Commercial |
$984.86
|
| Rate for Payer: BCBS Complete |
$505.67
|
| Rate for Payer: BCBS Trust/PPO |
$171.92
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Meridian Medicaid |
$505.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,620.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,140.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,140.79
|
| Rate for Payer: Priority Health SBD |
$1,140.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,064.90
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM
|
Professional
|
Both
|
$3,100.00
|
|
|
Service Code
|
HCPCS 27049
|
| Min. Negotiated Rate |
$913.34 |
| Max. Negotiated Rate |
$4,326.25 |
| Rate for Payer: Aetna Commercial |
$1,808.92
|
| Rate for Payer: BCBS Complete |
$959.01
|
| Rate for Payer: BCBS Trust/PPO |
$4,326.25
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Meridian Medicaid |
$959.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$913.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,044.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,044.12
|
| Rate for Payer: Priority Health SBD |
$2,044.12
|
| Rate for Payer: UMR Bronson Commercial |
$1,426.00
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM
|
Professional
|
Both
|
$3,312.00
|
|
|
Service Code
|
HCPCS 27329
|
| Min. Negotiated Rate |
$668.39 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Aetna Commercial |
$1,391.29
|
| Rate for Payer: BCBS Complete |
$701.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: Cash Price |
$2,649.60
|
| Rate for Payer: Cash Price |
$2,649.60
|
| Rate for Payer: Meridian Medicaid |
$701.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,318.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,591.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,591.69
|
| Rate for Payer: Priority Health SBD |
$1,591.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,523.52
|
|
|
PR RAPID DESENSITIZATION PROCEDURE EACH HOUR
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 95180
|
| Min. Negotiated Rate |
$64.54 |
| Max. Negotiated Rate |
$430.04 |
| Rate for Payer: Aetna Commercial |
$105.91
|
| Rate for Payer: BCBS Complete |
$67.77
|
| Rate for Payer: BCBS Trust/PPO |
$430.04
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Meridian Medicaid |
$67.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.82
|
| Rate for Payer: Priority Health Narrow Network |
$125.82
|
| Rate for Payer: Priority Health SBD |
$125.82
|
| Rate for Payer: UMR Bronson Commercial |
$114.08
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$366.96 |
| Max. Negotiated Rate |
$750.60 |
| Rate for Payer: Aetna American Axle |
$542.10
|
| Rate for Payer: Aetna Commercial |
$708.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.10
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$717.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.20
|
| Rate for Payer: Healthscope Commercial |
$750.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$708.90
|
| Rate for Payer: PHP Commercial |
$708.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.80
|
| Rate for Payer: Priority Health SBD |
$525.42
|
| Rate for Payer: UMR Bronson Commercial |
$366.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.50
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$308.58 |
| Max. Negotiated Rate |
$9,057.42 |
| Rate for Payer: Aetna American Axle |
$542.10
|
| Rate for Payer: Aetna Commercial |
$708.90
|
| Rate for Payer: Aetna Medicare |
$2,992.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.10
|
| 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 |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cofinity Commercial |
$717.24
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$667.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,877.15
|
| Rate for Payer: Healthscope Commercial |
$750.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$583.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$625.50
|
| 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 |
$708.90
|
| Rate for Payer: PACE Medicare |
$2,733.29
|
| Rate for Payer: PACE SWMI |
$2,877.15
|
| Rate for Payer: PHP Commercial |
$708.90
|
| 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 |
$583.80
|
| 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 |
$525.42
|
| Rate for Payer: Railroad Medicare Medicare |
$2,877.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$395.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,877.15
|
| Rate for Payer: UHC Exchange |
$359.53
|
| Rate for Payer: UHC Medicare Advantage |
$2,963.46
|
| Rate for Payer: UMR Bronson Commercial |
$308.58
|
| Rate for Payer: VA VA |
$2,877.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$625.50
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$475.12
|
| Rate for Payer: BCBS Complete |
$333.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.47
|
| Rate for Payer: Priority Health Narrow Network |
$550.47
|
| Rate for Payer: Priority Health SBD |
$550.47
|
| Rate for Payer: UMR Bronson Commercial |
$383.64
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$834.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$333.60 |
| Max. Negotiated Rate |
$1,777.73 |
| Rate for Payer: Aetna Commercial |
$475.12
|
| Rate for Payer: BCBS Complete |
$333.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Cash Price |
$667.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.47
|
| Rate for Payer: Priority Health Narrow Network |
$550.47
|
| Rate for Payer: Priority Health SBD |
$550.47
|
| Rate for Payer: UMR Bronson Commercial |
$383.64
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$7,055.00
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$377.57 |
| Max. Negotiated Rate |
$4,938.50 |
| Rate for Payer: Aetna Commercial |
$2,954.27
|
| Rate for Payer: BCBS Complete |
$1,476.31
|
| Rate for Payer: BCBS Trust/PPO |
$377.57
|
| Rate for Payer: Cash Price |
$5,644.00
|
| Rate for Payer: Cash Price |
$5,644.00
|
| Rate for Payer: Meridian Medicaid |
$1,476.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,406.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,938.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,370.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,370.30
|
| Rate for Payer: Priority Health SBD |
$3,370.30
|
| Rate for Payer: UMR Bronson Commercial |
$3,245.30
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$1,192.00
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$1,139.77 |
| Rate for Payer: Aetna Commercial |
$969.02
|
| Rate for Payer: BCBS Complete |
$500.08
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Meridian Medicaid |
$500.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$834.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,139.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.77
|
| Rate for Payer: Priority Health SBD |
$1,139.77
|
| Rate for Payer: UMR Bronson Commercial |
$548.32
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,496.00
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$467.96 |
| Max. Negotiated Rate |
$2,447.20 |
| Rate for Payer: Aetna Commercial |
$954.95
|
| Rate for Payer: BCBS Complete |
$491.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.54
|
| Rate for Payer: Cash Price |
$2,796.80
|
| Rate for Payer: Cash Price |
$2,796.80
|
| Rate for Payer: Meridian Medicaid |
$491.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,447.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,121.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,121.90
|
| Rate for Payer: Priority Health SBD |
$1,121.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,608.16
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$1,633.10 |
| Rate for Payer: Aetna Commercial |
$1,106.28
|
| Rate for Payer: BCBS Complete |
$567.85
|
| Rate for Payer: BCBS Trust/PPO |
$544.15
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Meridian Medicaid |
$567.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,293.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,293.47
|
| Rate for Payer: Priority Health SBD |
$1,293.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,073.18
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$485.21 |
| Max. Negotiated Rate |
$1,153.56 |
| Rate for Payer: Aetna Commercial |
$999.14
|
| Rate for Payer: BCBS Complete |
$509.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.81
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Meridian Medicaid |
$509.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,042.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.56
|
| Rate for Payer: Priority Health SBD |
$1,153.56
|
| Rate for Payer: UMR Bronson Commercial |
$684.94
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
IP
|
$2,268.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$997.92 |
| Max. Negotiated Rate |
$2,041.20 |
| Rate for Payer: Aetna American Axle |
$1,474.20
|
| Rate for Payer: Aetna Commercial |
$1,927.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.20
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cofinity Commercial |
$1,950.48
|
| Rate for Payer: Cofinity Commercial |
$1,587.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.40
|
| Rate for Payer: Healthscope Commercial |
$2,041.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,587.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,701.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,927.80
|
| Rate for Payer: PHP Commercial |
$1,927.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health SBD |
$1,428.84
|
| Rate for Payer: UMR Bronson Commercial |
$997.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,701.00
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,268.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Aetna Commercial |
$992.84
|
| Rate for Payer: BCBS Complete |
$504.56
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Meridian Medicaid |
$504.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: Priority Health SBD |
$1,142.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.28
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
OP
|
$2,268.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$738.71 |
| Max. Negotiated Rate |
$20,018.71 |
| Rate for Payer: Aetna American Axle |
$1,474.20
|
| Rate for Payer: Aetna Commercial |
$1,927.80
|
| Rate for Payer: Aetna Medicare |
$6,613.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.75
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cofinity Commercial |
$1,950.48
|
| Rate for Payer: Cofinity Commercial |
$1,587.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,814.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$2,041.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,587.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,701.00
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,927.80
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$1,927.80
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,018.71
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$16,014.97
|
| Rate for Payer: Priority Health SBD |
$1,428.84
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,359.09
|
| Rate for Payer: UHC Exchange |
$738.71
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: UMR Bronson Commercial |
$839.16
|
| Rate for Payer: VA VA |
$6,359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,701.00
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,268.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Aetna Commercial |
$992.84
|
| Rate for Payer: BCBS Complete |
$504.56
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Cash Price |
$1,814.40
|
| Rate for Payer: Meridian Medicaid |
$504.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$480.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,587.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: Priority Health SBD |
$1,142.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,043.28
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,289.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$486.07 |
| Max. Negotiated Rate |
$1,602.30 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: BCBS Complete |
$510.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Meridian Medicaid |
$510.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$486.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,602.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.96
|
| Rate for Payer: Priority Health SBD |
$1,148.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,052.94
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$2,961.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$200.75 |
| Max. Negotiated Rate |
$2,072.70 |
| Rate for Payer: Aetna Commercial |
$1,457.34
|
| Rate for Payer: BCBS Complete |
$749.01
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Meridian Medicaid |
$749.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,072.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,674.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,674.93
|
| Rate for Payer: Priority Health SBD |
$1,674.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,362.06
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,270.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$2,289.00 |
| Rate for Payer: Aetna Commercial |
$1,470.76
|
| Rate for Payer: BCBS Complete |
$749.01
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: Cash Price |
$2,616.00
|
| Rate for Payer: Cash Price |
$2,616.00
|
| Rate for Payer: Meridian Medicaid |
$749.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$713.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,289.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,694.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,694.85
|
| Rate for Payer: Priority Health SBD |
$1,694.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,504.20
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,334.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$4,433.80 |
| Rate for Payer: Aetna Commercial |
$1,893.04
|
| Rate for Payer: BCBS Complete |
$948.73
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Meridian Medicaid |
$948.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$903.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,433.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,169.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,169.76
|
| Rate for Payer: Priority Health SBD |
$2,169.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,913.64
|
|
