|
PR REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP
|
Professional
|
Both
|
$907.00
|
|
|
Service Code
|
HCPCS 24201
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$716.23 |
| Rate for Payer: Aetna Commercial |
$518.78
|
| Rate for Payer: Aetna Medicare |
$402.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.78
|
| Rate for Payer: BCBS Complete |
$362.80
|
| Rate for Payer: BCBS MAPPO |
$387.15
|
| Rate for Payer: BCN Medicare Advantage |
$387.15
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cash Price |
$725.60
|
| Rate for Payer: Cofinity Commercial |
$557.50
|
| Rate for Payer: Cofinity Commercial |
$518.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.15
|
| Rate for Payer: Healthscope Commercial |
$619.44
|
| Rate for Payer: Healthscope Commercial |
$716.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$406.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.55
|
| Rate for Payer: Nomi Health Commercial |
$464.58
|
| Rate for Payer: PACE SWMI |
$387.15
|
| Rate for Payer: PHP Medicare Advantage |
$387.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$589.55
|
| Rate for Payer: Priority Health Medicare |
$387.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$387.15
|
| Rate for Payer: UHC Medicare Advantage |
$387.15
|
|
|
PR REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,105.00
|
|
|
Service Code
|
HCPCS 27090
|
| Min. Negotiated Rate |
$799.27 |
| Max. Negotiated Rate |
$1,478.65 |
| Rate for Payer: Aetna Commercial |
$1,071.02
|
| Rate for Payer: Aetna Medicare |
$831.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,071.02
|
| Rate for Payer: BCBS Complete |
$842.00
|
| Rate for Payer: BCBS MAPPO |
$799.27
|
| Rate for Payer: BCN Medicare Advantage |
$799.27
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cash Price |
$1,684.00
|
| Rate for Payer: Cofinity Commercial |
$1,150.95
|
| Rate for Payer: Cofinity Commercial |
$1,071.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$799.27
|
| Rate for Payer: Healthscope Commercial |
$1,478.65
|
| Rate for Payer: Healthscope Commercial |
$1,278.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$839.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,368.25
|
| Rate for Payer: Nomi Health Commercial |
$959.12
|
| Rate for Payer: PACE SWMI |
$799.27
|
| Rate for Payer: PHP Medicare Advantage |
$799.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,368.25
|
| Rate for Payer: Priority Health Medicare |
$799.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$799.27
|
| Rate for Payer: UHC Medicare Advantage |
$799.27
|
|
|
PR REMOVAL HYPOGLOSSAL NERVE NSTIM RA PG&RESPIR SNR
|
Professional
|
Both
|
$2,509.00
|
|
|
Service Code
|
HCPCS 64584
|
| Min. Negotiated Rate |
$696.91 |
| Max. Negotiated Rate |
$1,630.85 |
| Rate for Payer: Aetna Commercial |
$933.86
|
| Rate for Payer: Aetna Medicare |
$724.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.55
|
| Rate for Payer: BCBS Complete |
$1,003.60
|
| Rate for Payer: BCBS MAPPO |
$696.91
|
| Rate for Payer: BCN Medicare Advantage |
$696.91
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cash Price |
$2,007.20
|
| Rate for Payer: Cofinity Commercial |
$933.86
|
| Rate for Payer: Cofinity Commercial |
$1,003.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.91
|
| Rate for Payer: Healthscope Commercial |
$1,115.06
|
| Rate for Payer: Healthscope Commercial |
$1,289.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,630.85
|
| Rate for Payer: Nomi Health Commercial |
$836.29
|
| Rate for Payer: PACE SWMI |
$696.91
|
| Rate for Payer: PHP Medicare Advantage |
$696.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,630.85
|
| Rate for Payer: Priority Health Medicare |
$696.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.91
|
| Rate for Payer: UHC Medicare Advantage |
$696.91
|
|
|
PR REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 69210
|
| Min. Negotiated Rate |
$30.64 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Commercial |
$41.06
|
| Rate for Payer: Aetna Medicare |
$31.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.06
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS MAPPO |
$30.64
|
| Rate for Payer: BCN Medicare Advantage |
$30.64
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$44.12
|
| Rate for Payer: Cofinity Commercial |
$41.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$56.68
|
| Rate for Payer: Healthscope Commercial |
$49.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.05
|
| Rate for Payer: Nomi Health Commercial |
$36.77
|
| Rate for Payer: PACE SWMI |
$30.64
|
| Rate for Payer: PHP Medicare Advantage |
$30.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$30.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.64
|
| Rate for Payer: UHC Medicare Advantage |
$30.64
|
|
|
PR REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 69209
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$25.77 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare |
$14.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.67
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$13.93
|
| Rate for Payer: BCN Medicare Advantage |
$13.93
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Cofinity Commercial |
$18.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$25.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$16.72
|
| Rate for Payer: PACE SWMI |
$13.93
|
| Rate for Payer: PHP Medicare Advantage |
$13.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$13.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.93
|
| Rate for Payer: UHC Medicare Advantage |
$13.93
|
|
|
PR REMOVAL IMPACTED VAG FB SPX W/ANES OTH/THN LOCAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 57415
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$307.91 |
| Rate for Payer: Aetna Commercial |
$223.03
|
| Rate for Payer: Aetna Medicare |
$173.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.03
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$166.44
|
| Rate for Payer: BCN Medicare Advantage |
$166.44
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$239.67
|
| Rate for Payer: Cofinity Commercial |
$223.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$307.91
|
| Rate for Payer: Healthscope Commercial |
$266.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.80
|
| Rate for Payer: Nomi Health Commercial |
$199.73
|
| Rate for Payer: PACE SWMI |
$166.44
|
| Rate for Payer: PHP Medicare Advantage |
$166.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Medicare |
$166.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.44
|
| Rate for Payer: UHC Medicare Advantage |
$166.44
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$151.83 |
| Max. Negotiated Rate |
$1,931.58 |
| Rate for Payer: Aetna Commercial |
$204.85
|
| Rate for Payer: Aetna Medicare |
$713.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$857.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$857.75
|
| Rate for Payer: BCBS Complete |
$386.19
|
| Rate for Payer: BCBS MAPPO |
$686.20
|
| Rate for Payer: BCN Medicare Advantage |
$686.20
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$168.70
|
| Rate for Payer: Cofinity Commercial |
$207.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.20
|
| Rate for Payer: Healthscope Commercial |
$216.90
|
| Rate for Payer: Mclaren Medicaid |
$367.80
|
| Rate for Payer: Mclaren Medicare |
$686.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.51
|
| Rate for Payer: Meridian Medicaid |
$386.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$789.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: PACE Medicare |
$651.89
|
| Rate for Payer: PACE SWMI |
$686.20
|
| Rate for Payer: PHP Commercial |
$204.85
|
| Rate for Payer: PHP Medicare Advantage |
$686.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$686.20
|
| Rate for Payer: Priority Health SBD |
$151.83
|
| Rate for Payer: Railroad Medicare Medicare |
$686.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,931.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.20
|
| Rate for Payer: UHC Medicare Advantage |
$686.20
|
| Rate for Payer: UHCCP Medicaid |
$386.33
|
| Rate for Payer: VA VA |
$686.20
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$164.48 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$92.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$142.26
|
| Rate for Payer: Healthscope Commercial |
$164.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.65
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 11976
|
| Hospital Charge Code |
11976
|
| Min. Negotiated Rate |
$88.91 |
| Max. Negotiated Rate |
$164.48 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$92.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.03
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$88.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.91
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$128.03
|
| Rate for Payer: Cofinity Commercial |
$119.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$142.26
|
| Rate for Payer: Healthscope Commercial |
$164.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.65
|
| Rate for Payer: Nomi Health Commercial |
$106.69
|
| Rate for Payer: PACE SWMI |
$88.91
|
| Rate for Payer: PHP Medicare Advantage |
$88.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$88.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.91
|
| Rate for Payer: UHC Medicare Advantage |
$88.91
|
|
|
PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 11976
|
| Hospital Charge Code |
11976
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$151.83 |
| Max. Negotiated Rate |
$216.90 |
| Rate for Payer: Aetna Commercial |
$204.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.65
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$168.70
|
| Rate for Payer: Cofinity Commercial |
$207.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.80
|
| Rate for Payer: Healthscope Commercial |
$216.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.85
|
| Rate for Payer: PHP Commercial |
$204.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health SBD |
$151.83
|
|
|
PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 33241
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$375.90 |
| Rate for Payer: Aetna Commercial |
$272.27
|
| Rate for Payer: Aetna Medicare |
$211.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.27
|
| Rate for Payer: BCBS Complete |
$175.20
|
| Rate for Payer: BCBS MAPPO |
$203.19
|
| Rate for Payer: BCN Medicare Advantage |
$203.19
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$292.59
|
| Rate for Payer: Cofinity Commercial |
$272.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.19
|
| Rate for Payer: Healthscope Commercial |
$375.90
|
| Rate for Payer: Healthscope Commercial |
$325.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$284.70
|
| Rate for Payer: Nomi Health Commercial |
$243.83
|
| Rate for Payer: PACE SWMI |
$203.19
|
| Rate for Payer: PHP Medicare Advantage |
$203.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.70
|
| Rate for Payer: Priority Health Medicare |
$203.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.19
|
| Rate for Payer: UHC Medicare Advantage |
$203.19
|
|
|
PR REMOVAL IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$745.68 |
| Rate for Payer: Aetna Commercial |
$540.11
|
| Rate for Payer: Aetna Medicare |
$419.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.42
|
| Rate for Payer: BCBS Complete |
$434.00
|
| Rate for Payer: BCBS MAPPO |
$403.07
|
| Rate for Payer: BCN Medicare Advantage |
$403.07
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$540.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.07
|
| Rate for Payer: Healthscope Commercial |
$644.91
|
| Rate for Payer: Healthscope Commercial |
$745.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.25
|
| Rate for Payer: Nomi Health Commercial |
$483.68
|
| Rate for Payer: PACE SWMI |
$403.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.07
|
| Rate for Payer: UHC Medicare Advantage |
$403.07
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$683.55 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$922.25
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.25
|
| 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 |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$759.50
|
| Rate for Payer: Cofinity Commercial |
$933.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$759.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$976.50
|
| 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 |
$922.25
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$922.25
|
| 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 |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$683.55
|
| 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 IMPLANT DEEP
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
HCPCS 20680
|
| Min. Negotiated Rate |
$403.07 |
| Max. Negotiated Rate |
$745.68 |
| Rate for Payer: Aetna Commercial |
$540.11
|
| Rate for Payer: Aetna Medicare |
$419.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.11
|
| Rate for Payer: BCBS Complete |
$434.00
|
| Rate for Payer: BCBS MAPPO |
$403.07
|
| Rate for Payer: BCN Medicare Advantage |
$403.07
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$580.42
|
| Rate for Payer: Cofinity Commercial |
$540.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.07
|
| Rate for Payer: Healthscope Commercial |
$644.91
|
| Rate for Payer: Healthscope Commercial |
$745.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$705.25
|
| Rate for Payer: Nomi Health Commercial |
$483.68
|
| Rate for Payer: PACE SWMI |
$403.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health Medicare |
$403.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.07
|
| Rate for Payer: UHC Medicare Advantage |
$403.07
|
|
|
PR REMOVAL IMPLANT DEEP
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 20680
|
| Hospital Charge Code |
20680
|
| Min. Negotiated Rate |
$683.55 |
| Max. Negotiated Rate |
$976.50 |
| Rate for Payer: Aetna Commercial |
$922.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.25
|
| Rate for Payer: Cash Price |
$868.00
|
| Rate for Payer: Cofinity Commercial |
$759.50
|
| Rate for Payer: Cofinity Commercial |
$933.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$759.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$868.00
|
| Rate for Payer: Healthscope Commercial |
$976.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$922.25
|
| Rate for Payer: PHP Commercial |
$922.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$705.25
|
| Rate for Payer: Priority Health SBD |
$683.55
|
|
|
PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP
|
Professional
|
Both
|
$833.00
|
|
|
Service Code
|
HCPCS 36262
|
| Min. Negotiated Rate |
$303.54 |
| Max. Negotiated Rate |
$561.55 |
| Rate for Payer: Aetna Commercial |
$406.74
|
| Rate for Payer: Aetna Medicare |
$315.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.74
|
| Rate for Payer: BCBS Complete |
$333.20
|
| Rate for Payer: BCBS MAPPO |
$303.54
|
| Rate for Payer: BCN Medicare Advantage |
$303.54
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cash Price |
$666.40
|
| Rate for Payer: Cofinity Commercial |
$437.10
|
| Rate for Payer: Cofinity Commercial |
$406.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.54
|
| Rate for Payer: Healthscope Commercial |
$561.55
|
| Rate for Payer: Healthscope Commercial |
$485.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$364.25
|
| Rate for Payer: PACE SWMI |
$303.54
|
| Rate for Payer: PHP Medicare Advantage |
$303.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.45
|
| Rate for Payer: Priority Health Medicare |
$303.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.54
|
| Rate for Payer: UHC Medicare Advantage |
$303.54
|
|
|
PR REMOVAL IMPLANT FROM FINGER/HAND
|
Professional
|
Both
|
$1,044.00
|
|
|
Service Code
|
HCPCS 26320
|
| Min. Negotiated Rate |
$338.64 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna Commercial |
$453.78
|
| Rate for Payer: Aetna Medicare |
$352.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.78
|
| Rate for Payer: BCBS Complete |
$417.60
|
| Rate for Payer: BCBS MAPPO |
$338.64
|
| Rate for Payer: BCN Medicare Advantage |
$338.64
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cofinity Commercial |
$487.64
|
| Rate for Payer: Cofinity Commercial |
$453.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.64
|
| Rate for Payer: Healthscope Commercial |
$541.82
|
| Rate for Payer: Healthscope Commercial |
$626.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.60
|
| Rate for Payer: Nomi Health Commercial |
$406.37
|
| Rate for Payer: PACE SWMI |
$338.64
|
| Rate for Payer: PHP Medicare Advantage |
$338.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.60
|
| Rate for Payer: Priority Health Medicare |
$338.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.64
|
| Rate for Payer: UHC Medicare Advantage |
$338.64
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$578.97 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$781.15
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.35
|
| 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 |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$643.30
|
| Rate for Payer: Cofinity Commercial |
$790.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$827.10
|
| 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 |
$781.15
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$781.15
|
| 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 |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$578.97
|
| 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 IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$137.77 |
| Max. Negotiated Rate |
$597.35 |
| Rate for Payer: Aetna Commercial |
$184.61
|
| Rate for Payer: Aetna Medicare |
$143.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.39
|
| Rate for Payer: BCBS Complete |
$367.60
|
| Rate for Payer: BCBS MAPPO |
$137.77
|
| Rate for Payer: BCN Medicare Advantage |
$137.77
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$198.39
|
| Rate for Payer: Cofinity Commercial |
$184.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.77
|
| Rate for Payer: Healthscope Commercial |
$220.43
|
| Rate for Payer: Healthscope Commercial |
$254.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.35
|
| Rate for Payer: Nomi Health Commercial |
$165.32
|
| Rate for Payer: PACE SWMI |
$137.77
|
| Rate for Payer: PHP Medicare Advantage |
$137.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$137.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.77
|
| Rate for Payer: UHC Medicare Advantage |
$137.77
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 20670
|
| Hospital Charge Code |
20670
|
| Min. Negotiated Rate |
$578.97 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Aetna Commercial |
$781.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.35
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$643.30
|
| Rate for Payer: Cofinity Commercial |
$790.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$643.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$735.20
|
| Rate for Payer: Healthscope Commercial |
$827.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.15
|
| Rate for Payer: PHP Commercial |
$781.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health SBD |
$578.97
|
|
|
PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$919.00
|
|
|
Service Code
|
HCPCS 20670
|
| Min. Negotiated Rate |
$137.77 |
| Max. Negotiated Rate |
$597.35 |
| Rate for Payer: Aetna Commercial |
$184.61
|
| Rate for Payer: Aetna Medicare |
$143.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.61
|
| Rate for Payer: BCBS Complete |
$367.60
|
| Rate for Payer: BCBS MAPPO |
$137.77
|
| Rate for Payer: BCN Medicare Advantage |
$137.77
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cash Price |
$735.20
|
| Rate for Payer: Cofinity Commercial |
$198.39
|
| Rate for Payer: Cofinity Commercial |
$184.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.77
|
| Rate for Payer: Healthscope Commercial |
$254.87
|
| Rate for Payer: Healthscope Commercial |
$220.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$597.35
|
| Rate for Payer: Nomi Health Commercial |
$165.32
|
| Rate for Payer: PACE SWMI |
$137.77
|
| Rate for Payer: PHP Medicare Advantage |
$137.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.35
|
| Rate for Payer: Priority Health Medicare |
$137.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.77
|
| Rate for Payer: UHC Medicare Advantage |
$137.77
|
|
|
PR REMOVAL INDWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$1,695.00
|
|
|
Service Code
|
HCPCS 50384
|
| Min. Negotiated Rate |
$214.55 |
| Max. Negotiated Rate |
$1,101.75 |
| Rate for Payer: Aetna Commercial |
$287.50
|
| Rate for Payer: Aetna Medicare |
$223.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.50
|
| Rate for Payer: BCBS Complete |
$678.00
|
| Rate for Payer: BCBS MAPPO |
$214.55
|
| Rate for Payer: BCN Medicare Advantage |
$214.55
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cash Price |
$1,356.00
|
| Rate for Payer: Cofinity Commercial |
$308.95
|
| Rate for Payer: Cofinity Commercial |
$287.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.55
|
| Rate for Payer: Healthscope Commercial |
$343.28
|
| Rate for Payer: Healthscope Commercial |
$396.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.75
|
| Rate for Payer: Nomi Health Commercial |
$257.46
|
| Rate for Payer: PACE SWMI |
$214.55
|
| Rate for Payer: PHP Medicare Advantage |
$214.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,101.75
|
| Rate for Payer: Priority Health Medicare |
$214.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.55
|
| Rate for Payer: UHC Medicare Advantage |
$214.55
|
|
|
PR REMOVAL INTACT BREAST IMPLANT
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 19328
|
| Min. Negotiated Rate |
$531.46 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$712.16
|
| Rate for Payer: Aetna Medicare |
$552.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.16
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$531.46
|
| Rate for Payer: BCN Medicare Advantage |
$531.46
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$765.30
|
| Rate for Payer: Cofinity Commercial |
$712.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.46
|
| Rate for Payer: Healthscope Commercial |
$983.20
|
| Rate for Payer: Healthscope Commercial |
$850.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.50
|
| Rate for Payer: Nomi Health Commercial |
$637.75
|
| Rate for Payer: PACE SWMI |
$531.46
|
| Rate for Payer: PHP Medicare Advantage |
$531.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$531.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.46
|
| Rate for Payer: UHC Medicare Advantage |
$531.46
|
|
|
PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 33968
|
| Min. Negotiated Rate |
$32.58 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Commercial |
$43.66
|
| Rate for Payer: Aetna Medicare |
$33.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.66
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS MAPPO |
$32.58
|
| Rate for Payer: BCN Medicare Advantage |
$32.58
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cofinity Commercial |
$46.92
|
| Rate for Payer: Cofinity Commercial |
$43.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.58
|
| Rate for Payer: Healthscope Commercial |
$52.13
|
| Rate for Payer: Healthscope Commercial |
$60.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.40
|
| Rate for Payer: Nomi Health Commercial |
$39.10
|
| Rate for Payer: PACE SWMI |
$32.58
|
| Rate for Payer: PHP Medicare Advantage |
$32.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health Medicare |
$32.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.58
|
| Rate for Payer: UHC Medicare Advantage |
$32.58
|
|
|
PR REMOVAL INTRA-ARTICULAR DRUG DELIVERY DEVICE
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 20705
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$221.15 |
| Rate for Payer: Aetna Commercial |
$160.18
|
| Rate for Payer: Aetna Medicare |
$124.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.18
|
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: BCBS MAPPO |
$119.54
|
| Rate for Payer: BCN Medicare Advantage |
$119.54
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$172.14
|
| Rate for Payer: Cofinity Commercial |
$160.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.54
|
| Rate for Payer: Healthscope Commercial |
$221.15
|
| Rate for Payer: Healthscope Commercial |
$191.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.40
|
| Rate for Payer: Nomi Health Commercial |
$143.45
|
| Rate for Payer: PACE SWMI |
$119.54
|
| Rate for Payer: PHP Medicare Advantage |
$119.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.40
|
| Rate for Payer: Priority Health Medicare |
$119.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.54
|
| Rate for Payer: UHC Medicare Advantage |
$119.54
|
|
