|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$2,487.07 |
| Rate for Payer: Aetna Commercial |
$1,801.44
|
| Rate for Payer: Aetna Medicare |
$1,398.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.88
|
| Rate for Payer: BCBS Complete |
$985.60
|
| Rate for Payer: BCBS MAPPO |
$1,344.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,344.36
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cofinity Commercial |
$1,935.88
|
| Rate for Payer: Cofinity Commercial |
$1,801.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,344.36
|
| Rate for Payer: Healthscope Commercial |
$2,487.07
|
| Rate for Payer: Healthscope Commercial |
$2,150.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,411.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,601.60
|
| Rate for Payer: Nomi Health Commercial |
$1,613.23
|
| Rate for Payer: PACE SWMI |
$1,344.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,344.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.60
|
| Rate for Payer: Priority Health Medicare |
$1,344.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,344.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,344.36
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$2,293.67 |
| Rate for Payer: Aetna Commercial |
$1,661.36
|
| Rate for Payer: Aetna Medicare |
$1,289.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,785.34
|
| Rate for Payer: BCBS Complete |
$812.00
|
| Rate for Payer: BCBS MAPPO |
$1,239.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,239.82
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cofinity Commercial |
$1,661.36
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,239.82
|
| Rate for Payer: Healthscope Commercial |
$1,983.71
|
| Rate for Payer: Healthscope Commercial |
$2,293.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,301.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,319.50
|
| Rate for Payer: Nomi Health Commercial |
$1,487.78
|
| Rate for Payer: PACE SWMI |
$1,239.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,239.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.50
|
| Rate for Payer: Priority Health Medicare |
$1,239.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,239.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,239.82
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$3,025.92 |
| Rate for Payer: Aetna Commercial |
$2,191.74
|
| Rate for Payer: Aetna Medicare |
$1,701.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,191.74
|
| Rate for Payer: BCBS Complete |
$1,400.00
|
| Rate for Payer: BCBS MAPPO |
$1,635.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,635.63
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$2,355.31
|
| Rate for Payer: Cofinity Commercial |
$2,191.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,635.63
|
| Rate for Payer: Healthscope Commercial |
$3,025.92
|
| Rate for Payer: Healthscope Commercial |
$2,617.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,717.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,275.00
|
| Rate for Payer: Nomi Health Commercial |
$1,962.76
|
| Rate for Payer: PACE SWMI |
$1,635.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,635.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health Medicare |
$1,635.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,635.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.63
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$1,448.18 |
| Rate for Payer: Aetna Commercial |
$1,048.95
|
| Rate for Payer: Aetna Medicare |
$814.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.95
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$782.80
|
| Rate for Payer: BCN Medicare Advantage |
$782.80
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,127.23
|
| Rate for Payer: Cofinity Commercial |
$1,048.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$782.80
|
| Rate for Payer: Healthscope Commercial |
$1,252.48
|
| Rate for Payer: Healthscope Commercial |
$1,448.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.50
|
| Rate for Payer: Nomi Health Commercial |
$939.36
|
| Rate for Payer: PACE SWMI |
$782.80
|
| Rate for Payer: PHP Medicare Advantage |
$782.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$782.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$782.80
|
| Rate for Payer: UHC Medicare Advantage |
$782.80
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,084.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$1,233.60 |
| Max. Negotiated Rate |
$2,427.77 |
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,889.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,889.73
|
| Rate for Payer: BCBS Complete |
$1,233.60
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Healthscope Commercial |
$2,427.77
|
| Rate for Payer: Healthscope Commercial |
$2,427.77
|
| Rate for Payer: Healthscope Commercial |
$2,099.70
|
| Rate for Payer: Healthscope Commercial |
$2,099.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,004.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,989.00
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.60
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$2,096.12 |
| Rate for Payer: Aetna Commercial |
$1,518.27
|
| Rate for Payer: Aetna Medicare |
$1,178.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.27
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$1,133.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.04
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,631.58
|
| Rate for Payer: Cofinity Commercial |
$1,518.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.04
|
| Rate for Payer: Healthscope Commercial |
$1,812.86
|
| Rate for Payer: Healthscope Commercial |
$2,096.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$994.50
|
| Rate for Payer: Nomi Health Commercial |
$1,359.65
|
| Rate for Payer: PACE SWMI |
$1,133.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$1,133.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.04
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$152.77 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Medicare |
$85.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.92
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$82.58
|
| Rate for Payer: BCN Medicare Advantage |
$82.58
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$110.66
|
| Rate for Payer: Cofinity Commercial |
$118.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.58
|
| Rate for Payer: Healthscope Commercial |
$132.13
|
| Rate for Payer: Healthscope Commercial |
$152.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Nomi Health Commercial |
$99.10
|
| Rate for Payer: PACE SWMI |
$82.58
|
| Rate for Payer: PHP Medicare Advantage |
$82.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$82.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.58
|
| Rate for Payer: UHC Medicare Advantage |
$82.58
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$8.59
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.59
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.41
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$9.23
|
| Rate for Payer: Cofinity Commercial |
$8.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$11.86
|
| Rate for Payer: Healthscope Commercial |
$10.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$7.69
|
| Rate for Payer: PACE SWMI |
$6.41
|
| Rate for Payer: PHP Medicare Advantage |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.41
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$11.06 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.01
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Healthscope Commercial |
$11.06
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Nomi Health Commercial |
$7.18
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$5.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.60
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$19.82
|
| Rate for Payer: Healthscope Commercial |
$22.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.25
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,182.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,182.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$1,356.31 |
| Rate for Payer: Aetna Commercial |
$982.41
|
| Rate for Payer: Aetna Medicare |
$762.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.72
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$733.14
|
| Rate for Payer: BCN Medicare Advantage |
$733.14
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$982.41
|
| Rate for Payer: Cofinity Commercial |
$1,055.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.14
|
| Rate for Payer: Healthscope Commercial |
$1,356.31
|
| Rate for Payer: Healthscope Commercial |
$1,173.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.90
|
| Rate for Payer: Nomi Health Commercial |
$879.77
|
| Rate for Payer: PACE SWMI |
$733.14
|
| Rate for Payer: PHP Medicare Advantage |
$733.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$733.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.14
|
| Rate for Payer: UHC Medicare Advantage |
$733.14
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$260.74 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.86
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Healthscope Commercial |
$225.50
|
| Rate for Payer: Healthscope Commercial |
$260.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.20
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.23
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Healthscope Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,658.16 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,842.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health SBD |
$1,658.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.08
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Healthscope Commercial |
$1,196.51
|
| Rate for Payer: Healthscope Commercial |
$1,383.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,710.80
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$747.82 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.86
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Healthscope Commercial |
$1,196.51
|
| Rate for Payer: Healthscope Commercial |
$1,383.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,710.80
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,658.16 |
| Max. Negotiated Rate |
$2,368.80 |
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.80
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,842.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health SBD |
$1,658.16
|
|
|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$181.60 |
| Rate for Payer: Aetna Commercial |
$131.53
|
| Rate for Payer: Aetna Medicare |
$102.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$98.16
|
| Rate for Payer: BCN Medicare Advantage |
$98.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$141.35
|
| Rate for Payer: Cofinity Commercial |
$131.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.16
|
| Rate for Payer: Healthscope Commercial |
$181.60
|
| Rate for Payer: Healthscope Commercial |
$157.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.15
|
| Rate for Payer: Nomi Health Commercial |
$117.79
|
| Rate for Payer: PACE SWMI |
$98.16
|
| Rate for Payer: PHP Medicare Advantage |
$98.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$98.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.16
|
| Rate for Payer: UHC Medicare Advantage |
$98.16
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,919.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$2,204.42 |
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,596.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,596.72
|
| Rate for Payer: BCBS Complete |
$1,121.60
|
| Rate for Payer: BCBS Complete |
$1,167.60
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Healthscope Commercial |
$1,906.53
|
| Rate for Payer: Healthscope Commercial |
$1,906.53
|
| Rate for Payer: Healthscope Commercial |
$2,204.42
|
| Rate for Payer: Healthscope Commercial |
$2,204.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,822.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,897.35
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.35
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$1,998.17 |
| Rate for Payer: Aetna Commercial |
$1,447.32
|
| Rate for Payer: Aetna Medicare |
$1,123.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.32
|
| Rate for Payer: BCBS Complete |
$491.60
|
| Rate for Payer: BCBS MAPPO |
$1,080.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.09
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,555.33
|
| Rate for Payer: Cofinity Commercial |
$1,447.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.09
|
| Rate for Payer: Healthscope Commercial |
$1,998.17
|
| Rate for Payer: Healthscope Commercial |
$1,728.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$798.85
|
| Rate for Payer: Nomi Health Commercial |
$1,296.11
|
| Rate for Payer: PACE SWMI |
$1,080.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health Medicare |
$1,080.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.09
|
|
