|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$890.50 |
| Max. Negotiated Rate |
$1,370.00 |
| Rate for Payer: Aetna Commercial |
$1,233.00
|
| Rate for Payer: ASR ASR |
$1,328.90
|
| Rate for Payer: ASR Commercial |
$1,328.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.41
|
| Rate for Payer: BCN Commercial |
$1,062.16
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,287.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.00
|
| Rate for Payer: Healthscope Commercial |
$1,370.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,328.90
|
| Rate for Payer: Mclaren Commercial |
$1,233.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.50
|
| Rate for Payer: Nomi Health Commercial |
$1,123.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,205.60
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 45171
|
| Hospital Charge Code |
45171
|
| Min. Negotiated Rate |
$398.52 |
| Max. Negotiated Rate |
$2,751.91 |
| Rate for Payer: Aetna Commercial |
$825.89
|
| Rate for Payer: Aetna Medicare |
$685.00
|
| Rate for Payer: BCBS Complete |
$418.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,751.91
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Meridian Medicaid |
$418.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,109.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,109.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$735.63
|
| Rate for Payer: UHC Exchange |
$735.63
|
| Rate for Payer: UHCCP Medicaid |
$398.52
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,092.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$662.43 |
| Max. Negotiated Rate |
$1,843.47 |
| Rate for Payer: Aetna Commercial |
$1,385.01
|
| Rate for Payer: Aetna Medicare |
$1,046.00
|
| Rate for Payer: BCBS Complete |
$695.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: BCN Commercial |
$1,500.73
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Cash Price |
$1,673.60
|
| Rate for Payer: Meridian Medicaid |
$695.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,359.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,843.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,843.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,210.79
|
| Rate for Payer: UHC Exchange |
$1,210.79
|
| Rate for Payer: UHCCP Medicaid |
$662.43
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$573.40 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$982.56
|
| Rate for Payer: Aetna Medicare |
$774.50
|
| Rate for Payer: BCBS Complete |
$602.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$1,319.92
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Meridian Medicaid |
$602.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,219.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,219.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$939.05
|
| Rate for Payer: UHC Exchange |
$939.05
|
| Rate for Payer: UHCCP Medicaid |
$573.40
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,107.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$632.82 |
| Max. Negotiated Rate |
$1,527.61 |
| Rate for Payer: Aetna Commercial |
$1,133.75
|
| Rate for Payer: Aetna Medicare |
$1,053.50
|
| Rate for Payer: BCBS Complete |
$664.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,266.07
|
| Rate for Payer: BCN Commercial |
$1,527.61
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Cash Price |
$1,685.60
|
| Rate for Payer: Meridian Medicaid |
$664.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$632.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,369.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,406.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,406.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,095.30
|
| Rate for Payer: UHC Exchange |
$1,095.30
|
| Rate for Payer: UHCCP Medicaid |
$632.82
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$226.21 |
| Max. Negotiated Rate |
$801.43 |
| Rate for Payer: Aetna Commercial |
$459.09
|
| Rate for Payer: Aetna Medicare |
$364.00
|
| Rate for Payer: BCBS Complete |
$237.52
|
| Rate for Payer: BCBS Trust/PPO |
$229.28
|
| Rate for Payer: BCN Commercial |
$801.43
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Meridian Medicaid |
$237.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.83
|
| Rate for Payer: Priority Health Narrow Network |
$625.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.26
|
| Rate for Payer: UHC Exchange |
$397.26
|
| Rate for Payer: UHCCP Medicaid |
$226.21
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
IP
|
$1,802.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$1,171.30 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: ASR ASR |
$1,747.94
|
| Rate for Payer: ASR Commercial |
$1,747.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,468.45
|
| Rate for Payer: BCN Commercial |
$1,397.09
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Healthscope Commercial |
$1,802.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,747.94
|
| Rate for Payer: Mclaren Commercial |
$1,621.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.76
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Facility
|
OP
|
$1,802.00
|
|
|
Service Code
|
CPT 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$1,171.30 |
| Max. Negotiated Rate |
$4,927.45 |
| Rate for Payer: Aetna Commercial |
$1,621.80
|
| Rate for Payer: Aetna Medicare |
$3,179.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: ASR ASR |
$1,747.94
|
| Rate for Payer: ASR Commercial |
$1,747.94
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,475.66
|
| Rate for Payer: BCN Commercial |
$1,397.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,693.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,441.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,802.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,747.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,179.00
|
| Rate for Payer: Mclaren Commercial |
$1,621.80
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,531.70
|
| Rate for Payer: Nomi Health Commercial |
$1,477.64
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$3,496.90
|
| Rate for Payer: PHP Medicaid |
$1,703.94
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,578.91
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,263.20
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,585.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$4,927.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP DNSP |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$353.58 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: Aetna Medicare |
$901.00
|
| Rate for Payer: BCBS Complete |
$371.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: BCN Commercial |
$794.10
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Meridian Medicaid |
$371.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.04
|
| Rate for Payer: Priority Health Narrow Network |
$835.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.14
|
| Rate for Payer: UHC Exchange |
$597.14
|
| Rate for Payer: UHCCP Medicaid |
$353.58
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 25109
|
| Hospital Charge Code |
25109
|
| Min. Negotiated Rate |
$353.58 |
| Max. Negotiated Rate |
$1,326.56 |
| Rate for Payer: Aetna Commercial |
$711.43
|
| Rate for Payer: Aetna Medicare |
$901.00
|
| Rate for Payer: BCBS Complete |
$371.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,326.56
|
| Rate for Payer: BCN Commercial |
$794.10
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Meridian Medicaid |
$371.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$353.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$835.04
|
| Rate for Payer: Priority Health Narrow Network |
$835.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.14
|
| Rate for Payer: UHC Exchange |
$597.14
|
| Rate for Payer: UHCCP Medicaid |
$353.58
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$2,226.78 |
| Rate for Payer: Aetna Commercial |
$150.24
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,226.78
|
| Rate for Payer: BCN Commercial |
$314.22
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.64
|
| Rate for Payer: Priority Health Narrow Network |
$204.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$129.58
|
| Rate for Payer: UHC Exchange |
$129.58
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$412.58 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$662.98
|
| Rate for Payer: Aetna Medicare |
$599.50
|
| Rate for Payer: BCBS Complete |
$433.21
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$933.86
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Meridian Medicaid |
$433.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$867.36
|
| Rate for Payer: Priority Health Narrow Network |
$867.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$600.67
|
| Rate for Payer: UHC Exchange |
$600.67
|
| Rate for Payer: UHCCP Medicaid |
$412.58
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$12.95 |
| Max. Negotiated Rate |
$1,702.06 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: Aetna Medicare |
$997.50
|
| Rate for Payer: BCBS Complete |
$788.14
|
| Rate for Payer: BCBS Trust/PPO |
$12.95
|
| Rate for Payer: BCN Commercial |
$1,702.06
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Meridian Medicaid |
$788.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$750.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,611.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,611.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,210.33
|
| Rate for Payer: UHC Exchange |
$1,210.33
|
| Rate for Payer: UHCCP Medicaid |
$750.61
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Facility
|
OP
|
$2,228.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$1,448.20 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$2,005.20
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$2,161.16
|
| Rate for Payer: ASR Commercial |
$2,161.16
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,824.51
|
| Rate for Payer: BCN Commercial |
$1,727.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$2,094.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,782.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$2,228.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,161.16
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$2,005.20
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,893.80
|
| Rate for Payer: Nomi Health Commercial |
$1,826.96
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,952.17
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,561.83
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,960.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: Aetna Medicare |
$1,114.00
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: BCN Commercial |
$791.66
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$830.96
|
| Rate for Payer: Priority Health Narrow Network |
$830.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.31
|
| Rate for Payer: UHC Exchange |
$627.31
|
| Rate for Payer: UHCCP Medicaid |
$351.66
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Facility
|
IP
|
$2,228.00
|
|
|
Service Code
|
CPT 25073
|
| Hospital Charge Code |
25073
|
| Min. Negotiated Rate |
$1,448.20 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$2,005.20
|
| Rate for Payer: ASR ASR |
$2,161.16
|
| Rate for Payer: ASR Commercial |
$2,161.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.60
|
| Rate for Payer: BCN Commercial |
$1,727.37
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cofinity Commercial |
$2,094.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,782.40
|
| Rate for Payer: Healthscope Commercial |
$2,228.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,161.16
|
| Rate for Payer: Mclaren Commercial |
$2,005.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,893.80
|
| Rate for Payer: Nomi Health Commercial |
$1,826.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,960.64
|
|
|
PR EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>
|
Professional
|
Both
|
$2,228.00
|
|
|
Service Code
|
HCPCS 25073
|
| Min. Negotiated Rate |
$221.36 |
| Max. Negotiated Rate |
$1,448.20 |
| Rate for Payer: Aetna Commercial |
$712.93
|
| Rate for Payer: Aetna Medicare |
$1,114.00
|
| Rate for Payer: BCBS Complete |
$369.24
|
| Rate for Payer: BCBS Trust/PPO |
$221.36
|
| Rate for Payer: BCN Commercial |
$791.66
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Cash Price |
$1,782.40
|
| Rate for Payer: Meridian Medicaid |
$369.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,448.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$830.96
|
| Rate for Payer: Priority Health Narrow Network |
$830.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$627.31
|
| Rate for Payer: UHC Exchange |
$627.31
|
| Rate for Payer: UHCCP Medicaid |
$351.66
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
21552
|
| Min. Negotiated Rate |
$801.45 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$1,196.01
|
| Rate for Payer: ASR Commercial |
$1,196.01
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.70
|
| Rate for Payer: BCN Commercial |
$955.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cofinity Commercial |
$1,159.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$1,233.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,196.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$1,109.70
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,048.05
|
| Rate for Payer: Nomi Health Commercial |
$1,011.06
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.35
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$864.33
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,085.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 21552
|
| Hospital Charge Code |
21552
|
| Min. Negotiated Rate |
$801.45 |
| Max. Negotiated Rate |
$1,233.00 |
| Rate for Payer: Aetna Commercial |
$1,109.70
|
| Rate for Payer: ASR ASR |
$1,196.01
|
| Rate for Payer: ASR Commercial |
$1,196.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.77
|
| Rate for Payer: BCN Commercial |
$955.94
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cofinity Commercial |
$1,159.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$986.40
|
| Rate for Payer: Healthscope Commercial |
$1,233.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,196.01
|
| Rate for Payer: Mclaren Commercial |
$1,109.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,048.05
|
| Rate for Payer: Nomi Health Commercial |
$1,011.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,085.04
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$1,233.00
|
|
|
Service Code
|
HCPCS 21552
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$801.45 |
| Rate for Payer: Aetna Commercial |
$597.45
|
| Rate for Payer: Aetna Medicare |
$616.50
|
| Rate for Payer: BCBS Complete |
$305.51
|
| Rate for Payer: BCBS Trust/PPO |
$25.86
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Meridian Medicaid |
$305.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.02
|
| Rate for Payer: Priority Health Narrow Network |
$690.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.98
|
| Rate for Payer: UHC Exchange |
$533.98
|
| Rate for Payer: UHCCP Medicaid |
$290.96
|
|
|
PR EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/>
|
Professional
|
Both
|
$1,233.00
|
|
|
Service Code
|
HCPCS 21552
|
| Hospital Charge Code |
21552
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$801.45 |
| Rate for Payer: Aetna Commercial |
$597.45
|
| Rate for Payer: Aetna Medicare |
$616.50
|
| Rate for Payer: BCBS Complete |
$305.51
|
| Rate for Payer: BCBS Trust/PPO |
$25.86
|
| Rate for Payer: BCN Commercial |
$656.79
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Cash Price |
$986.40
|
| Rate for Payer: Meridian Medicaid |
$305.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$801.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$690.02
|
| Rate for Payer: Priority Health Narrow Network |
$690.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$533.98
|
| Rate for Payer: UHC Exchange |
$533.98
|
| Rate for Payer: UHCCP Medicaid |
$290.96
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 21933
|
| Hospital Charge Code |
21933
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,134.25 |
| Rate for Payer: Aetna Commercial |
$990.70
|
| Rate for Payer: Aetna Medicare |
$592.50
|
| Rate for Payer: BCBS Complete |
$501.87
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$1,082.42
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Meridian Medicaid |
$501.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$886.54
|
| Rate for Payer: UHC Exchange |
$886.54
|
| Rate for Payer: UHCCP Medicaid |
$477.97
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
IP
|
$1,185.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$770.25 |
| Max. Negotiated Rate |
$1,185.00 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: ASR ASR |
$1,149.45
|
| Rate for Payer: ASR Commercial |
$1,149.45
|
| Rate for Payer: BCBS Trust/PPO |
$965.66
|
| Rate for Payer: BCN Commercial |
$918.73
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.00
|
| Rate for Payer: Healthscope Commercial |
$1,185.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,149.45
|
| Rate for Payer: Mclaren Commercial |
$1,066.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.25
|
| Rate for Payer: Nomi Health Commercial |
$971.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,042.80
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Facility
|
OP
|
$1,185.00
|
|
|
Service Code
|
CPT 21933
|
| Hospital Charge Code |
21933
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$770.25 |
| Max. Negotiated Rate |
$4,346.48 |
| Rate for Payer: Aetna Commercial |
$1,066.50
|
| Rate for Payer: Aetna Medicare |
$2,804.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: ASR ASR |
$1,149.45
|
| Rate for Payer: ASR Commercial |
$1,149.45
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$970.40
|
| Rate for Payer: BCN Commercial |
$918.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$948.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$1,185.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,149.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,804.18
|
| Rate for Payer: Mclaren Commercial |
$1,066.50
|
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,007.25
|
| Rate for Payer: Nomi Health Commercial |
$971.70
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$3,084.60
|
| Rate for Payer: PHP Medicaid |
$1,503.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.30
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$830.68
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,042.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$4,346.48
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP DNSP |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/>
|
Professional
|
Both
|
$1,185.00
|
|
|
Service Code
|
HCPCS 21933
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$1,134.25 |
| Rate for Payer: Aetna Commercial |
$990.70
|
| Rate for Payer: Aetna Medicare |
$592.50
|
| Rate for Payer: BCBS Complete |
$501.87
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$1,082.42
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Cash Price |
$948.00
|
| Rate for Payer: Meridian Medicaid |
$501.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$770.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,134.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,134.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$886.54
|
| Rate for Payer: UHC Exchange |
$886.54
|
| Rate for Payer: UHCCP Medicaid |
$477.97
|
|
