|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$622.93 |
| Rate for Payer: PHP Medicare Advantage |
$323.85
|
| Rate for Payer: Aetna Commercial |
$433.96
|
| Rate for Payer: Aetna Medicare |
$336.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.34
|
| Rate for Payer: BCBS Complete |
$221.87
|
| Rate for Payer: BCBS MAPPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$537.82
|
| Rate for Payer: BCN Medicare Advantage |
$323.85
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$466.34
|
| Rate for Payer: Cofinity Commercial |
$433.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.85
|
| Rate for Payer: Healthscope Commercial |
$599.12
|
| Rate for Payer: Healthscope Commercial |
$518.16
|
| Rate for Payer: Mclaren Medicaid |
$211.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.04
|
| Rate for Payer: Meridian Medicaid |
$221.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$356.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$622.93
|
| Rate for Payer: Nomi Health Commercial |
$388.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.75
|
| Rate for Payer: PACE SWMI |
$323.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$585.86
|
| Rate for Payer: Priority Health Medicare |
$323.85
|
| Rate for Payer: Priority Health SBD |
$585.86
|
| Rate for Payer: Priority Health Tiered Network |
$585.86
|
| Rate for Payer: Railroad Medicare Medicare |
$323.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$619.41
|
| Rate for Payer: UHC Core |
$619.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$323.85
|
| Rate for Payer: UHC Exchange |
$619.41
|
| Rate for Payer: UHC Medicaid |
$211.30
|
| Rate for Payer: UHCCP Medicaid |
$211.30
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$214.57
|
| Rate for Payer: Aetna Medicare |
$166.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.59
|
| Rate for Payer: BCBS Complete |
$111.37
|
| Rate for Payer: BCBS MAPPO |
$160.13
|
| Rate for Payer: BCN Commercial |
$256.96
|
| Rate for Payer: BCN Medicare Advantage |
$160.13
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Cofinity Commercial |
$230.59
|
| Rate for Payer: Cofinity Commercial |
$214.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.13
|
| Rate for Payer: Healthscope Commercial |
$296.24
|
| Rate for Payer: Healthscope Commercial |
$256.21
|
| Rate for Payer: Mclaren Medicaid |
$106.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.14
|
| Rate for Payer: Meridian Medicaid |
$111.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.54
|
| Rate for Payer: Nomi Health Commercial |
$192.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.00
|
| Rate for Payer: PACE SWMI |
$160.13
|
| Rate for Payer: PHP Medicare Advantage |
$160.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$274.68
|
| Rate for Payer: Priority Health Medicare |
$160.13
|
| Rate for Payer: Priority Health SBD |
$274.68
|
| Rate for Payer: Priority Health Tiered Network |
$274.68
|
| Rate for Payer: Railroad Medicare Medicare |
$160.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.80
|
| Rate for Payer: UHC Core |
$286.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.13
|
| Rate for Payer: UHC Exchange |
$286.80
|
| Rate for Payer: UHC Medicaid |
$106.07
|
| Rate for Payer: UHCCP Medicaid |
$106.07
|
|
|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$934.00
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$250.28 |
| Max. Negotiated Rate |
$700.72 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$393.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.43
|
| Rate for Payer: BCBS Complete |
$262.79
|
| Rate for Payer: BCBS MAPPO |
$378.77
|
| Rate for Payer: BCN Commercial |
$617.49
|
| Rate for Payer: BCN Medicare Advantage |
$378.77
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$545.43
|
| Rate for Payer: Cofinity Commercial |
$507.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.77
|
| Rate for Payer: Healthscope Commercial |
$700.72
|
| Rate for Payer: Healthscope Commercial |
$606.03
|
| Rate for Payer: Mclaren Medicaid |
$250.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.71
|
| Rate for Payer: Meridian Medicaid |
$262.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$416.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.53
|
| Rate for Payer: Nomi Health Commercial |
$454.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$700.50
|
| Rate for Payer: PACE SWMI |
$378.77
|
| Rate for Payer: PHP Medicare Advantage |
$378.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$660.09
|
| Rate for Payer: Priority Health Medicare |
$378.77
|
| Rate for Payer: Priority Health SBD |
$660.09
|
| Rate for Payer: Priority Health Tiered Network |
$660.09
|
| Rate for Payer: Railroad Medicare Medicare |
$378.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.80
|
| Rate for Payer: UHC Core |
$630.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$378.77
|
| Rate for Payer: UHC Exchange |
$630.80
|
| Rate for Payer: UHC Medicaid |
$250.28
|
| Rate for Payer: UHCCP Medicaid |
$250.28
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,168.00
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$493.10 |
| Max. Negotiated Rate |
$1,626.00 |
| Rate for Payer: Aetna Commercial |
$1,013.48
|
| Rate for Payer: Aetna Medicare |
$786.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,013.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,089.12
|
| Rate for Payer: BCBS Complete |
$517.75
|
| Rate for Payer: BCBS MAPPO |
$756.33
|
| Rate for Payer: BCN Commercial |
$1,259.89
|
| Rate for Payer: BCN Medicare Advantage |
$756.33
|
| Rate for Payer: Cash Price |
$1,734.40
|
| Rate for Payer: Cash Price |
$1,734.40
|
| Rate for Payer: Cofinity Commercial |
$1,089.12
|
| Rate for Payer: Cofinity Commercial |
$1,013.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$756.33
|
| Rate for Payer: Healthscope Commercial |
$1,399.21
|
| Rate for Payer: Healthscope Commercial |
$1,210.13
|
| Rate for Payer: Mclaren Medicaid |
$493.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$794.15
|
| Rate for Payer: Meridian Medicaid |
$517.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$831.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.33
|
| Rate for Payer: Nomi Health Commercial |
$907.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,626.00
|
| Rate for Payer: PACE SWMI |
$756.33
|
| Rate for Payer: PHP Medicare Advantage |
$756.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,346.80
|
| Rate for Payer: Priority Health Medicare |
$756.33
|
| Rate for Payer: Priority Health SBD |
$1,346.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,346.80
|
| Rate for Payer: Railroad Medicare Medicare |
$756.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,454.21
|
| Rate for Payer: UHC Core |
$1,454.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$756.33
|
| Rate for Payer: UHC Exchange |
$1,454.21
|
| Rate for Payer: UHC Medicaid |
$493.10
|
| Rate for Payer: UHCCP Medicaid |
$493.10
|
|
|
PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$2,584.00
|
|
|
Service Code
|
HCPCS 64584
|
| Min. Negotiated Rate |
$402.78 |
| Max. Negotiated Rate |
$1,938.00 |
| Rate for Payer: Aetna Commercial |
$834.71
|
| Rate for Payer: Aetna Medicare |
$647.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.00
|
| Rate for Payer: BCBS Complete |
$422.92
|
| Rate for Payer: BCBS MAPPO |
$622.92
|
| Rate for Payer: BCN Commercial |
$1,094.56
|
| Rate for Payer: BCN Medicare Advantage |
$622.92
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cash Price |
$2,067.20
|
| Rate for Payer: Cofinity Commercial |
$897.00
|
| Rate for Payer: Cofinity Commercial |
$834.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.92
|
| Rate for Payer: Healthscope Commercial |
$996.67
|
| Rate for Payer: Healthscope Commercial |
$1,152.40
|
| Rate for Payer: Mclaren Medicaid |
$402.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.07
|
| Rate for Payer: Meridian Medicaid |
$422.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$685.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,292.44
|
| Rate for Payer: Nomi Health Commercial |
$747.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,938.00
|
| Rate for Payer: PACE SWMI |
$622.92
|
| Rate for Payer: PHP Medicare Advantage |
$622.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,271.32
|
| Rate for Payer: Priority Health Medicare |
$622.92
|
| Rate for Payer: Priority Health SBD |
$1,271.32
|
| Rate for Payer: Priority Health Tiered Network |
$1,271.32
|
| Rate for Payer: Railroad Medicare Medicare |
$622.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,198.89
|
| Rate for Payer: UHC Core |
$1,198.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$622.92
|
| Rate for Payer: UHC Exchange |
$1,198.89
|
| Rate for Payer: UHC Medicaid |
$402.78
|
| Rate for Payer: UHCCP Medicaid |
$402.78
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$36.07
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS MAPPO |
$26.92
|
| Rate for Payer: BCN Commercial |
$37.70
|
| Rate for Payer: BCN Medicare Advantage |
$26.92
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$38.76
|
| Rate for Payer: Cofinity Commercial |
$36.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.92
|
| Rate for Payer: Healthscope Commercial |
$49.80
|
| Rate for Payer: Healthscope Commercial |
$43.07
|
| Rate for Payer: Mclaren Medicaid |
$17.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.27
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.01
|
| Rate for Payer: Nomi Health Commercial |
$32.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PACE SWMI |
$26.92
|
| Rate for Payer: PHP Medicare Advantage |
$26.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.23
|
| Rate for Payer: Priority Health Medicare |
$26.92
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: Priority Health Tiered Network |
$47.23
|
| Rate for Payer: Railroad Medicare Medicare |
$26.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.90
|
| Rate for Payer: UHC Core |
$58.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.92
|
| Rate for Payer: UHC Exchange |
$58.90
|
| Rate for Payer: UHC Medicaid |
$17.25
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Aetna Commercial |
$20.93
|
| Rate for Payer: Aetna Medicare |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.93
|
| Rate for Payer: BCBS MAPPO |
$15.62
|
| Rate for Payer: BCN Commercial |
$23.40
|
| Rate for Payer: BCN Medicare Advantage |
$15.62
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$20.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$24.99
|
| Rate for Payer: Healthscope Commercial |
$28.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.67
|
| Rate for Payer: Nomi Health Commercial |
$18.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: PACE SWMI |
$15.62
|
| Rate for Payer: PHP Medicare Advantage |
$15.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$23.12
|
| Rate for Payer: Priority Health Medicare |
$15.62
|
| Rate for Payer: Priority Health SBD |
$23.12
|
| Rate for Payer: Priority Health Tiered Network |
$23.12
|
| Rate for Payer: Railroad Medicare Medicare |
$15.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.04
|
| Rate for Payer: UHC Core |
$23.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.62
|
| Rate for Payer: UHC Exchange |
$23.04
|
|
|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$310.19 |
| Rate for Payer: Priority Health Tiered Network |
$266.79
|
| Rate for Payer: Aetna Commercial |
$204.67
|
| Rate for Payer: Aetna Medicare |
$158.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.95
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$152.74
|
| Rate for Payer: BCN Commercial |
$263.44
|
| Rate for Payer: BCN Medicare Advantage |
$152.74
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$219.95
|
| Rate for Payer: Cofinity Commercial |
$204.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.74
|
| Rate for Payer: Healthscope Commercial |
$282.57
|
| Rate for Payer: Healthscope Commercial |
$244.38
|
| Rate for Payer: Mclaren Medicaid |
$99.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.38
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$168.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.19
|
| Rate for Payer: Nomi Health Commercial |
$183.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PACE SWMI |
$152.74
|
| Rate for Payer: PHP Medicare Advantage |
$152.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.79
|
| Rate for Payer: Priority Health Medicare |
$152.74
|
| Rate for Payer: Priority Health SBD |
$266.79
|
| Rate for Payer: Railroad Medicare Medicare |
$152.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.22
|
| Rate for Payer: UHC Core |
$296.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$152.74
|
| Rate for Payer: UHC Exchange |
$296.22
|
| Rate for Payer: UHC Medicaid |
$99.68
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$107.75
|
| Rate for Payer: Aetna Medicare |
$83.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.79
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$80.41
|
| Rate for Payer: BCN Commercial |
$137.45
|
| Rate for Payer: BCN Medicare Advantage |
$80.41
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$107.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.41
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Healthscope Commercial |
$128.66
|
| Rate for Payer: Mclaren Medicaid |
$51.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.43
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.94
|
| Rate for Payer: Nomi Health Commercial |
$96.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE SWMI |
$80.41
|
| Rate for Payer: PHP Medicare Advantage |
$80.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$125.80
|
| Rate for Payer: Priority Health Medicare |
$80.41
|
| Rate for Payer: Priority Health SBD |
$125.80
|
| Rate for Payer: Priority Health Tiered Network |
$125.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.84
|
| Rate for Payer: UHC Core |
$167.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.41
|
| Rate for Payer: UHC Exchange |
$167.84
|
| Rate for Payer: UHC Medicaid |
$51.12
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Aetna Commercial |
$210.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.20
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Advantage |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$213.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.40
|
| Rate for Payer: Healthscope Commercial |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PHP Commercial |
$210.80
|
| Rate for Payer: Priority Health SBD |
$156.24
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$186.00 |
| Rate for Payer: Aetna Commercial |
$107.75
|
| Rate for Payer: Aetna Medicare |
$83.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.79
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$80.41
|
| Rate for Payer: BCN Commercial |
$137.45
|
| Rate for Payer: BCN Medicare Advantage |
$80.41
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$107.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.41
|
| Rate for Payer: Healthscope Commercial |
$148.76
|
| Rate for Payer: Healthscope Commercial |
$128.66
|
| Rate for Payer: Mclaren Medicaid |
$51.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.43
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.94
|
| Rate for Payer: Nomi Health Commercial |
$96.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE SWMI |
$80.41
|
| Rate for Payer: PHP Medicare Advantage |
$80.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$125.80
|
| Rate for Payer: Priority Health Medicare |
$80.41
|
| Rate for Payer: Priority Health SBD |
$125.80
|
| Rate for Payer: Priority Health Tiered Network |
$125.80
|
| Rate for Payer: Railroad Medicare Medicare |
$80.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.84
|
| Rate for Payer: UHC Core |
$167.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.41
|
| Rate for Payer: UHC Exchange |
$167.84
|
| Rate for Payer: UHC Medicaid |
$51.12
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$156.24 |
| Max. Negotiated Rate |
$2,281.79 |
| Rate for Payer: Aetna Commercial |
$210.80
|
| Rate for Payer: Aetna Medicare |
$733.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$881.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$881.99
|
| Rate for Payer: BCBS Complete |
$387.51
|
| Rate for Payer: BCBS MAPPO |
$705.59
|
| Rate for Payer: BCBS Trust/PPO |
$535.08
|
| Rate for Payer: BCN Commercial |
$535.08
|
| Rate for Payer: BCN Medicare Advantage |
$705.59
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Advantage |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$213.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$198.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.59
|
| Rate for Payer: Healthscope Commercial |
$223.20
|
| Rate for Payer: Mclaren Medicaid |
$369.02
|
| Rate for Payer: Mclaren Medicare |
$705.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.87
|
| Rate for Payer: Meridian Medicaid |
$740.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$811.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.80
|
| Rate for Payer: Nomi Health Commercial |
$2,116.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE Medicare |
$670.31
|
| Rate for Payer: PACE SWMI |
$705.59
|
| Rate for Payer: PHP Commercial |
$210.80
|
| Rate for Payer: PHP Medicare Advantage |
$705.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,281.79
|
| Rate for Payer: Priority Health Medicare |
$705.59
|
| Rate for Payer: Priority Health SBD |
$156.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,825.43
|
| Rate for Payer: Railroad Medicare Medicare |
$705.59
|
| Rate for Payer: UHC Medicaid |
$369.02
|
| Rate for Payer: UHCCP Medicaid |
$369.02
|
| Rate for Payer: VA VA |
$705.59
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$126.10 |
| Max. Negotiated Rate |
$377.21 |
| Rate for Payer: Aetna Commercial |
$260.20
|
| Rate for Payer: Aetna Medicare |
$201.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.62
|
| Rate for Payer: BCBS Complete |
$132.41
|
| Rate for Payer: BCBS MAPPO |
$194.18
|
| Rate for Payer: BCN Commercial |
$318.70
|
| Rate for Payer: BCN Medicare Advantage |
$194.18
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Cofinity Commercial |
$279.62
|
| Rate for Payer: Cofinity Commercial |
$260.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.18
|
| Rate for Payer: Healthscope Commercial |
$359.23
|
| Rate for Payer: Healthscope Commercial |
$310.69
|
| Rate for Payer: Mclaren Medicaid |
$126.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.89
|
| Rate for Payer: Meridian Medicaid |
$132.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$213.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.21
|
| Rate for Payer: Nomi Health Commercial |
$233.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.25
|
| Rate for Payer: PACE SWMI |
$194.18
|
| Rate for Payer: PHP Medicare Advantage |
$194.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$342.73
|
| Rate for Payer: Priority Health Medicare |
$194.18
|
| Rate for Payer: Priority Health SBD |
$342.73
|
| Rate for Payer: Priority Health Tiered Network |
$342.73
|
| Rate for Payer: Railroad Medicare Medicare |
$194.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.89
|
| Rate for Payer: UHC Core |
$375.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.18
|
| Rate for Payer: UHC Exchange |
$375.89
|
| Rate for Payer: UHC Medicaid |
$126.10
|
| Rate for Payer: UHCCP Medicaid |
$126.10
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,118.00
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$251.55 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Aetna Commercial |
$515.47
|
| Rate for Payer: Aetna Medicare |
$400.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.94
|
| Rate for Payer: BCBS Complete |
$264.13
|
| Rate for Payer: BCBS MAPPO |
$384.68
|
| Rate for Payer: BCN Commercial |
$637.42
|
| Rate for Payer: BCN Medicare Advantage |
$384.68
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cash Price |
$894.40
|
| Rate for Payer: Cofinity Commercial |
$553.94
|
| Rate for Payer: Cofinity Commercial |
$515.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.68
|
| Rate for Payer: Healthscope Commercial |
$711.66
|
| Rate for Payer: Healthscope Commercial |
$615.49
|
| Rate for Payer: Mclaren Medicaid |
$251.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.91
|
| Rate for Payer: Meridian Medicaid |
$264.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$423.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$740.56
|
| Rate for Payer: Nomi Health Commercial |
$461.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$838.50
|
| Rate for Payer: PACE SWMI |
$384.68
|
| Rate for Payer: PHP Medicare Advantage |
$384.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$681.39
|
| Rate for Payer: Priority Health Medicare |
$384.68
|
| Rate for Payer: Priority Health SBD |
$681.39
|
| Rate for Payer: Priority Health Tiered Network |
$681.39
|
| Rate for Payer: Railroad Medicare Medicare |
$384.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$734.05
|
| Rate for Payer: UHC Core |
$734.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$384.68
|
| Rate for Payer: UHC Exchange |
$734.05
|
| Rate for Payer: UHC Medicaid |
$251.55
|
| Rate for Payer: UHCCP Medicaid |
$251.55
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Aetna Commercial |
$413.03
|
| Rate for Payer: Aetna Medicare |
$320.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.85
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCBS MAPPO |
$308.23
|
| Rate for Payer: BCN Commercial |
$478.07
|
| Rate for Payer: BCN Medicare Advantage |
$308.23
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cofinity Commercial |
$443.85
|
| Rate for Payer: Cofinity Commercial |
$413.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.23
|
| Rate for Payer: Healthscope Commercial |
$570.23
|
| Rate for Payer: Healthscope Commercial |
$493.17
|
| Rate for Payer: Mclaren Medicaid |
$201.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.64
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.69
|
| Rate for Payer: Nomi Health Commercial |
$369.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$643.50
|
| Rate for Payer: PACE SWMI |
$308.23
|
| Rate for Payer: PHP Medicare Advantage |
$308.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$514.10
|
| Rate for Payer: Priority Health Medicare |
$308.23
|
| Rate for Payer: Priority Health SBD |
$514.10
|
| Rate for Payer: Priority Health Tiered Network |
$514.10
|
| Rate for Payer: Railroad Medicare Medicare |
$308.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$542.04
|
| Rate for Payer: UHC Core |
$542.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.23
|
| Rate for Payer: UHC Exchange |
$542.04
|
| Rate for Payer: UHC Medicaid |
$201.71
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$215.34 |
| Max. Negotiated Rate |
$806.25 |
| Rate for Payer: Aetna Commercial |
$436.25
|
| Rate for Payer: Aetna Medicare |
$338.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.81
|
| Rate for Payer: BCBS Complete |
$226.11
|
| Rate for Payer: BCBS MAPPO |
$325.56
|
| Rate for Payer: BCN Commercial |
$541.31
|
| Rate for Payer: BCN Medicare Advantage |
$325.56
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Cofinity Commercial |
$468.81
|
| Rate for Payer: Cofinity Commercial |
$436.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.56
|
| Rate for Payer: Healthscope Commercial |
$602.29
|
| Rate for Payer: Healthscope Commercial |
$520.90
|
| Rate for Payer: Mclaren Medicaid |
$215.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$226.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.50
|
| Rate for Payer: Nomi Health Commercial |
$390.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$806.25
|
| Rate for Payer: PACE SWMI |
$325.56
|
| Rate for Payer: PHP Medicare Advantage |
$325.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$578.65
|
| Rate for Payer: Priority Health Medicare |
$325.56
|
| Rate for Payer: Priority Health SBD |
$578.65
|
| Rate for Payer: Priority Health Tiered Network |
$578.65
|
| Rate for Payer: Railroad Medicare Medicare |
$325.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.89
|
| Rate for Payer: UHC Core |
$600.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$325.56
|
| Rate for Payer: UHC Exchange |
$600.89
|
| Rate for Payer: UHC Medicaid |
$215.34
|
| Rate for Payer: UHCCP Medicaid |
$215.34
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$89.25 |
| Max. Negotiated Rate |
$710.25 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Medicare |
$140.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.13
|
| Rate for Payer: BCBS Complete |
$93.71
|
| Rate for Payer: BCBS MAPPO |
$134.81
|
| Rate for Payer: BCN Commercial |
$173.57
|
| Rate for Payer: BCN Medicare Advantage |
$134.81
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$194.13
|
| Rate for Payer: Cofinity Commercial |
$180.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.81
|
| Rate for Payer: Healthscope Commercial |
$249.40
|
| Rate for Payer: Healthscope Commercial |
$215.70
|
| Rate for Payer: Mclaren Medicaid |
$89.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.55
|
| Rate for Payer: Meridian Medicaid |
$93.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.04
|
| Rate for Payer: Nomi Health Commercial |
$161.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$710.25
|
| Rate for Payer: PACE SWMI |
$134.81
|
| Rate for Payer: PHP Medicare Advantage |
$134.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$235.29
|
| Rate for Payer: Priority Health Medicare |
$134.81
|
| Rate for Payer: Priority Health SBD |
$235.29
|
| Rate for Payer: Priority Health Tiered Network |
$235.29
|
| Rate for Payer: Railroad Medicare Medicare |
$134.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.20
|
| Rate for Payer: UHC Core |
$251.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.81
|
| Rate for Payer: UHC Exchange |
$251.20
|
| Rate for Payer: UHC Medicaid |
$89.25
|
| Rate for Payer: UHCCP Medicaid |
$89.25
|
|
|
PR REMOVAL INDWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,746.00
|
|
|
Service Code
|
HCPCS 50384
|
| Min. Negotiated Rate |
$125.24 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Aetna Commercial |
$263.43
|
| Rate for Payer: Aetna Medicare |
$204.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.09
|
| Rate for Payer: BCBS Complete |
$131.50
|
| Rate for Payer: BCBS MAPPO |
$196.59
|
| Rate for Payer: BCN Commercial |
$332.15
|
| Rate for Payer: BCN Medicare Advantage |
$196.59
|
| Rate for Payer: Cash Price |
$1,396.80
|
| Rate for Payer: Cash Price |
$1,396.80
|
| Rate for Payer: Cofinity Commercial |
$283.09
|
| Rate for Payer: Cofinity Commercial |
$263.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.59
|
| Rate for Payer: Healthscope Commercial |
$363.69
|
| Rate for Payer: Healthscope Commercial |
$314.54
|
| Rate for Payer: Mclaren Medicaid |
$125.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.42
|
| Rate for Payer: Meridian Medicaid |
$131.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$216.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.89
|
| Rate for Payer: Nomi Health Commercial |
$235.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,309.50
|
| Rate for Payer: PACE SWMI |
$196.59
|
| Rate for Payer: PHP Medicare Advantage |
$196.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$361.82
|
| Rate for Payer: Priority Health Medicare |
$196.59
|
| Rate for Payer: Priority Health SBD |
$361.82
|
| Rate for Payer: Priority Health Tiered Network |
$361.82
|
| Rate for Payer: Railroad Medicare Medicare |
$196.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.77
|
| Rate for Payer: UHC Core |
$409.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$196.59
|
| Rate for Payer: UHC Exchange |
$409.77
|
| Rate for Payer: UHC Medicaid |
$125.24
|
| Rate for Payer: UHCCP Medicaid |
$125.24
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$327.38 |
| Max. Negotiated Rate |
$1,182.00 |
| Rate for Payer: Aetna Commercial |
$669.84
|
| Rate for Payer: Aetna Medicare |
$519.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$669.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.83
|
| Rate for Payer: BCBS Complete |
$343.75
|
| Rate for Payer: BCBS MAPPO |
$499.88
|
| Rate for Payer: BCN Commercial |
$841.58
|
| Rate for Payer: BCN Medicare Advantage |
$499.88
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$719.83
|
| Rate for Payer: Cofinity Commercial |
$669.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$499.88
|
| Rate for Payer: Healthscope Commercial |
$924.78
|
| Rate for Payer: Healthscope Commercial |
$799.81
|
| Rate for Payer: Mclaren Medicaid |
$327.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$524.87
|
| Rate for Payer: Meridian Medicaid |
$343.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$549.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$977.81
|
| Rate for Payer: Nomi Health Commercial |
$599.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$499.88
|
| Rate for Payer: PHP Medicare Advantage |
$499.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$327.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$770.28
|
| Rate for Payer: Priority Health Medicare |
$499.88
|
| Rate for Payer: Priority Health SBD |
$770.28
|
| Rate for Payer: Priority Health Tiered Network |
$770.28
|
| Rate for Payer: Railroad Medicare Medicare |
$499.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.93
|
| Rate for Payer: UHC Core |
$869.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$499.88
|
| Rate for Payer: UHC Exchange |
$869.93
|
| Rate for Payer: UHC Medicaid |
$327.38
|
| Rate for Payer: UHCCP Medicaid |
$327.38
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$40.13
|
| Rate for Payer: Aetna Medicare |
$31.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.13
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.95
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: BCN Medicare Advantage |
$29.95
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$43.13
|
| Rate for Payer: Cofinity Commercial |
$40.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.95
|
| Rate for Payer: Healthscope Commercial |
$55.41
|
| Rate for Payer: Healthscope Commercial |
$47.92
|
| Rate for Payer: Mclaren Medicaid |
$18.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.45
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.90
|
| Rate for Payer: Nomi Health Commercial |
$35.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.25
|
| Rate for Payer: PACE SWMI |
$29.95
|
| Rate for Payer: PHP Medicare Advantage |
$29.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53.56
|
| Rate for Payer: Priority Health Medicare |
$29.95
|
| Rate for Payer: Priority Health SBD |
$53.56
|
| Rate for Payer: Priority Health Tiered Network |
$53.56
|
| Rate for Payer: Railroad Medicare Medicare |
$29.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.41
|
| Rate for Payer: UHC Core |
$60.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.95
|
| Rate for Payer: UHC Exchange |
$60.41
|
| Rate for Payer: UHC Medicaid |
$18.96
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
|
|
PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 20705
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$221.60 |
| Rate for Payer: Aetna Commercial |
$142.28
|
| Rate for Payer: Aetna Medicare |
$110.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.90
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$106.18
|
| Rate for Payer: BCN Commercial |
$185.25
|
| Rate for Payer: BCN Medicare Advantage |
$106.18
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$152.90
|
| Rate for Payer: Cofinity Commercial |
$142.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.18
|
| Rate for Payer: Healthscope Commercial |
$196.43
|
| Rate for Payer: Healthscope Commercial |
$169.89
|
| Rate for Payer: Mclaren Medicaid |
$67.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.49
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.60
|
| Rate for Payer: Nomi Health Commercial |
$127.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: PACE SWMI |
$106.18
|
| Rate for Payer: PHP Medicare Advantage |
$106.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.03
|
| Rate for Payer: Priority Health Medicare |
$106.18
|
| Rate for Payer: Priority Health SBD |
$198.03
|
| Rate for Payer: Priority Health Tiered Network |
$198.03
|
| Rate for Payer: Railroad Medicare Medicare |
$106.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$213.43
|
| Rate for Payer: UHC Core |
$213.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.18
|
| Rate for Payer: UHC Exchange |
$213.43
|
| Rate for Payer: UHC Medicaid |
$67.73
|
| Rate for Payer: UHCCP Medicaid |
$67.73
|
|
|
PR REMOVAL INTRAUTERINE DEVICE IUD
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 58301
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$77.55
|
| Rate for Payer: Aetna Medicare |
$60.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.33
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.87
|
| Rate for Payer: BCN Commercial |
$77.75
|
| Rate for Payer: BCN Medicare Advantage |
$57.87
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$83.33
|
| Rate for Payer: Cofinity Commercial |
$77.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.87
|
| Rate for Payer: Healthscope Commercial |
$92.59
|
| Rate for Payer: Healthscope Commercial |
$107.06
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.76
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.37
|
| Rate for Payer: Nomi Health Commercial |
$69.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE SWMI |
$57.87
|
| Rate for Payer: PHP Medicare Advantage |
$57.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99.87
|
| Rate for Payer: Priority Health Medicare |
$57.87
|
| Rate for Payer: Priority Health SBD |
$99.87
|
| Rate for Payer: Priority Health Tiered Network |
$99.87
|
| Rate for Payer: Railroad Medicare Medicare |
$57.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.82
|
| Rate for Payer: UHC Core |
$119.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.87
|
| Rate for Payer: UHC Exchange |
$119.82
|
| Rate for Payer: UHC Medicaid |
$36.85
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA
|
Professional
|
Both
|
$6,285.00
|
|
|
Service Code
|
HCPCS 32442
|
| Min. Negotiated Rate |
$1,802.41 |
| Max. Negotiated Rate |
$5,461.79 |
| Rate for Payer: Aetna Commercial |
$3,806.54
|
| Rate for Payer: Aetna Medicare |
$2,954.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,806.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,090.61
|
| Rate for Payer: BCBS Complete |
$1,892.53
|
| Rate for Payer: BCBS MAPPO |
$2,840.70
|
| Rate for Payer: BCN Commercial |
$4,482.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,840.70
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cofinity Commercial |
$4,090.61
|
| Rate for Payer: Cofinity Commercial |
$3,806.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,840.70
|
| Rate for Payer: Healthscope Commercial |
$5,255.30
|
| Rate for Payer: Healthscope Commercial |
$4,545.12
|
| Rate for Payer: Mclaren Medicaid |
$1,802.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,982.74
|
| Rate for Payer: Meridian Medicaid |
$1,892.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,124.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,419.01
|
| Rate for Payer: Nomi Health Commercial |
$3,408.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,713.75
|
| Rate for Payer: PACE SWMI |
$2,840.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,840.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,221.49
|
| Rate for Payer: Priority Health Medicare |
$2,840.70
|
| Rate for Payer: Priority Health SBD |
$4,221.49
|
| Rate for Payer: Priority Health Tiered Network |
$4,221.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,840.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,461.79
|
| Rate for Payer: UHC Core |
$5,461.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,840.70
|
| Rate for Payer: UHC Exchange |
$5,461.79
|
| Rate for Payer: UHC Medicaid |
$1,802.41
|
| Rate for Payer: UHCCP Medicaid |
$1,802.41
|
|
|
PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 11982
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Medicare |
$65.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.86
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$63.10
|
| Rate for Payer: BCN Commercial |
$108.56
|
| Rate for Payer: BCN Medicare Advantage |
$63.10
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cofinity Commercial |
$90.86
|
| Rate for Payer: Cofinity Commercial |
$84.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.10
|
| Rate for Payer: Healthscope Commercial |
$116.73
|
| Rate for Payer: Healthscope Commercial |
$100.96
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.25
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.05
|
| Rate for Payer: Nomi Health Commercial |
$75.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.50
|
| Rate for Payer: PACE SWMI |
$63.10
|
| Rate for Payer: PHP Medicare Advantage |
$63.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99.37
|
| Rate for Payer: Priority Health Medicare |
$63.10
|
| Rate for Payer: Priority Health SBD |
$99.37
|
| Rate for Payer: Priority Health Tiered Network |
$99.37
|
| Rate for Payer: Railroad Medicare Medicare |
$63.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.31
|
| Rate for Payer: UHC Core |
$134.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$63.10
|
| Rate for Payer: UHC Exchange |
$134.31
|
| Rate for Payer: UHC Medicaid |
$40.26
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR REMOVAL OF LUNG PNEUMONECTOMY
|
Professional
|
Both
|
$5,668.00
|
|
|
Service Code
|
HCPCS 32440
|
| Min. Negotiated Rate |
$949.98 |
| Max. Negotiated Rate |
$4,251.00 |
| Rate for Payer: Priority Health SBD |
$2,185.31
|
| Rate for Payer: Aetna Commercial |
$1,990.76
|
| Rate for Payer: Aetna Medicare |
$1,545.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,990.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.32
|
| Rate for Payer: BCBS Complete |
$997.48
|
| Rate for Payer: BCBS MAPPO |
$1,485.64
|
| Rate for Payer: BCN Commercial |
$2,320.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,485.64
|
| Rate for Payer: Cash Price |
$4,534.40
|
| Rate for Payer: Cash Price |
$4,534.40
|
| Rate for Payer: Cofinity Commercial |
$2,139.32
|
| Rate for Payer: Cofinity Commercial |
$1,990.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,485.64
|
| Rate for Payer: Healthscope Commercial |
$2,748.43
|
| Rate for Payer: Healthscope Commercial |
$2,377.02
|
| Rate for Payer: Mclaren Medicaid |
$949.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,559.92
|
| Rate for Payer: Meridian Medicaid |
$997.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,634.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,777.44
|
| Rate for Payer: Nomi Health Commercial |
$1,782.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,251.00
|
| Rate for Payer: PACE SWMI |
$1,485.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,485.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,185.31
|
| Rate for Payer: Priority Health Medicare |
$1,485.64
|
| Rate for Payer: Priority Health Tiered Network |
$2,185.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,485.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,778.24
|
| Rate for Payer: UHC Core |
$2,778.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,485.64
|
| Rate for Payer: UHC Exchange |
$2,778.24
|
| Rate for Payer: UHC Medicaid |
$949.98
|
| Rate for Payer: UHCCP Medicaid |
$949.98
|
|
