|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$1,989.05 |
| Rate for Payer: Aetna Commercial |
$205.66
|
| Rate for Payer: BCBS Complete |
$118.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,989.05
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Meridian Medicaid |
$118.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.50
|
| Rate for Payer: Priority Health Narrow Network |
$249.50
|
| Rate for Payer: Priority Health SBD |
$249.50
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$268.22 |
| Rate for Payer: Aetna Commercial |
$102.24
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$268.22
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.45
|
| Rate for Payer: Priority Health Narrow Network |
$113.45
|
| Rate for Payer: Priority Health SBD |
$113.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$268.22 |
| Rate for Payer: Aetna Commercial |
$102.24
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$268.22
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.45
|
| Rate for Payer: Priority Health Narrow Network |
$113.45
|
| Rate for Payer: Priority Health SBD |
$113.45
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$103.84 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Aetna American Axle |
$153.40
|
| Rate for Payer: Aetna Commercial |
$200.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.40
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$165.20
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
| Rate for Payer: Healthscope Commercial |
$212.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
| Rate for Payer: PHP Commercial |
$200.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health SBD |
$148.68
|
| Rate for Payer: UMR Bronson Commercial |
$103.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$87.32 |
| Max. Negotiated Rate |
$1,968.76 |
| Rate for Payer: Aetna American Axle |
$153.40
|
| Rate for Payer: Aetna Commercial |
$200.60
|
| Rate for Payer: Aetna Medicare |
$650.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$781.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$781.74
|
| Rate for Payer: BCBS Complete |
$359.22
|
| Rate for Payer: BCBS MAPPO |
$625.39
|
| Rate for Payer: BCBS Trust/PPO |
$694.01
|
| Rate for Payer: BCN Medicare Advantage |
$625.39
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$165.20
|
| Rate for Payer: Cofinity Commercial |
$202.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.39
|
| Rate for Payer: Healthscope Commercial |
$212.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.00
|
| Rate for Payer: Mclaren Medicaid |
$342.09
|
| Rate for Payer: Mclaren Medicare |
$625.39
|
| Rate for Payer: Meridian Medicaid |
$359.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$656.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.60
|
| Rate for Payer: PACE Medicare |
$594.12
|
| Rate for Payer: PACE SWMI |
$625.39
|
| Rate for Payer: PHP Commercial |
$200.60
|
| Rate for Payer: PHP Medicare Advantage |
$625.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,968.76
|
| Rate for Payer: Priority Health Medicare |
$625.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.01
|
| Rate for Payer: Priority Health SBD |
$148.68
|
| Rate for Payer: Railroad Medicare Medicare |
$625.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$625.39
|
| Rate for Payer: UHC Exchange |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$644.15
|
| Rate for Payer: UMR Bronson Commercial |
$87.32
|
| Rate for Payer: VA VA |
$625.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.00
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$1,338.18 |
| Rate for Payer: Aetna Commercial |
$287.03
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,338.18
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Meridian Medicaid |
$142.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.85
|
| Rate for Payer: Priority Health Narrow Network |
$338.85
|
| Rate for Payer: Priority Health SBD |
$338.85
|
| Rate for Payer: UMR Bronson Commercial |
$197.34
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$270.72 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$557.80
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.37
|
| Rate for Payer: Priority Health Narrow Network |
$641.37
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: UMR Bronson Commercial |
$489.44
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,064.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$270.72 |
| Max. Negotiated Rate |
$8,162.77 |
| Rate for Payer: Aetna Commercial |
$557.80
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Trust/PPO |
$8,162.77
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.37
|
| Rate for Payer: Priority Health Narrow Network |
$641.37
|
| Rate for Payer: Priority Health SBD |
$641.37
|
| Rate for Payer: UMR Bronson Commercial |
$489.44
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$1,064.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$393.68 |
| Max. Negotiated Rate |
$7,951.14 |
| Rate for Payer: Aetna American Axle |
$691.60
|
| Rate for Payer: Aetna Commercial |
$904.40
|
| Rate for Payer: Aetna Medicare |
$2,626.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,157.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,157.18
|
| Rate for Payer: BCBS Complete |
$1,450.79
|
| Rate for Payer: BCBS MAPPO |
$2,525.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,462.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.74
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$744.80
|
| Rate for Payer: Cofinity Commercial |
$915.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.74
|
| Rate for Payer: Healthscope Commercial |
$957.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$744.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.00
|
| 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 |
$904.40
|
| Rate for Payer: PACE Medicare |
$2,399.45
|
| Rate for Payer: PACE SWMI |
$2,525.74
|
| Rate for Payer: PHP Commercial |
$904.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,951.14
|
| Rate for Payer: Priority Health Medicare |
$2,525.74
|
| Rate for Payer: Priority Health Narrow Network |
$6,360.91
|
| Rate for Payer: Priority Health SBD |
$670.32
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,525.74
|
| Rate for Payer: UHC Exchange |
$416.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,601.51
|
| Rate for Payer: UMR Bronson Commercial |
$393.68
|
| Rate for Payer: VA VA |
$2,525.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.00
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$1,064.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$468.16 |
| Max. Negotiated Rate |
$957.60 |
| Rate for Payer: Aetna American Axle |
$691.60
|
| Rate for Payer: Aetna Commercial |
$904.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.60
|
| Rate for Payer: Cash Price |
$851.20
|
| Rate for Payer: Cofinity Commercial |
$744.80
|
| Rate for Payer: Cofinity Commercial |
$915.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.20
|
| Rate for Payer: Healthscope Commercial |
$957.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$744.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$904.40
|
| Rate for Payer: PHP Commercial |
$904.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.80
|
| Rate for Payer: Priority Health SBD |
$670.32
|
| Rate for Payer: UMR Bronson Commercial |
$468.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.00
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$417.45
|
| Rate for Payer: BCBS Complete |
$213.36
|
| Rate for Payer: BCBS Trust/PPO |
$244.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Meridian Medicaid |
$213.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$571.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.64
|
| Rate for Payer: Priority Health Narrow Network |
$501.64
|
| Rate for Payer: Priority Health SBD |
$501.64
|
| Rate for Payer: UMR Bronson Commercial |
$375.82
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,024.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$716.80 |
| Rate for Payer: Aetna Commercial |
$463.71
|
| Rate for Payer: BCBS Complete |
$240.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Cash Price |
$819.20
|
| Rate for Payer: Meridian Medicaid |
$240.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$542.82
|
| Rate for Payer: Priority Health Narrow Network |
$542.82
|
| Rate for Payer: Priority Health SBD |
$542.82
|
| Rate for Payer: UMR Bronson Commercial |
$471.04
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.11
|
| Rate for Payer: Priority Health Narrow Network |
$221.11
|
| Rate for Payer: Priority Health SBD |
$221.11
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$143.42 |
| Max. Negotiated Rate |
$4,536.73 |
| Rate for Payer: Aetna American Axle |
$585.65
|
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: Aetna Medicare |
$1,498.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.65
|
| 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 |
$1,541.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,441.13
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Cofinity Commercial |
$630.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,441.13
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| 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 |
$765.85
|
| Rate for Payer: PACE Medicare |
$1,369.07
|
| Rate for Payer: PACE SWMI |
$1,441.13
|
| Rate for Payer: PHP Commercial |
$765.85
|
| 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 |
$630.70
|
| 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 |
$567.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,441.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,441.13
|
| Rate for Payer: UHC Exchange |
$143.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,484.36
|
| Rate for Payer: UMR Bronson Commercial |
$333.37
|
| Rate for Payer: VA VA |
$1,441.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$22,818.32 |
| Rate for Payer: Aetna Commercial |
$190.75
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCBS Trust/PPO |
$22,818.32
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$221.11
|
| Rate for Payer: Priority Health Narrow Network |
$221.11
|
| Rate for Payer: Priority Health SBD |
$221.11
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$396.44 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna American Axle |
$585.65
|
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.65
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$630.70
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$765.85
|
| Rate for Payer: PHP Commercial |
$765.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.70
|
| Rate for Payer: Priority Health SBD |
$567.63
|
| Rate for Payer: UMR Bronson Commercial |
$396.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR REMOVAL INDWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,662.00
|
|
|
Service Code
|
HCPCS 50384
|
| Min. Negotiated Rate |
$140.79 |
| Max. Negotiated Rate |
$3,794.78 |
| Rate for Payer: Aetna Commercial |
$294.10
|
| Rate for Payer: BCBS Complete |
$147.83
|
| Rate for Payer: BCBS Trust/PPO |
$3,794.78
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Meridian Medicaid |
$147.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,163.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.80
|
| Rate for Payer: Priority Health Narrow Network |
$358.80
|
| Rate for Payer: Priority Health SBD |
$358.80
|
| Rate for Payer: UMR Bronson Commercial |
$764.52
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna Commercial |
$597.87
|
| Rate for Payer: BCBS Complete |
$373.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Meridian Medicaid |
$373.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$683.15
|
| Rate for Payer: Priority Health Narrow Network |
$683.15
|
| Rate for Payer: Priority Health SBD |
$683.15
|
| Rate for Payer: UMR Bronson Commercial |
$690.00
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$267.85 |
| Rate for Payer: Aetna Commercial |
$45.62
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$267.85
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.67
|
| Rate for Payer: Priority Health Narrow Network |
$52.67
|
| Rate for Payer: Priority Health SBD |
$52.67
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
PR REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 58301
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$510.34 |
| Rate for Payer: Aetna Commercial |
$80.07
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$510.34
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$44.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.27
|
| Rate for Payer: Priority Health Narrow Network |
$93.27
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA
|
Professional
|
Both
|
$5,982.00
|
|
|
Service Code
|
HCPCS 32442
|
| Min. Negotiated Rate |
$640.30 |
| Max. Negotiated Rate |
$4,187.40 |
| Rate for Payer: Aetna Commercial |
$3,956.55
|
| Rate for Payer: BCBS Complete |
$2,009.05
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: Cash Price |
$4,785.60
|
| Rate for Payer: Cash Price |
$4,785.60
|
| Rate for Payer: Meridian Medicaid |
$2,009.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,187.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,146.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,146.10
|
| Rate for Payer: Priority Health SBD |
$4,146.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,751.72
|
|
|
PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 11982
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$438.68 |
| Rate for Payer: Aetna Commercial |
$82.16
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS Trust/PPO |
$438.68
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.43
|
| Rate for Payer: Priority Health Narrow Network |
$90.43
|
| Rate for Payer: Priority Health SBD |
$90.43
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
PR REMOVAL OF LUNG PNEUMONECTOMY
|
Professional
|
Both
|
$5,395.00
|
|
|
Service Code
|
HCPCS 32440
|
| Min. Negotiated Rate |
$544.68 |
| Max. Negotiated Rate |
$3,776.50 |
| Rate for Payer: Aetna Commercial |
$2,027.10
|
| Rate for Payer: BCBS Complete |
$1,037.74
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: Cash Price |
$4,316.00
|
| Rate for Payer: Cash Price |
$4,316.00
|
| Rate for Payer: Meridian Medicaid |
$1,037.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,776.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,136.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,136.50
|
| Rate for Payer: Priority Health SBD |
$2,136.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,481.70
|
|
|
PR REMOVAL OF SUTURES
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS S0630
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$66.04 |
| Rate for Payer: Aetna Commercial |
$27.32
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$66.04
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 49402
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$2,108.97 |
| Rate for Payer: Aetna Commercial |
$1,153.44
|
| Rate for Payer: BCBS Complete |
$574.33
|
| Rate for Payer: BCBS Trust/PPO |
$2,108.97
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Meridian Medicaid |
$574.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$546.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,549.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,500.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,500.50
|
| Rate for Payer: Priority Health SBD |
$1,500.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.98
|
|
