|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Facility
|
OP
|
$2,876.00
|
|
|
Service Code
|
CPT 25077
|
| Hospital Charge Code |
25077
|
| Min. Negotiated Rate |
$635.28 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Aetna Commercial |
$2,444.60
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.40
|
| 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: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$635.28
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Commercial |
$2,473.36
|
| Rate for Payer: Cofinity Commercial |
$2,013.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,013.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,300.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$2,588.40
|
| 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 |
$2,444.60
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$2,444.60
|
| 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 |
$1,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$1,811.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$924.69
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,578.75
|
| Rate for Payer: VA VA |
$2,804.18
|
|
|
PR RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM
|
Professional
|
Both
|
$2,876.00
|
|
|
Service Code
|
HCPCS 25077
|
| Min. Negotiated Rate |
$256.75 |
| Max. Negotiated Rate |
$157,583.00 |
| Rate for Payer: Aetna Commercial |
$1,119.42
|
| Rate for Payer: Aetna Medicare |
$868.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.96
|
| Rate for Payer: BCBS Complete |
$584.62
|
| Rate for Payer: BCBS MAPPO |
$835.39
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$1,300.37
|
| Rate for Payer: BCN Medicare Advantage |
$835.39
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cash Price |
$2,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,202.96
|
| Rate for Payer: Cofinity Commercial |
$1,119.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.39
|
| Rate for Payer: Healthscope Commercial |
$1,545.47
|
| Rate for Payer: Healthscope Commercial |
$1,336.62
|
| Rate for Payer: Mclaren Medicaid |
$556.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.16
|
| Rate for Payer: Meridian Medicaid |
$584.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,583.00
|
| Rate for Payer: Nomi Health Commercial |
$1,002.47
|
| Rate for Payer: PACE SWMI |
$835.39
|
| Rate for Payer: PHP Medicare Advantage |
$835.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,321.00
|
| Rate for Payer: Priority Health Medicare |
$835.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,321.00
|
| Rate for Payer: Priority Health SBD |
$1,321.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,014.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.39
|
| Rate for Payer: UHC Exchange |
$1,014.09
|
| Rate for Payer: UHC Medicare Advantage |
$835.39
|
| Rate for Payer: UHCCP Medicaid |
$556.78
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 21557
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$169,902.00 |
| Rate for Payer: Aetna Commercial |
$1,231.12
|
| Rate for Payer: Aetna Medicare |
$955.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,231.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,323.00
|
| Rate for Payer: BCBS Complete |
$645.46
|
| Rate for Payer: BCBS MAPPO |
$918.75
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$1,396.64
|
| Rate for Payer: BCN Medicare Advantage |
$918.75
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$1,323.00
|
| Rate for Payer: Cofinity Commercial |
$1,231.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.75
|
| Rate for Payer: Healthscope Commercial |
$1,699.69
|
| Rate for Payer: Healthscope Commercial |
$1,470.00
|
| Rate for Payer: Mclaren Medicaid |
$614.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.69
|
| Rate for Payer: Meridian Medicaid |
$645.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169,902.00
|
| Rate for Payer: Nomi Health Commercial |
$1,102.50
|
| Rate for Payer: PACE SWMI |
$918.75
|
| Rate for Payer: PHP Medicare Advantage |
$918.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$614.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,469.59
|
| Rate for Payer: Priority Health Medicare |
$918.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.59
|
| Rate for Payer: Priority Health SBD |
$1,469.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$870.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.75
|
| Rate for Payer: UHC Exchange |
$870.13
|
| Rate for Payer: UHC Medicare Advantage |
$918.75
|
| Rate for Payer: UHCCP Medicaid |
$614.72
|
|
|
PR RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>
|
Professional
|
Both
|
$3,418.00
|
|
|
Service Code
|
HCPCS 21558
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$239,497.00 |
| Rate for Payer: Aetna Commercial |
$1,732.27
|
| Rate for Payer: Aetna Medicare |
$1,344.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,861.55
|
| Rate for Payer: BCBS Complete |
$904.67
|
| Rate for Payer: BCBS MAPPO |
$1,292.74
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$1,962.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,292.74
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cash Price |
$2,734.40
|
| Rate for Payer: Cofinity Commercial |
$1,861.55
|
| Rate for Payer: Cofinity Commercial |
$1,732.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,292.74
|
| Rate for Payer: Healthscope Commercial |
$2,068.38
|
| Rate for Payer: Healthscope Commercial |
$2,391.57
|
| Rate for Payer: Mclaren Medicaid |
$861.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,357.38
|
| Rate for Payer: Meridian Medicaid |
$904.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239,497.00
|
| Rate for Payer: Nomi Health Commercial |
$1,551.29
|
| Rate for Payer: PACE SWMI |
$1,292.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,292.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$861.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,048.16
|
| Rate for Payer: Priority Health Medicare |
$1,292.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,048.16
|
| Rate for Payer: Priority Health SBD |
$2,048.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,292.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,292.74
|
| Rate for Payer: UHCCP Medicaid |
$861.59
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26117
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$131,582.00 |
| Rate for Payer: Aetna Commercial |
$966.72
|
| Rate for Payer: Aetna Medicare |
$750.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.72
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS MAPPO |
$721.43
|
| Rate for Payer: BCBS Trust/PPO |
$171.92
|
| Rate for Payer: BCN Commercial |
$1,091.70
|
| Rate for Payer: BCN Medicare Advantage |
$721.43
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$966.72
|
| Rate for Payer: Cofinity Commercial |
$1,038.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.43
|
| Rate for Payer: Healthscope Commercial |
$1,334.65
|
| Rate for Payer: Healthscope Commercial |
$1,154.29
|
| Rate for Payer: Mclaren Medicaid |
$488.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.50
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131,582.00
|
| Rate for Payer: Nomi Health Commercial |
$865.72
|
| Rate for Payer: PACE SWMI |
$721.43
|
| Rate for Payer: PHP Medicare Advantage |
$721.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.53
|
| Rate for Payer: Priority Health Medicare |
$721.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.53
|
| Rate for Payer: Priority Health SBD |
$1,150.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$685.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.43
|
| Rate for Payer: UHC Exchange |
$685.80
|
| Rate for Payer: UHC Medicare Advantage |
$721.43
|
| Rate for Payer: UHCCP Medicaid |
$488.20
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 27049
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$239,020.00 |
| Rate for Payer: Aetna Commercial |
$1,839.71
|
| Rate for Payer: Aetna Medicare |
$1,427.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,977.00
|
| Rate for Payer: BCBS Complete |
$966.62
|
| Rate for Payer: BCBS MAPPO |
$1,372.92
|
| Rate for Payer: BCBS Trust/PPO |
$4,326.25
|
| Rate for Payer: BCN Commercial |
$1,956.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.92
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$1,977.00
|
| Rate for Payer: Cofinity Commercial |
$1,839.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.92
|
| Rate for Payer: Healthscope Commercial |
$2,539.90
|
| Rate for Payer: Healthscope Commercial |
$2,196.67
|
| Rate for Payer: Mclaren Medicaid |
$920.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,441.57
|
| Rate for Payer: Meridian Medicaid |
$966.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239,020.00
|
| Rate for Payer: Nomi Health Commercial |
$1,647.50
|
| Rate for Payer: PACE SWMI |
$1,372.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$920.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.00
|
| Rate for Payer: Priority Health Medicare |
$1,372.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.00
|
| Rate for Payer: Priority Health SBD |
$2,182.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,187.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,372.92
|
| Rate for Payer: UHC Exchange |
$1,187.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.92
|
| Rate for Payer: UHCCP Medicaid |
$920.59
|
|
|
PR RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM
|
Professional
|
Both
|
$3,378.00
|
|
|
Service Code
|
HCPCS 27329
|
| Min. Negotiated Rate |
$673.08 |
| Max. Negotiated Rate |
$185,222.00 |
| Rate for Payer: Aetna Commercial |
$1,349.19
|
| Rate for Payer: Aetna Medicare |
$1,047.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,349.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,449.88
|
| Rate for Payer: BCBS Complete |
$706.73
|
| Rate for Payer: BCBS MAPPO |
$1,006.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$1,523.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,006.86
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cash Price |
$2,702.40
|
| Rate for Payer: Cofinity Commercial |
$1,449.88
|
| Rate for Payer: Cofinity Commercial |
$1,349.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,006.86
|
| Rate for Payer: Healthscope Commercial |
$1,862.69
|
| Rate for Payer: Healthscope Commercial |
$1,610.98
|
| Rate for Payer: Mclaren Medicaid |
$673.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,057.20
|
| Rate for Payer: Meridian Medicaid |
$706.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185,222.00
|
| Rate for Payer: Nomi Health Commercial |
$1,208.23
|
| Rate for Payer: PACE SWMI |
$1,006.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,006.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$673.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,596.80
|
| Rate for Payer: Priority Health Medicare |
$1,006.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,596.80
|
| Rate for Payer: Priority Health SBD |
$1,596.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,212.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,006.86
|
| Rate for Payer: UHC Exchange |
$1,212.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,006.86
|
| Rate for Payer: UHCCP Medicaid |
$673.08
|
|
|
PR RAPID DESENSITIZATION PROCEDURE EACH HOUR
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 95180
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$14,915.00 |
| Rate for Payer: Aetna Commercial |
$128.99
|
| Rate for Payer: Aetna Medicare |
$100.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.61
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCBS MAPPO |
$96.26
|
| Rate for Payer: BCBS Trust/PPO |
$430.04
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: BCN Medicare Advantage |
$96.26
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$138.61
|
| Rate for Payer: Cofinity Commercial |
$128.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.26
|
| Rate for Payer: Healthscope Commercial |
$178.08
|
| Rate for Payer: Healthscope Commercial |
$154.02
|
| Rate for Payer: Mclaren Medicaid |
$64.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.07
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,915.00
|
| Rate for Payer: Nomi Health Commercial |
$115.51
|
| Rate for Payer: PACE SWMI |
$96.26
|
| Rate for Payer: PHP Medicare Advantage |
$96.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.75
|
| Rate for Payer: Priority Health Medicare |
$96.26
|
| Rate for Payer: Priority Health Narrow Network |
$138.75
|
| Rate for Payer: Priority Health SBD |
$138.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.26
|
| Rate for Payer: UHC Exchange |
$146.99
|
| Rate for Payer: UHC Medicare Advantage |
$96.26
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$63,362.00 |
| Rate for Payer: Aetna Commercial |
$467.98
|
| Rate for Payer: Aetna Medicare |
$363.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.91
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$349.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: BCN Medicare Advantage |
$349.24
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$502.91
|
| Rate for Payer: Cofinity Commercial |
$467.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.24
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Healthscope Commercial |
$558.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63,362.00
|
| Rate for Payer: Nomi Health Commercial |
$419.09
|
| Rate for Payer: PACE SWMI |
$349.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.73
|
| Rate for Payer: Priority Health Medicare |
$349.24
|
| Rate for Payer: Priority Health Narrow Network |
$558.73
|
| Rate for Payer: Priority Health SBD |
$558.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.24
|
| Rate for Payer: UHC Exchange |
$578.77
|
| Rate for Payer: UHC Medicare Advantage |
$349.24
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Commercial |
$723.35
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.15
|
| 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: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.51
|
| Rate for Payer: BCN Commercial |
$1,089.51
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$731.86
|
| Rate for Payer: Cofinity Commercial |
$595.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$765.90
|
| 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 |
$723.35
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$723.35
|
| 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 |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$536.13
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.40
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
28313
|
| Min. Negotiated Rate |
$536.13 |
| Max. Negotiated Rate |
$765.90 |
| Rate for Payer: Aetna Commercial |
$723.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.15
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$595.70
|
| Rate for Payer: Cofinity Commercial |
$731.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$595.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$680.80
|
| Rate for Payer: Healthscope Commercial |
$765.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$723.35
|
| Rate for Payer: PHP Commercial |
$723.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health SBD |
$536.13
|
|
|
PR RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 28313
|
| Min. Negotiated Rate |
$340.40 |
| Max. Negotiated Rate |
$63,362.00 |
| Rate for Payer: Aetna Commercial |
$467.98
|
| Rate for Payer: Aetna Medicare |
$363.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.91
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$349.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,777.73
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: BCN Medicare Advantage |
$349.24
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$502.91
|
| Rate for Payer: Cofinity Commercial |
$467.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.24
|
| Rate for Payer: Healthscope Commercial |
$558.78
|
| Rate for Payer: Healthscope Commercial |
$646.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63,362.00
|
| Rate for Payer: Nomi Health Commercial |
$419.09
|
| Rate for Payer: PACE SWMI |
$349.24
|
| Rate for Payer: PHP Medicare Advantage |
$349.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.73
|
| Rate for Payer: Priority Health Medicare |
$349.24
|
| Rate for Payer: Priority Health Narrow Network |
$558.73
|
| Rate for Payer: Priority Health SBD |
$558.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.24
|
| Rate for Payer: UHC Exchange |
$578.77
|
| Rate for Payer: UHC Medicare Advantage |
$349.24
|
|
|
PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD
|
Professional
|
Both
|
$7,196.00
|
|
|
Service Code
|
HCPCS 21175
|
| Min. Negotiated Rate |
$377.57 |
| Max. Negotiated Rate |
$391,059.00 |
| Rate for Payer: Aetna Commercial |
$2,822.29
|
| Rate for Payer: Aetna Medicare |
$2,190.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,822.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,032.91
|
| Rate for Payer: BCBS Complete |
$1,485.71
|
| Rate for Payer: BCBS MAPPO |
$2,106.19
|
| Rate for Payer: BCBS Trust/PPO |
$377.57
|
| Rate for Payer: BCN Commercial |
$3,551.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,106.19
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cash Price |
$5,756.80
|
| Rate for Payer: Cofinity Commercial |
$3,032.91
|
| Rate for Payer: Cofinity Commercial |
$2,822.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,106.19
|
| Rate for Payer: Healthscope Commercial |
$3,896.45
|
| Rate for Payer: Healthscope Commercial |
$3,369.90
|
| Rate for Payer: Mclaren Medicaid |
$1,414.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,211.50
|
| Rate for Payer: Meridian Medicaid |
$1,485.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391,059.00
|
| Rate for Payer: Nomi Health Commercial |
$2,527.43
|
| Rate for Payer: PACE SWMI |
$2,106.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,106.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,414.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,677.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,358.99
|
| Rate for Payer: Priority Health Medicare |
$2,106.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,358.99
|
| Rate for Payer: Priority Health SBD |
$3,358.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,424.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,106.19
|
| Rate for Payer: UHC Exchange |
$2,424.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,106.19
|
| Rate for Payer: UHCCP Medicaid |
$1,414.96
|
|
|
PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 26545
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$129,206.00 |
| Rate for Payer: Aetna Commercial |
$920.10
|
| Rate for Payer: Aetna Medicare |
$714.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$920.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.76
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$686.64
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$1,090.73
|
| Rate for Payer: BCN Medicare Advantage |
$686.64
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cofinity Commercial |
$988.76
|
| Rate for Payer: Cofinity Commercial |
$920.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.64
|
| Rate for Payer: Healthscope Commercial |
$1,270.28
|
| Rate for Payer: Healthscope Commercial |
$1,098.62
|
| Rate for Payer: Mclaren Medicaid |
$473.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.97
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129,206.00
|
| Rate for Payer: Nomi Health Commercial |
$823.97
|
| Rate for Payer: PACE SWMI |
$686.64
|
| Rate for Payer: PHP Medicare Advantage |
$686.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.81
|
| Rate for Payer: Priority Health Medicare |
$686.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,137.81
|
| Rate for Payer: Priority Health SBD |
$1,137.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$885.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.64
|
| Rate for Payer: UHC Exchange |
$885.06
|
| Rate for Payer: UHC Medicare Advantage |
$686.64
|
| Rate for Payer: UHCCP Medicaid |
$473.50
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS
|
Professional
|
Both
|
$3,566.00
|
|
|
Service Code
|
HCPCS 26542
|
| Min. Negotiated Rate |
$466.90 |
| Max. Negotiated Rate |
$127,125.00 |
| Rate for Payer: Aetna Commercial |
$907.13
|
| Rate for Payer: Aetna Medicare |
$704.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.82
|
| Rate for Payer: BCBS Complete |
$490.24
|
| Rate for Payer: BCBS MAPPO |
$676.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,587.54
|
| Rate for Payer: BCN Commercial |
$1,073.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.96
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cash Price |
$2,852.80
|
| Rate for Payer: Cofinity Commercial |
$974.82
|
| Rate for Payer: Cofinity Commercial |
$907.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.96
|
| Rate for Payer: Healthscope Commercial |
$1,252.38
|
| Rate for Payer: Healthscope Commercial |
$1,083.14
|
| Rate for Payer: Mclaren Medicaid |
$466.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.81
|
| Rate for Payer: Meridian Medicaid |
$490.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127,125.00
|
| Rate for Payer: Nomi Health Commercial |
$812.35
|
| Rate for Payer: PACE SWMI |
$676.96
|
| Rate for Payer: PHP Medicare Advantage |
$676.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,317.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.97
|
| Rate for Payer: Priority Health Medicare |
$676.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.97
|
| Rate for Payer: Priority Health SBD |
$1,117.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$857.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.96
|
| Rate for Payer: UHC Exchange |
$857.46
|
| Rate for Payer: UHC Medicare Advantage |
$676.96
|
| Rate for Payer: UHCCP Medicaid |
$466.90
|
|
|
PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26541
|
| Min. Negotiated Rate |
$540.81 |
| Max. Negotiated Rate |
$147,177.00 |
| Rate for Payer: Aetna Commercial |
$1,055.18
|
| Rate for Payer: Aetna Medicare |
$818.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.93
|
| Rate for Payer: BCBS Complete |
$567.85
|
| Rate for Payer: BCBS MAPPO |
$787.45
|
| Rate for Payer: BCBS Trust/PPO |
$544.15
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| Rate for Payer: BCN Medicare Advantage |
$787.45
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.93
|
| Rate for Payer: Cofinity Commercial |
$1,055.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.45
|
| Rate for Payer: Healthscope Commercial |
$1,456.78
|
| Rate for Payer: Healthscope Commercial |
$1,259.92
|
| Rate for Payer: Mclaren Medicaid |
$540.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.82
|
| Rate for Payer: Meridian Medicaid |
$567.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147,177.00
|
| Rate for Payer: Nomi Health Commercial |
$944.94
|
| Rate for Payer: PACE SWMI |
$787.45
|
| Rate for Payer: PHP Medicare Advantage |
$787.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.00
|
| Rate for Payer: Priority Health Medicare |
$787.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,292.00
|
| Rate for Payer: Priority Health SBD |
$1,292.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,032.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.45
|
| Rate for Payer: UHC Exchange |
$1,032.62
|
| Rate for Payer: UHC Medicare Advantage |
$787.45
|
| Rate for Payer: UHCCP Medicaid |
$540.81
|
|
|
PR RCNSTJ DISLC PATELLA W/PATELLECTOMY
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 27424
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$133,171.00 |
| Rate for Payer: Aetna Commercial |
$971.66
|
| Rate for Payer: Aetna Medicare |
$754.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$971.66
|
| Rate for Payer: BCBS Complete |
$514.40
|
| Rate for Payer: BCBS MAPPO |
$725.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,069.81
|
| Rate for Payer: BCN Commercial |
$1,103.92
|
| Rate for Payer: BCN Medicare Advantage |
$725.12
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cofinity Commercial |
$971.66
|
| Rate for Payer: Cofinity Commercial |
$1,044.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.12
|
| Rate for Payer: Healthscope Commercial |
$1,341.47
|
| Rate for Payer: Healthscope Commercial |
$1,160.19
|
| Rate for Payer: Mclaren Medicaid |
$489.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.38
|
| Rate for Payer: Meridian Medicaid |
$514.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133,171.00
|
| Rate for Payer: Nomi Health Commercial |
$870.14
|
| Rate for Payer: PACE SWMI |
$725.12
|
| Rate for Payer: PHP Medicare Advantage |
$725.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$987.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,159.19
|
| Rate for Payer: Priority Health Medicare |
$725.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,159.19
|
| Rate for Payer: Priority Health SBD |
$1,159.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.12
|
| Rate for Payer: UHC Exchange |
$902.27
|
| Rate for Payer: UHC Medicare Advantage |
$725.12
|
| Rate for Payer: UHCCP Medicaid |
$489.90
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
OP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$792.43 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna Commercial |
$1,966.05
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,503.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,368.43
|
| Rate for Payer: BCN Commercial |
$2,368.43
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,989.18
|
| Rate for Payer: Cofinity Commercial |
$1,619.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,081.70
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$1,966.05
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$1,457.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.43
|
| Rate for Payer: UHC Core |
$6,837.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,940.59
|
| Rate for Payer: VA VA |
$6,999.28
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$131,872.00 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$747.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.47
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Healthscope Commercial |
$1,330.17
|
| Rate for Payer: Healthscope Commercial |
$1,150.42
|
| Rate for Payer: Mclaren Medicaid |
$485.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131,872.00
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.00
|
| Rate for Payer: Priority Health Medicare |
$719.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.00
|
| Rate for Payer: Priority Health SBD |
$1,148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Exchange |
$901.93
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
| Rate for Payer: UHCCP Medicaid |
$485.85
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 27422
|
| Hospital Charge Code |
27422
|
| Min. Negotiated Rate |
$478.11 |
| Max. Negotiated Rate |
$131,872.00 |
| Rate for Payer: Aetna Commercial |
$963.47
|
| Rate for Payer: Aetna Medicare |
$747.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.47
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS MAPPO |
$719.01
|
| Rate for Payer: BCBS Trust/PPO |
$478.11
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: BCN Medicare Advantage |
$719.01
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$963.47
|
| Rate for Payer: Cofinity Commercial |
$1,035.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.01
|
| Rate for Payer: Healthscope Commercial |
$1,330.17
|
| Rate for Payer: Healthscope Commercial |
$1,150.42
|
| Rate for Payer: Mclaren Medicaid |
$485.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$754.96
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131,872.00
|
| Rate for Payer: Nomi Health Commercial |
$862.81
|
| Rate for Payer: PACE SWMI |
$719.01
|
| Rate for Payer: PHP Medicare Advantage |
$719.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.00
|
| Rate for Payer: Priority Health Medicare |
$719.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.00
|
| Rate for Payer: Priority Health SBD |
$1,148.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.01
|
| Rate for Payer: UHC Exchange |
$901.93
|
| Rate for Payer: UHC Medicare Advantage |
$719.01
|
| Rate for Payer: UHCCP Medicaid |
$485.85
|
|
|
PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL
|
Facility
|
IP
|
$2,313.00
|
|
|
Service Code
|
CPT 27422
|
| Hospital Charge Code |
27422
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,457.19 |
| Max. Negotiated Rate |
$2,081.70 |
| Rate for Payer: Aetna Commercial |
$1,966.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,503.45
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,619.10
|
| Rate for Payer: Cofinity Commercial |
$1,989.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,619.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,850.40
|
| Rate for Payer: Healthscope Commercial |
$2,081.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,966.05
|
| Rate for Payer: PHP Commercial |
$1,966.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,503.45
|
| Rate for Payer: Priority Health SBD |
$1,457.19
|
|
|
PR RCNSTJ DISLOCATING PATELLA
|
Professional
|
Both
|
$2,335.00
|
|
|
Service Code
|
HCPCS 27420
|
| Min. Negotiated Rate |
$487.77 |
| Max. Negotiated Rate |
$132,651.00 |
| Rate for Payer: Aetna Commercial |
$967.10
|
| Rate for Payer: Aetna Medicare |
$750.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.10
|
| Rate for Payer: BCBS Complete |
$512.16
|
| Rate for Payer: BCBS MAPPO |
$721.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$1,099.53
|
| Rate for Payer: BCN Medicare Advantage |
$721.72
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cash Price |
$1,868.00
|
| Rate for Payer: Cofinity Commercial |
$967.10
|
| Rate for Payer: Cofinity Commercial |
$1,039.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.72
|
| Rate for Payer: Healthscope Commercial |
$1,335.18
|
| Rate for Payer: Healthscope Commercial |
$1,154.75
|
| Rate for Payer: Mclaren Medicaid |
$487.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.81
|
| Rate for Payer: Meridian Medicaid |
$512.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132,651.00
|
| Rate for Payer: Nomi Health Commercial |
$866.06
|
| Rate for Payer: PACE SWMI |
$721.72
|
| Rate for Payer: PHP Medicare Advantage |
$721.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,517.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.22
|
| Rate for Payer: Priority Health Medicare |
$721.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.22
|
| Rate for Payer: Priority Health SBD |
$1,161.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$721.72
|
| Rate for Payer: UHC Exchange |
$903.91
|
| Rate for Payer: UHC Medicare Advantage |
$721.72
|
| Rate for Payer: UHCCP Medicaid |
$487.77
|
|
|
PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT
|
Professional
|
Both
|
$3,020.00
|
|
|
Service Code
|
HCPCS 24344
|
| Min. Negotiated Rate |
$200.75 |
| Max. Negotiated Rate |
$193,369.00 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,108.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,427.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.41
|
| Rate for Payer: BCBS Complete |
$755.49
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCBS Trust/PPO |
$200.75
|
| Rate for Payer: BCN Commercial |
$1,602.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cash Price |
$2,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Healthscope Commercial |
$1,971.29
|
| Rate for Payer: Healthscope Commercial |
$1,704.90
|
| Rate for Payer: Mclaren Medicaid |
$719.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Meridian Medicaid |
$755.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193,369.00
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,963.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,704.18
|
| Rate for Payer: Priority Health Medicare |
$1,065.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.18
|
| Rate for Payer: Priority Health SBD |
$1,704.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Exchange |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
| Rate for Payer: UHCCP Medicaid |
$719.51
|
|
|
PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF
|
Professional
|
Both
|
$3,335.00
|
|
|
Service Code
|
HCPCS 24346
|
| Min. Negotiated Rate |
$272.60 |
| Max. Negotiated Rate |
$195,768.00 |
| Rate for Payer: Aetna Commercial |
$1,427.85
|
| Rate for Payer: Aetna Medicare |
$1,108.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,427.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,534.41
|
| Rate for Payer: BCBS Complete |
$755.49
|
| Rate for Payer: BCBS MAPPO |
$1,065.56
|
| Rate for Payer: BCBS Trust/PPO |
$272.60
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.56
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,534.41
|
| Rate for Payer: Cofinity Commercial |
$1,427.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.56
|
| Rate for Payer: Healthscope Commercial |
$1,971.29
|
| Rate for Payer: Healthscope Commercial |
$1,704.90
|
| Rate for Payer: Mclaren Medicaid |
$719.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,118.84
|
| Rate for Payer: Meridian Medicaid |
$755.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195,768.00
|
| Rate for Payer: Nomi Health Commercial |
$1,278.67
|
| Rate for Payer: PACE SWMI |
$1,065.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,167.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,704.18
|
| Rate for Payer: Priority Health Medicare |
$1,065.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,704.18
|
| Rate for Payer: Priority Health SBD |
$1,704.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.56
|
| Rate for Payer: UHC Exchange |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,065.56
|
| Rate for Payer: UHCCP Medicaid |
$719.51
|
|
|
PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT
|
Professional
|
Both
|
$6,461.00
|
|
|
Service Code
|
HCPCS 21194
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$250,159.00 |
| Rate for Payer: Aetna Commercial |
$1,798.74
|
| Rate for Payer: Aetna Medicare |
$1,396.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,798.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,932.97
|
| Rate for Payer: BCBS Complete |
$956.77
|
| Rate for Payer: BCBS MAPPO |
$1,342.34
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$2,076.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.34
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cash Price |
$5,168.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.97
|
| Rate for Payer: Cofinity Commercial |
$1,798.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.34
|
| Rate for Payer: Healthscope Commercial |
$2,483.33
|
| Rate for Payer: Healthscope Commercial |
$2,147.74
|
| Rate for Payer: Mclaren Medicaid |
$911.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.46
|
| Rate for Payer: Meridian Medicaid |
$956.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250,159.00
|
| Rate for Payer: Nomi Health Commercial |
$1,610.81
|
| Rate for Payer: PACE SWMI |
$1,342.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$911.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,199.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,158.59
|
| Rate for Payer: Priority Health Medicare |
$1,342.34
|
| Rate for Payer: Priority Health Narrow Network |
$2,158.59
|
| Rate for Payer: Priority Health SBD |
$2,158.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.34
|
| Rate for Payer: UHC Exchange |
$1,458.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.34
|
| Rate for Payer: UHCCP Medicaid |
$911.21
|
|
