|
PR EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26205
|
| Min. Negotiated Rate |
$586.51 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$785.92
|
| Rate for Payer: Aetna Medicare |
$586.51
|
| Rate for Payer: BCBS Complete |
$944.40
|
| Rate for Payer: BCBS MAPPO |
$586.51
|
| Rate for Payer: BCN Medicare Advantage |
$586.51
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$844.57
|
| Rate for Payer: Cofinity Commercial |
$785.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.51
|
| Rate for Payer: Healthscope Commercial |
$703.81
|
| Rate for Payer: Healthscope Whirlpool |
$703.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.84
|
| Rate for Payer: Nomi Health Commercial |
$703.81
|
| Rate for Payer: PACE SWMI |
$586.51
|
| Rate for Payer: PHP Medicare Advantage |
$586.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health Medicare |
$586.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.51
|
| Rate for Payer: UHC Medicare Advantage |
$586.51
|
| Rate for Payer: UHCCP DNSP |
$586.51
|
|
|
PR EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT
|
Professional
|
Both
|
$1,782.00
|
|
|
Service Code
|
HCPCS 26215
|
| Min. Negotiated Rate |
$548.78 |
| Max. Negotiated Rate |
$1,158.30 |
| Rate for Payer: Aetna Commercial |
$735.37
|
| Rate for Payer: Aetna Medicare |
$548.78
|
| Rate for Payer: BCBS Complete |
$712.80
|
| Rate for Payer: BCBS MAPPO |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$548.78
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cash Price |
$1,425.60
|
| Rate for Payer: Cofinity Commercial |
$790.24
|
| Rate for Payer: Cofinity Commercial |
$735.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.78
|
| Rate for Payer: Healthscope Commercial |
$658.54
|
| Rate for Payer: Healthscope Whirlpool |
$658.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.22
|
| Rate for Payer: Nomi Health Commercial |
$658.54
|
| Rate for Payer: PACE SWMI |
$548.78
|
| Rate for Payer: PHP Medicare Advantage |
$548.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,158.30
|
| Rate for Payer: Priority Health Medicare |
$548.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.78
|
| Rate for Payer: UHC Medicare Advantage |
$548.78
|
| Rate for Payer: UHCCP DNSP |
$548.78
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 27637
|
| Min. Negotiated Rate |
$722.87 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$968.65
|
| Rate for Payer: Aetna Medicare |
$722.87
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$722.87
|
| Rate for Payer: BCN Medicare Advantage |
$722.87
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$968.65
|
| Rate for Payer: Cofinity Commercial |
$1,040.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.87
|
| Rate for Payer: Healthscope Commercial |
$867.44
|
| Rate for Payer: Healthscope Whirlpool |
$867.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$759.01
|
| Rate for Payer: Nomi Health Commercial |
$867.44
|
| Rate for Payer: PACE SWMI |
$722.87
|
| Rate for Payer: PHP Medicare Advantage |
$722.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$722.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.87
|
| Rate for Payer: UHC Medicare Advantage |
$722.87
|
| Rate for Payer: UHCCP DNSP |
$722.87
|
|
|
PR EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 27638
|
| Min. Negotiated Rate |
$718.72 |
| Max. Negotiated Rate |
$1,438.45 |
| Rate for Payer: Aetna Commercial |
$963.08
|
| Rate for Payer: Aetna Medicare |
$718.72
|
| Rate for Payer: BCBS Complete |
$885.20
|
| Rate for Payer: BCBS MAPPO |
$718.72
|
| Rate for Payer: BCN Medicare Advantage |
$718.72
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$963.08
|
| Rate for Payer: Cofinity Commercial |
$1,034.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$718.72
|
| Rate for Payer: Healthscope Commercial |
$862.46
|
| Rate for Payer: Healthscope Whirlpool |
$862.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.66
|
| Rate for Payer: Nomi Health Commercial |
$862.46
|
| Rate for Payer: PACE SWMI |
$718.72
|
| Rate for Payer: PHP Medicare Advantage |
$718.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health Medicare |
$718.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$718.72
|
| Rate for Payer: UHC Medicare Advantage |
$718.72
|
| Rate for Payer: UHCCP DNSP |
$718.72
|
|
|
PR EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 28104
|
| Min. Negotiated Rate |
$341.68 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$457.85
|
| Rate for Payer: Aetna Medicare |
$341.68
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$341.68
|
| Rate for Payer: BCN Medicare Advantage |
$341.68
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$492.02
|
| Rate for Payer: Cofinity Commercial |
$457.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.68
|
| Rate for Payer: Healthscope Commercial |
$410.02
|
| Rate for Payer: Healthscope Whirlpool |
$410.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.76
|
| Rate for Payer: Nomi Health Commercial |
$410.02
|
| Rate for Payer: PACE SWMI |
$341.68
|
| Rate for Payer: PHP Medicare Advantage |
$341.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$341.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.68
|
| Rate for Payer: UHC Medicare Advantage |
$341.68
|
| Rate for Payer: UHCCP DNSP |
$341.68
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 24116
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$1,196.12 |
| Rate for Payer: Aetna Commercial |
$1,113.06
|
| Rate for Payer: Aetna Medicare |
$830.64
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$830.64
|
| Rate for Payer: BCN Medicare Advantage |
$830.64
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$1,196.12
|
| Rate for Payer: Cofinity Commercial |
$1,113.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.64
|
| Rate for Payer: Healthscope Commercial |
$996.77
|
| Rate for Payer: Healthscope Whirlpool |
$996.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.17
|
| Rate for Payer: Nomi Health Commercial |
$996.77
|
| Rate for Payer: PACE SWMI |
$830.64
|
| Rate for Payer: PHP Medicare Advantage |
$830.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$830.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.64
|
| Rate for Payer: UHC Medicare Advantage |
$830.64
|
| Rate for Payer: UHCCP DNSP |
$830.64
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 23140
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$775.20 |
| Rate for Payer: Aetna Commercial |
$721.36
|
| Rate for Payer: Aetna Medicare |
$538.33
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$538.33
|
| Rate for Payer: BCN Medicare Advantage |
$538.33
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$721.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.33
|
| Rate for Payer: Healthscope Commercial |
$646.00
|
| Rate for Payer: Healthscope Whirlpool |
$646.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.25
|
| Rate for Payer: Nomi Health Commercial |
$646.00
|
| Rate for Payer: PACE SWMI |
$538.33
|
| Rate for Payer: PHP Medicare Advantage |
$538.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$538.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$538.33
|
| Rate for Payer: UHC Medicare Advantage |
$538.33
|
| Rate for Payer: UHCCP DNSP |
$538.33
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$814.45 |
| Max. Negotiated Rate |
$1,253.00 |
| Rate for Payer: Aetna Commercial |
$1,127.70
|
| Rate for Payer: ASR ASR |
$1,215.41
|
| Rate for Payer: ASR Commercial |
$1,215.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,021.07
|
| Rate for Payer: BCN Commercial |
$971.45
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$1,177.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.40
|
| Rate for Payer: Healthscope Commercial |
$1,253.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.41
|
| Rate for Payer: Mclaren Commercial |
$1,127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.05
|
| Rate for Payer: Nomi Health Commercial |
$1,027.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.64
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 24120
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$693.57
|
| Rate for Payer: Aetna Medicare |
$517.59
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$517.59
|
| Rate for Payer: BCN Medicare Advantage |
$517.59
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$745.33
|
| Rate for Payer: Cofinity Commercial |
$693.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.59
|
| Rate for Payer: Healthscope Commercial |
$621.11
|
| Rate for Payer: Healthscope Whirlpool |
$621.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.47
|
| Rate for Payer: Nomi Health Commercial |
$621.11
|
| Rate for Payer: PACE SWMI |
$517.59
|
| Rate for Payer: PHP Medicare Advantage |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health Medicare |
$517.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.59
|
| Rate for Payer: UHC Medicare Advantage |
$517.59
|
| Rate for Payer: UHCCP DNSP |
$517.59
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$693.57
|
| Rate for Payer: Aetna Medicare |
$517.59
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$517.59
|
| Rate for Payer: BCN Medicare Advantage |
$517.59
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$745.33
|
| Rate for Payer: Cofinity Commercial |
$693.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.59
|
| Rate for Payer: Healthscope Commercial |
$621.11
|
| Rate for Payer: Healthscope Whirlpool |
$621.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.47
|
| Rate for Payer: Nomi Health Commercial |
$621.11
|
| Rate for Payer: PACE SWMI |
$517.59
|
| Rate for Payer: PHP Medicare Advantage |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health Medicare |
$517.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.59
|
| Rate for Payer: UHC Medicare Advantage |
$517.59
|
| Rate for Payer: UHCCP DNSP |
$517.59
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$814.45 |
| Max. Negotiated Rate |
$4,904.82 |
| Rate for Payer: Aetna Commercial |
$1,127.70
|
| Rate for Payer: Aetna Medicare |
$3,164.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: ASR ASR |
$1,215.41
|
| Rate for Payer: ASR Commercial |
$1,215.41
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,026.08
|
| Rate for Payer: BCN Commercial |
$971.45
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$1,177.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,253.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,215.41
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,164.40
|
| Rate for Payer: Mclaren Commercial |
$1,127.70
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.05
|
| Rate for Payer: Nomi Health Commercial |
$1,027.46
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$3,480.84
|
| Rate for Payer: PHP Medicaid |
$1,696.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.88
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health Narrow Network |
$878.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$4,904.82
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP DNSP |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 23155
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,111.00 |
| Rate for Payer: Aetna Commercial |
$1,033.85
|
| Rate for Payer: Aetna Medicare |
$771.53
|
| Rate for Payer: BCBS Complete |
$564.40
|
| Rate for Payer: BCBS MAPPO |
$771.53
|
| Rate for Payer: BCN Medicare Advantage |
$771.53
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$1,111.00
|
| Rate for Payer: Cofinity Commercial |
$1,033.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.53
|
| Rate for Payer: Healthscope Commercial |
$925.84
|
| Rate for Payer: Healthscope Whirlpool |
$925.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.11
|
| Rate for Payer: Nomi Health Commercial |
$925.84
|
| Rate for Payer: PACE SWMI |
$771.53
|
| Rate for Payer: PHP Medicare Advantage |
$771.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health Medicare |
$771.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.53
|
| Rate for Payer: UHC Medicare Advantage |
$771.53
|
| Rate for Payer: UHCCP DNSP |
$771.53
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$948.41 |
| Rate for Payer: Aetna Commercial |
$882.55
|
| Rate for Payer: Aetna Medicare |
$658.62
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$658.62
|
| Rate for Payer: BCN Medicare Advantage |
$658.62
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$948.41
|
| Rate for Payer: Cofinity Commercial |
$882.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.62
|
| Rate for Payer: Healthscope Commercial |
$790.34
|
| Rate for Payer: Healthscope Whirlpool |
$790.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.55
|
| Rate for Payer: Nomi Health Commercial |
$790.34
|
| Rate for Payer: PACE SWMI |
$658.62
|
| Rate for Payer: PHP Medicare Advantage |
$658.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$658.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.62
|
| Rate for Payer: UHC Medicare Advantage |
$658.62
|
| Rate for Payer: UHCCP DNSP |
$658.62
|
|
|
PR EXC/CURTG CST/B9 TUM PHALANGES FOOT
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 28108
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$398.25 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Aetna Medicare |
$276.56
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$276.56
|
| Rate for Payer: BCN Medicare Advantage |
$276.56
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$398.25
|
| Rate for Payer: Cofinity Commercial |
$370.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.56
|
| Rate for Payer: Healthscope Commercial |
$331.87
|
| Rate for Payer: Healthscope Whirlpool |
$331.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.39
|
| Rate for Payer: Nomi Health Commercial |
$331.87
|
| Rate for Payer: PACE SWMI |
$276.56
|
| Rate for Payer: PHP Medicare Advantage |
$276.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$276.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.56
|
| Rate for Payer: UHC Medicare Advantage |
$276.56
|
| Rate for Payer: UHCCP DNSP |
$276.56
|
|
|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 28106
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$624.65 |
| Rate for Payer: Aetna Commercial |
$546.80
|
| Rate for Payer: Aetna Medicare |
$408.06
|
| Rate for Payer: BCBS Complete |
$384.40
|
| Rate for Payer: BCBS MAPPO |
$408.06
|
| Rate for Payer: BCN Medicare Advantage |
$408.06
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cofinity Commercial |
$587.61
|
| Rate for Payer: Cofinity Commercial |
$546.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.06
|
| Rate for Payer: Healthscope Commercial |
$489.67
|
| Rate for Payer: Healthscope Whirlpool |
$489.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.46
|
| Rate for Payer: Nomi Health Commercial |
$489.67
|
| Rate for Payer: PACE SWMI |
$408.06
|
| Rate for Payer: PHP Medicare Advantage |
$408.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.65
|
| Rate for Payer: Priority Health Medicare |
$408.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.06
|
| Rate for Payer: UHC Medicare Advantage |
$408.06
|
| Rate for Payer: UHCCP DNSP |
$408.06
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 25136
|
| Min. Negotiated Rate |
$401.20 |
| Max. Negotiated Rate |
$695.58 |
| Rate for Payer: Aetna Commercial |
$647.27
|
| Rate for Payer: Aetna Medicare |
$483.04
|
| Rate for Payer: BCBS Complete |
$401.20
|
| Rate for Payer: BCBS MAPPO |
$483.04
|
| Rate for Payer: BCN Medicare Advantage |
$483.04
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cofinity Commercial |
$695.58
|
| Rate for Payer: Cofinity Commercial |
$647.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.04
|
| Rate for Payer: Healthscope Commercial |
$579.65
|
| Rate for Payer: Healthscope Whirlpool |
$579.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.19
|
| Rate for Payer: Nomi Health Commercial |
$579.65
|
| Rate for Payer: PACE SWMI |
$483.04
|
| Rate for Payer: PHP Medicare Advantage |
$483.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.95
|
| Rate for Payer: Priority Health Medicare |
$483.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.04
|
| Rate for Payer: UHC Medicare Advantage |
$483.04
|
| Rate for Payer: UHCCP DNSP |
$483.04
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$784.66 |
| Rate for Payer: Aetna Commercial |
$730.17
|
| Rate for Payer: Aetna Medicare |
$544.90
|
| Rate for Payer: BCBS Complete |
$404.40
|
| Rate for Payer: BCBS MAPPO |
$544.90
|
| Rate for Payer: BCN Medicare Advantage |
$544.90
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cofinity Commercial |
$784.66
|
| Rate for Payer: Cofinity Commercial |
$730.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.90
|
| Rate for Payer: Healthscope Commercial |
$653.88
|
| Rate for Payer: Healthscope Whirlpool |
$653.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$572.14
|
| Rate for Payer: Nomi Health Commercial |
$653.88
|
| Rate for Payer: PACE SWMI |
$544.90
|
| Rate for Payer: PHP Medicare Advantage |
$544.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.15
|
| Rate for Payer: Priority Health Medicare |
$544.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.90
|
| Rate for Payer: UHC Medicare Advantage |
$544.90
|
| Rate for Payer: UHCCP DNSP |
$544.90
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 25126
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$837.23 |
| Rate for Payer: Aetna Commercial |
$779.09
|
| Rate for Payer: Aetna Medicare |
$581.41
|
| Rate for Payer: BCBS Complete |
$486.40
|
| Rate for Payer: BCBS MAPPO |
$581.41
|
| Rate for Payer: BCN Medicare Advantage |
$581.41
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cofinity Commercial |
$837.23
|
| Rate for Payer: Cofinity Commercial |
$779.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.41
|
| Rate for Payer: Healthscope Commercial |
$697.69
|
| Rate for Payer: Healthscope Whirlpool |
$697.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.48
|
| Rate for Payer: Nomi Health Commercial |
$697.69
|
| Rate for Payer: PACE SWMI |
$581.41
|
| Rate for Payer: PHP Medicare Advantage |
$581.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health Medicare |
$581.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.41
|
| Rate for Payer: UHC Medicare Advantage |
$581.41
|
| Rate for Payer: UHCCP DNSP |
$581.41
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 25125
|
| Min. Negotiated Rate |
$577.59 |
| Max. Negotiated Rate |
$1,507.35 |
| Rate for Payer: Aetna Commercial |
$773.97
|
| Rate for Payer: Aetna Medicare |
$577.59
|
| Rate for Payer: BCBS Complete |
$927.60
|
| Rate for Payer: BCBS MAPPO |
$577.59
|
| Rate for Payer: BCN Medicare Advantage |
$577.59
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cofinity Commercial |
$831.73
|
| Rate for Payer: Cofinity Commercial |
$773.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.59
|
| Rate for Payer: Healthscope Commercial |
$693.11
|
| Rate for Payer: Healthscope Whirlpool |
$693.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.47
|
| Rate for Payer: Nomi Health Commercial |
$693.11
|
| Rate for Payer: PACE SWMI |
$577.59
|
| Rate for Payer: PHP Medicare Advantage |
$577.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,507.35
|
| Rate for Payer: Priority Health Medicare |
$577.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.59
|
| Rate for Payer: UHC Medicare Advantage |
$577.59
|
| Rate for Payer: UHCCP DNSP |
$577.59
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$683.80 |
| Max. Negotiated Rate |
$5,788.66 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: Aetna Medicare |
$3,734.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: ASR ASR |
$1,020.44
|
| Rate for Payer: ASR Commercial |
$1,020.44
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCBS Trust/PPO |
$861.48
|
| Rate for Payer: BCN Commercial |
$815.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$988.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.44
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,734.62
|
| Rate for Payer: Mclaren Commercial |
$946.80
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.20
|
| Rate for Payer: Nomi Health Commercial |
$862.64
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$4,108.08
|
| Rate for Payer: PHP Medicaid |
$2,001.76
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$921.76
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health Narrow Network |
$737.45
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$5,788.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP DNSP |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$405.42 |
| Max. Negotiated Rate |
$683.80 |
| Rate for Payer: Aetna Commercial |
$543.26
|
| Rate for Payer: Aetna Medicare |
$405.42
|
| Rate for Payer: BCBS Complete |
$420.80
|
| Rate for Payer: BCBS MAPPO |
$405.42
|
| Rate for Payer: BCN Medicare Advantage |
$405.42
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$543.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.42
|
| Rate for Payer: Healthscope Commercial |
$486.50
|
| Rate for Payer: Healthscope Whirlpool |
$486.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.69
|
| Rate for Payer: Nomi Health Commercial |
$486.50
|
| Rate for Payer: PACE SWMI |
$405.42
|
| Rate for Payer: PHP Medicare Advantage |
$405.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health Medicare |
$405.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.42
|
| Rate for Payer: UHC Medicare Advantage |
$405.42
|
| Rate for Payer: UHCCP DNSP |
$405.42
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$405.42 |
| Max. Negotiated Rate |
$683.80 |
| Rate for Payer: Aetna Commercial |
$543.26
|
| Rate for Payer: Aetna Medicare |
$405.42
|
| Rate for Payer: BCBS Complete |
$420.80
|
| Rate for Payer: BCBS MAPPO |
$405.42
|
| Rate for Payer: BCN Medicare Advantage |
$405.42
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$543.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.42
|
| Rate for Payer: Healthscope Commercial |
$486.50
|
| Rate for Payer: Healthscope Whirlpool |
$486.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.69
|
| Rate for Payer: Nomi Health Commercial |
$486.50
|
| Rate for Payer: PACE SWMI |
$405.42
|
| Rate for Payer: PHP Medicare Advantage |
$405.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health Medicare |
$405.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.42
|
| Rate for Payer: UHC Medicare Advantage |
$405.42
|
| Rate for Payer: UHCCP DNSP |
$405.42
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$683.80 |
| Max. Negotiated Rate |
$1,052.00 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: ASR ASR |
$1,020.44
|
| Rate for Payer: ASR Commercial |
$1,020.44
|
| Rate for Payer: BCBS Trust/PPO |
$857.27
|
| Rate for Payer: BCN Commercial |
$815.62
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$988.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Healthscope Commercial |
$1,052.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,020.44
|
| Rate for Payer: Mclaren Commercial |
$946.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.20
|
| Rate for Payer: Nomi Health Commercial |
$862.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$925.76
|
|
|
PR EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 60200
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$926.74 |
| Rate for Payer: Aetna Commercial |
$862.38
|
| Rate for Payer: Aetna Medicare |
$643.57
|
| Rate for Payer: BCBS Complete |
$564.40
|
| Rate for Payer: BCBS MAPPO |
$643.57
|
| Rate for Payer: BCN Medicare Advantage |
$643.57
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$926.74
|
| Rate for Payer: Cofinity Commercial |
$862.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.57
|
| Rate for Payer: Healthscope Commercial |
$772.28
|
| Rate for Payer: Healthscope Whirlpool |
$772.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.75
|
| Rate for Payer: Nomi Health Commercial |
$772.28
|
| Rate for Payer: PACE SWMI |
$643.57
|
| Rate for Payer: PHP Medicare Advantage |
$643.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health Medicare |
$643.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.57
|
| Rate for Payer: UHC Medicare Advantage |
$643.57
|
| Rate for Payer: UHCCP DNSP |
$643.57
|
|
|
PR EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
HCPCS 49204
|
| Min. Negotiated Rate |
$1,588.00 |
| Max. Negotiated Rate |
$2,580.50 |
| Rate for Payer: Aetna Medicare |
$1,985.00
|
| Rate for Payer: BCBS Complete |
$1,588.00
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,580.50
|
|
