|
PR REMOVAL/BIVALVING FULL ARM/FULL LEG CAST
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 29705
|
| Min. Negotiated Rate |
$43.37 |
| Max. Negotiated Rate |
$80.23 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.12
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$43.37
|
| Rate for Payer: BCN Medicare Advantage |
$43.37
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.37
|
| Rate for Payer: Healthscope Commercial |
$80.23
|
| Rate for Payer: Healthscope Commercial |
$69.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE SWMI |
$43.37
|
| Rate for Payer: PHP Medicare Advantage |
$43.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$43.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.37
|
| Rate for Payer: UHC Medicare Advantage |
$43.37
|
|
|
PR REMOVAL CERCLAGE SUTURE UNDER ANESTHESIA
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 59871
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$240.50 |
| Rate for Payer: Aetna Commercial |
$173.82
|
| Rate for Payer: Aetna Medicare |
$134.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.82
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$129.72
|
| Rate for Payer: BCN Medicare Advantage |
$129.72
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$186.80
|
| Rate for Payer: Cofinity Commercial |
$173.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$207.55
|
| Rate for Payer: Healthscope Commercial |
$239.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$240.50
|
| Rate for Payer: Nomi Health Commercial |
$155.66
|
| Rate for Payer: PACE SWMI |
$129.72
|
| Rate for Payer: PHP Medicare Advantage |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.50
|
| Rate for Payer: Priority Health Medicare |
$129.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.72
|
| Rate for Payer: UHC Medicare Advantage |
$129.72
|
|
|
PR REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE
|
Professional
|
Both
|
$1,549.00
|
|
|
Service Code
|
HCPCS 21029
|
| Min. Negotiated Rate |
$598.30 |
| Max. Negotiated Rate |
$1,106.86 |
| Rate for Payer: Aetna Commercial |
$801.72
|
| Rate for Payer: Aetna Medicare |
$622.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.72
|
| Rate for Payer: BCBS Complete |
$619.60
|
| Rate for Payer: BCBS MAPPO |
$598.30
|
| Rate for Payer: BCN Medicare Advantage |
$598.30
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cash Price |
$1,239.20
|
| Rate for Payer: Cofinity Commercial |
$861.55
|
| Rate for Payer: Cofinity Commercial |
$801.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.30
|
| Rate for Payer: Healthscope Commercial |
$957.28
|
| Rate for Payer: Healthscope Commercial |
$1,106.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$628.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,006.85
|
| Rate for Payer: Nomi Health Commercial |
$717.96
|
| Rate for Payer: PACE SWMI |
$598.30
|
| Rate for Payer: PHP Medicare Advantage |
$598.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,006.85
|
| Rate for Payer: Priority Health Medicare |
$598.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.30
|
| Rate for Payer: UHC Medicare Advantage |
$598.30
|
|
|
PR REMOVAL CRNL NRV NSTIM ELTRDS & PULSE GENERATO
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 64570
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,348.41 |
| Rate for Payer: Aetna Commercial |
$976.69
|
| Rate for Payer: Aetna Medicare |
$758.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$976.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,049.57
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: BCBS MAPPO |
$728.87
|
| Rate for Payer: BCN Medicare Advantage |
$728.87
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$976.69
|
| Rate for Payer: Cofinity Commercial |
$1,049.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.87
|
| Rate for Payer: Healthscope Commercial |
$1,166.19
|
| Rate for Payer: Healthscope Commercial |
$1,348.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$765.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,001.65
|
| Rate for Payer: Nomi Health Commercial |
$874.64
|
| Rate for Payer: PACE SWMI |
$728.87
|
| Rate for Payer: PHP Medicare Advantage |
$728.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health Medicare |
$728.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.87
|
| Rate for Payer: UHC Medicare Advantage |
$728.87
|
|
|
PR REMOVAL EMBEDDED FOREIGN BODY EYELID
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 67938
|
| Min. Negotiated Rate |
$105.64 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: Aetna Medicare |
$109.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.56
|
| Rate for Payer: BCBS Complete |
$192.00
|
| Rate for Payer: BCBS MAPPO |
$105.64
|
| Rate for Payer: BCN Medicare Advantage |
$105.64
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$152.12
|
| Rate for Payer: Cofinity Commercial |
$141.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.64
|
| Rate for Payer: Healthscope Commercial |
$195.43
|
| Rate for Payer: Healthscope Commercial |
$169.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.00
|
| Rate for Payer: Nomi Health Commercial |
$126.77
|
| Rate for Payer: PACE SWMI |
$105.64
|
| Rate for Payer: PHP Medicare Advantage |
$105.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$105.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.64
|
| Rate for Payer: UHC Medicare Advantage |
$105.64
|
|
|
PR REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 20694
|
| Min. Negotiated Rate |
$329.90 |
| Max. Negotiated Rate |
$620.10 |
| Rate for Payer: Aetna Commercial |
$442.07
|
| Rate for Payer: Aetna Medicare |
$343.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.07
|
| Rate for Payer: BCBS Complete |
$381.60
|
| Rate for Payer: BCBS MAPPO |
$329.90
|
| Rate for Payer: BCN Medicare Advantage |
$329.90
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cofinity Commercial |
$475.06
|
| Rate for Payer: Cofinity Commercial |
$442.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.90
|
| Rate for Payer: Healthscope Commercial |
$527.84
|
| Rate for Payer: Healthscope Commercial |
$610.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.10
|
| Rate for Payer: Nomi Health Commercial |
$395.88
|
| Rate for Payer: PACE SWMI |
$329.90
|
| Rate for Payer: PHP Medicare Advantage |
$329.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.10
|
| Rate for Payer: Priority Health Medicare |
$329.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.90
|
| Rate for Payer: UHC Medicare Advantage |
$329.90
|
|
|
PR REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 65205
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Aetna Commercial |
$36.19
|
| Rate for Payer: Aetna Medicare |
$28.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.19
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$27.01
|
| Rate for Payer: BCN Medicare Advantage |
$27.01
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$38.89
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.01
|
| Rate for Payer: Healthscope Commercial |
$49.97
|
| Rate for Payer: Healthscope Commercial |
$43.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.10
|
| Rate for Payer: Nomi Health Commercial |
$32.41
|
| Rate for Payer: PACE SWMI |
$27.01
|
| Rate for Payer: PHP Medicare Advantage |
$27.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$27.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.01
|
| Rate for Payer: UHC Medicare Advantage |
$27.01
|
|
|
PR REMOVAL FOREIGN BODY DEEP PENILE TISSUE
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 54115
|
| Min. Negotiated Rate |
$340.00 |
| Max. Negotiated Rate |
$755.45 |
| Rate for Payer: Aetna Commercial |
$547.19
|
| Rate for Payer: Aetna Medicare |
$424.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.19
|
| Rate for Payer: BCBS Complete |
$340.00
|
| Rate for Payer: BCBS MAPPO |
$408.35
|
| Rate for Payer: BCN Medicare Advantage |
$408.35
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$588.02
|
| Rate for Payer: Cofinity Commercial |
$547.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.35
|
| Rate for Payer: Healthscope Commercial |
$653.36
|
| Rate for Payer: Healthscope Commercial |
$755.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.50
|
| Rate for Payer: Nomi Health Commercial |
$490.02
|
| Rate for Payer: PACE SWMI |
$408.35
|
| Rate for Payer: PHP Medicare Advantage |
$408.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.50
|
| Rate for Payer: Priority Health Medicare |
$408.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.35
|
| Rate for Payer: UHC Medicare Advantage |
$408.35
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$701.82 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$946.90
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Commercial |
$779.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$779.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,002.60
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.90
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$946.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$701.82
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
27372
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$701.82 |
| Max. Negotiated Rate |
$1,002.60 |
| Rate for Payer: Aetna Commercial |
$946.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.10
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$779.80
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$779.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$891.20
|
| Rate for Payer: Healthscope Commercial |
$1,002.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$946.90
|
| Rate for Payer: PHP Commercial |
$946.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health SBD |
$701.82
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 27372
|
| Min. Negotiated Rate |
$387.70 |
| Max. Negotiated Rate |
$724.10 |
| Rate for Payer: Aetna Commercial |
$519.52
|
| Rate for Payer: Aetna Medicare |
$403.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.52
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$387.70
|
| Rate for Payer: BCN Medicare Advantage |
$387.70
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$558.29
|
| Rate for Payer: Cofinity Commercial |
$519.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.70
|
| Rate for Payer: Healthscope Commercial |
$717.25
|
| Rate for Payer: Healthscope Commercial |
$620.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.10
|
| Rate for Payer: Nomi Health Commercial |
$465.24
|
| Rate for Payer: PACE SWMI |
$387.70
|
| Rate for Payer: PHP Medicare Advantage |
$387.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$387.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.70
|
| Rate for Payer: UHC Medicare Advantage |
$387.70
|
|
|
PR REMOVAL FOREIGN BODY DEEP THIGH/KNEE
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 27372
|
| Hospital Charge Code |
27372
|
| Min. Negotiated Rate |
$387.70 |
| Max. Negotiated Rate |
$724.10 |
| Rate for Payer: Aetna Commercial |
$519.52
|
| Rate for Payer: Aetna Medicare |
$403.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.52
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$387.70
|
| Rate for Payer: BCN Medicare Advantage |
$387.70
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$558.29
|
| Rate for Payer: Cofinity Commercial |
$519.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.70
|
| Rate for Payer: Healthscope Commercial |
$620.32
|
| Rate for Payer: Healthscope Commercial |
$717.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$724.10
|
| Rate for Payer: Nomi Health Commercial |
$465.24
|
| Rate for Payer: PACE SWMI |
$387.70
|
| Rate for Payer: PHP Medicare Advantage |
$387.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$387.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.70
|
| Rate for Payer: UHC Medicare Advantage |
$387.70
|
|
|
PR REMOVAL FOREIGN BODY FOOT COMPLICATED
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 28193
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$644.54 |
| Rate for Payer: Aetna Commercial |
$466.86
|
| Rate for Payer: Aetna Medicare |
$362.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.86
|
| Rate for Payer: BCBS Complete |
$376.80
|
| Rate for Payer: BCBS MAPPO |
$348.40
|
| Rate for Payer: BCN Medicare Advantage |
$348.40
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$501.70
|
| Rate for Payer: Cofinity Commercial |
$466.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.40
|
| Rate for Payer: Healthscope Commercial |
$557.44
|
| Rate for Payer: Healthscope Commercial |
$644.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.30
|
| Rate for Payer: Nomi Health Commercial |
$418.08
|
| Rate for Payer: PACE SWMI |
$348.40
|
| Rate for Payer: PHP Medicare Advantage |
$348.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health Medicare |
$348.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.40
|
| Rate for Payer: UHC Medicare Advantage |
$348.40
|
|
|
PR REMOVAL FOREIGN BODY FOOT DEEP
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 28192
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$550.87 |
| Rate for Payer: Aetna Commercial |
$399.01
|
| Rate for Payer: Aetna Medicare |
$309.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.01
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$297.77
|
| Rate for Payer: BCN Medicare Advantage |
$297.77
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$428.79
|
| Rate for Payer: Cofinity Commercial |
$399.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.77
|
| Rate for Payer: Healthscope Commercial |
$550.87
|
| Rate for Payer: Healthscope Commercial |
$476.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.25
|
| Rate for Payer: Nomi Health Commercial |
$357.32
|
| Rate for Payer: PACE SWMI |
$297.77
|
| Rate for Payer: PHP Medicare Advantage |
$297.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$297.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.77
|
| Rate for Payer: UHC Medicare Advantage |
$297.77
|
|
|
PR REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 28190
|
| Min. Negotiated Rate |
$125.94 |
| Max. Negotiated Rate |
$388.70 |
| Rate for Payer: Aetna Commercial |
$168.76
|
| Rate for Payer: Aetna Medicare |
$130.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.76
|
| Rate for Payer: BCBS Complete |
$239.20
|
| Rate for Payer: BCBS MAPPO |
$125.94
|
| Rate for Payer: BCN Medicare Advantage |
$125.94
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cofinity Commercial |
$181.35
|
| Rate for Payer: Cofinity Commercial |
$168.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.94
|
| Rate for Payer: Healthscope Commercial |
$201.50
|
| Rate for Payer: Healthscope Commercial |
$232.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.70
|
| Rate for Payer: Nomi Health Commercial |
$151.13
|
| Rate for Payer: PACE SWMI |
$125.94
|
| Rate for Payer: PHP Medicare Advantage |
$125.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.70
|
| Rate for Payer: Priority Health Medicare |
$125.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.94
|
| Rate for Payer: UHC Medicare Advantage |
$125.94
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL GENERAL ANES
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 30310
|
| Min. Negotiated Rate |
$147.60 |
| Max. Negotiated Rate |
$354.33 |
| Rate for Payer: Aetna Commercial |
$256.65
|
| Rate for Payer: Aetna Medicare |
$199.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.65
|
| Rate for Payer: BCBS Complete |
$147.60
|
| Rate for Payer: BCBS MAPPO |
$191.53
|
| Rate for Payer: BCN Medicare Advantage |
$191.53
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$275.80
|
| Rate for Payer: Cofinity Commercial |
$256.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.53
|
| Rate for Payer: Healthscope Commercial |
$354.33
|
| Rate for Payer: Healthscope Commercial |
$306.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.85
|
| Rate for Payer: Nomi Health Commercial |
$229.84
|
| Rate for Payer: PACE SWMI |
$191.53
|
| Rate for Payer: PHP Medicare Advantage |
$191.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health Medicare |
$191.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.53
|
| Rate for Payer: UHC Medicare Advantage |
$191.53
|
|
|
PR REMOVAL FOREIGN BODY INTRANASAL OFFICE PROCEDURE
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 30300
|
| Min. Negotiated Rate |
$112.35 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$116.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.55
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$112.35
|
| Rate for Payer: BCN Medicare Advantage |
$112.35
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$161.78
|
| Rate for Payer: Cofinity Commercial |
$150.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.35
|
| Rate for Payer: Healthscope Commercial |
$179.76
|
| Rate for Payer: Healthscope Commercial |
$207.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.80
|
| Rate for Payer: Nomi Health Commercial |
$134.82
|
| Rate for Payer: PACE SWMI |
$112.35
|
| Rate for Payer: PHP Medicare Advantage |
$112.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$112.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.35
|
| Rate for Payer: UHC Medicare Advantage |
$112.35
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 20520
|
| Hospital Charge Code |
20520
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Medicare |
$146.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$140.83
|
| Rate for Payer: BCN Medicare Advantage |
$140.83
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.83
|
| Rate for Payer: Healthscope Commercial |
$225.33
|
| Rate for Payer: Healthscope Commercial |
$260.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$169.00
|
| Rate for Payer: PACE SWMI |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$140.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.83
|
| Rate for Payer: UHC Medicare Advantage |
$140.83
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.15 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Commercial |
$348.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$364.50
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.25
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$344.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$255.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 20520
|
| Hospital Charge Code |
20520
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$255.15 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Aetna Commercial |
$344.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.25
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$283.50
|
| Rate for Payer: Cofinity Commercial |
$348.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$283.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.00
|
| Rate for Payer: Healthscope Commercial |
$364.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.25
|
| Rate for Payer: PHP Commercial |
$344.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health SBD |
$255.15
|
|
|
PR REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 20520
|
| Min. Negotiated Rate |
$140.83 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Medicare |
$146.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.71
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$140.83
|
| Rate for Payer: BCN Medicare Advantage |
$140.83
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$202.80
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.83
|
| Rate for Payer: Healthscope Commercial |
$260.54
|
| Rate for Payer: Healthscope Commercial |
$225.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.25
|
| Rate for Payer: Nomi Health Commercial |
$169.00
|
| Rate for Payer: PACE SWMI |
$140.83
|
| Rate for Payer: PHP Medicare Advantage |
$140.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$140.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.83
|
| Rate for Payer: UHC Medicare Advantage |
$140.83
|
|
|
PR REMOVAL FOREIGN BODY PELVIS/HIP DEEP
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS 27087
|
| Min. Negotiated Rate |
$546.80 |
| Max. Negotiated Rate |
$1,106.30 |
| Rate for Payer: Aetna Commercial |
$801.32
|
| Rate for Payer: Aetna Medicare |
$621.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$861.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$801.32
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS MAPPO |
$598.00
|
| Rate for Payer: BCN Medicare Advantage |
$598.00
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$861.12
|
| Rate for Payer: Cofinity Commercial |
$801.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$598.00
|
| Rate for Payer: Healthscope Commercial |
$1,106.30
|
| Rate for Payer: Healthscope Commercial |
$956.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.55
|
| Rate for Payer: Nomi Health Commercial |
$717.60
|
| Rate for Payer: PACE SWMI |
$598.00
|
| Rate for Payer: PHP Medicare Advantage |
$598.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health Medicare |
$598.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$598.00
|
| Rate for Payer: UHC Medicare Advantage |
$598.00
|
|
|
PR REMOVAL FOREIGN BODY PHARYNX
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 42809
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$222.70 |
| Rate for Payer: Aetna Commercial |
$161.31
|
| Rate for Payer: Aetna Medicare |
$125.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.31
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$120.38
|
| Rate for Payer: BCN Medicare Advantage |
$120.38
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$173.35
|
| Rate for Payer: Cofinity Commercial |
$161.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.38
|
| Rate for Payer: Healthscope Commercial |
$222.70
|
| Rate for Payer: Healthscope Commercial |
$192.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.95
|
| Rate for Payer: Nomi Health Commercial |
$144.46
|
| Rate for Payer: PACE SWMI |
$120.38
|
| Rate for Payer: PHP Medicare Advantage |
$120.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$120.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.38
|
| Rate for Payer: UHC Medicare Advantage |
$120.38
|
|
|
PR REMOVAL FOREIGN BODY SCROTUM
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 55120
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$630.05 |
| Rate for Payer: Aetna Commercial |
$456.36
|
| Rate for Payer: Aetna Medicare |
$354.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.36
|
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS MAPPO |
$340.57
|
| Rate for Payer: BCN Medicare Advantage |
$340.57
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$490.42
|
| Rate for Payer: Cofinity Commercial |
$456.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.57
|
| Rate for Payer: Healthscope Commercial |
$544.91
|
| Rate for Payer: Healthscope Commercial |
$630.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.85
|
| Rate for Payer: Nomi Health Commercial |
$408.68
|
| Rate for Payer: PACE SWMI |
$340.57
|
| Rate for Payer: PHP Medicare Advantage |
$340.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health Medicare |
$340.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.57
|
| Rate for Payer: UHC Medicare Advantage |
$340.57
|
|
|
PR REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 23330
|
| Min. Negotiated Rate |
$160.83 |
| Max. Negotiated Rate |
$297.54 |
| Rate for Payer: Aetna Commercial |
$215.51
|
| Rate for Payer: Aetna Medicare |
$167.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.51
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$160.83
|
| Rate for Payer: BCN Medicare Advantage |
$160.83
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$231.60
|
| Rate for Payer: Cofinity Commercial |
$215.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.83
|
| Rate for Payer: Healthscope Commercial |
$297.54
|
| Rate for Payer: Healthscope Commercial |
$257.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.50
|
| Rate for Payer: Nomi Health Commercial |
$193.00
|
| Rate for Payer: PACE SWMI |
$160.83
|
| Rate for Payer: PHP Medicare Advantage |
$160.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health Medicare |
$160.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.83
|
| Rate for Payer: UHC Medicare Advantage |
$160.83
|
|
