|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$1,835.63 |
| Rate for Payer: Aetna Commercial |
$1,329.59
|
| Rate for Payer: Aetna Medicare |
$1,031.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,428.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.59
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS MAPPO |
$992.23
|
| Rate for Payer: BCN Medicare Advantage |
$992.23
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Cofinity Commercial |
$1,329.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.23
|
| Rate for Payer: Healthscope Commercial |
$1,587.57
|
| Rate for Payer: Healthscope Commercial |
$1,835.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$436.80
|
| Rate for Payer: Nomi Health Commercial |
$1,190.68
|
| Rate for Payer: PACE SWMI |
$992.23
|
| Rate for Payer: PHP Medicare Advantage |
$992.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.80
|
| Rate for Payer: Priority Health Medicare |
$992.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.23
|
| Rate for Payer: UHC Medicare Advantage |
$992.23
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$718.40 |
| Max. Negotiated Rate |
$1,511.14 |
| Rate for Payer: Aetna Commercial |
$1,094.55
|
| Rate for Payer: Aetna Medicare |
$849.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.55
|
| Rate for Payer: BCBS Complete |
$718.40
|
| Rate for Payer: BCBS MAPPO |
$816.83
|
| Rate for Payer: BCN Medicare Advantage |
$816.83
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$1,176.24
|
| Rate for Payer: Cofinity Commercial |
$1,094.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.83
|
| Rate for Payer: Healthscope Commercial |
$1,511.14
|
| Rate for Payer: Healthscope Commercial |
$1,306.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,167.40
|
| Rate for Payer: Nomi Health Commercial |
$980.20
|
| Rate for Payer: PACE SWMI |
$816.83
|
| Rate for Payer: PHP Medicare Advantage |
$816.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health Medicare |
$816.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.83
|
| Rate for Payer: UHC Medicare Advantage |
$816.83
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$852.73 |
| Max. Negotiated Rate |
$1,612.00 |
| Rate for Payer: Aetna Commercial |
$1,142.66
|
| Rate for Payer: Aetna Medicare |
$886.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.66
|
| Rate for Payer: BCBS Complete |
$992.00
|
| Rate for Payer: BCBS MAPPO |
$852.73
|
| Rate for Payer: BCN Medicare Advantage |
$852.73
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cofinity Commercial |
$1,227.93
|
| Rate for Payer: Cofinity Commercial |
$1,142.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.73
|
| Rate for Payer: Healthscope Commercial |
$1,364.37
|
| Rate for Payer: Healthscope Commercial |
$1,577.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,612.00
|
| Rate for Payer: Nomi Health Commercial |
$1,023.28
|
| Rate for Payer: PACE SWMI |
$852.73
|
| Rate for Payer: PHP Medicare Advantage |
$852.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.00
|
| Rate for Payer: Priority Health Medicare |
$852.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.73
|
| Rate for Payer: UHC Medicare Advantage |
$852.73
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$885.13 |
| Max. Negotiated Rate |
$2,191.15 |
| Rate for Payer: Aetna Commercial |
$1,186.07
|
| Rate for Payer: Aetna Medicare |
$920.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,274.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.07
|
| Rate for Payer: BCBS Complete |
$1,348.40
|
| Rate for Payer: BCBS MAPPO |
$885.13
|
| Rate for Payer: BCN Medicare Advantage |
$885.13
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cofinity Commercial |
$1,274.59
|
| Rate for Payer: Cofinity Commercial |
$1,186.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.13
|
| Rate for Payer: Healthscope Commercial |
$1,637.49
|
| Rate for Payer: Healthscope Commercial |
$1,416.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,191.15
|
| Rate for Payer: Nomi Health Commercial |
$1,062.16
|
| Rate for Payer: PACE SWMI |
$885.13
|
| Rate for Payer: PHP Medicare Advantage |
$885.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,191.15
|
| Rate for Payer: Priority Health Medicare |
$885.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.13
|
| Rate for Payer: UHC Medicare Advantage |
$885.13
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$1,434.55 |
| Rate for Payer: Aetna Commercial |
$807.54
|
| Rate for Payer: Aetna Medicare |
$626.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.54
|
| Rate for Payer: BCBS Complete |
$882.80
|
| Rate for Payer: BCBS MAPPO |
$602.64
|
| Rate for Payer: BCN Medicare Advantage |
$602.64
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Cofinity Commercial |
$807.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.64
|
| Rate for Payer: Healthscope Commercial |
$1,114.88
|
| Rate for Payer: Healthscope Commercial |
$964.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.55
|
| Rate for Payer: Nomi Health Commercial |
$723.17
|
| Rate for Payer: PACE SWMI |
$602.64
|
| Rate for Payer: PHP Medicare Advantage |
$602.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.55
|
| Rate for Payer: Priority Health Medicare |
$602.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.64
|
| Rate for Payer: UHC Medicare Advantage |
$602.64
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,127.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$1,098.19 |
| Max. Negotiated Rate |
$3,332.55 |
| Rate for Payer: Aetna Commercial |
$1,471.57
|
| Rate for Payer: Aetna Medicare |
$1,142.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.57
|
| Rate for Payer: BCBS Complete |
$2,050.80
|
| Rate for Payer: BCBS MAPPO |
$1,098.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.19
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,581.39
|
| Rate for Payer: Cofinity Commercial |
$1,471.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.19
|
| Rate for Payer: Healthscope Commercial |
$1,757.10
|
| Rate for Payer: Healthscope Commercial |
$2,031.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,332.55
|
| Rate for Payer: Nomi Health Commercial |
$1,317.83
|
| Rate for Payer: PACE SWMI |
$1,098.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.55
|
| Rate for Payer: Priority Health Medicare |
$1,098.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.19
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$189.19 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: Aetna Medicare |
$196.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.43
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$189.19
|
| Rate for Payer: BCN Medicare Advantage |
$189.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.19
|
| Rate for Payer: Healthscope Commercial |
$302.70
|
| Rate for Payer: Healthscope Commercial |
$350.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$458.25
|
| Rate for Payer: Nomi Health Commercial |
$227.03
|
| Rate for Payer: PACE SWMI |
$189.19
|
| Rate for Payer: PHP Medicare Advantage |
$189.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$189.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.19
|
| Rate for Payer: UHC Medicare Advantage |
$189.19
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$110.97 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Aetna Commercial |
$148.70
|
| Rate for Payer: Aetna Medicare |
$115.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.70
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$110.97
|
| Rate for Payer: BCN Medicare Advantage |
$110.97
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$148.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.97
|
| Rate for Payer: Healthscope Commercial |
$205.29
|
| Rate for Payer: Healthscope Commercial |
$177.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.00
|
| Rate for Payer: Nomi Health Commercial |
$133.16
|
| Rate for Payer: PACE SWMI |
$110.97
|
| Rate for Payer: PHP Medicare Advantage |
$110.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Medicare |
$110.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.97
|
| Rate for Payer: UHC Medicare Advantage |
$110.97
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$604.43 |
| Max. Negotiated Rate |
$1,118.20 |
| Rate for Payer: Aetna Commercial |
$809.94
|
| Rate for Payer: Aetna Medicare |
$628.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.94
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$604.43
|
| Rate for Payer: BCN Medicare Advantage |
$604.43
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$870.38
|
| Rate for Payer: Cofinity Commercial |
$809.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.43
|
| Rate for Payer: Healthscope Commercial |
$1,118.20
|
| Rate for Payer: Healthscope Commercial |
$967.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.70
|
| Rate for Payer: Nomi Health Commercial |
$725.32
|
| Rate for Payer: PACE SWMI |
$604.43
|
| Rate for Payer: PHP Medicare Advantage |
$604.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$604.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.43
|
| Rate for Payer: UHC Medicare Advantage |
$604.43
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$165.41 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Medicare |
$92.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.81
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$89.41
|
| Rate for Payer: BCN Medicare Advantage |
$89.41
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Cofinity Commercial |
$119.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.41
|
| Rate for Payer: Healthscope Commercial |
$165.41
|
| Rate for Payer: Healthscope Commercial |
$143.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.20
|
| Rate for Payer: Nomi Health Commercial |
$107.29
|
| Rate for Payer: PACE SWMI |
$89.41
|
| Rate for Payer: PHP Medicare Advantage |
$89.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$89.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.41
|
| Rate for Payer: UHC Medicare Advantage |
$89.41
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$45.67 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.20
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$45.67
|
| Rate for Payer: BCN Medicare Advantage |
$45.67
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$65.76
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.67
|
| Rate for Payer: Healthscope Commercial |
$73.07
|
| Rate for Payer: Healthscope Commercial |
$84.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.95
|
| Rate for Payer: Nomi Health Commercial |
$54.80
|
| Rate for Payer: PACE SWMI |
$45.67
|
| Rate for Payer: PHP Medicare Advantage |
$45.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$45.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.67
|
| Rate for Payer: UHC Medicare Advantage |
$45.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$38.67 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$40.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.82
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$38.67
|
| Rate for Payer: BCN Medicare Advantage |
$38.67
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.67
|
| Rate for Payer: Healthscope Commercial |
$71.54
|
| Rate for Payer: Healthscope Commercial |
$61.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.25
|
| Rate for Payer: Nomi Health Commercial |
$46.40
|
| Rate for Payer: PACE SWMI |
$38.67
|
| Rate for Payer: PHP Medicare Advantage |
$38.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$38.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$38.67
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$118.95 |
| Rate for Payer: Aetna Commercial |
$62.14
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.14
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$46.37
|
| Rate for Payer: BCN Medicare Advantage |
$46.37
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$66.77
|
| Rate for Payer: Cofinity Commercial |
$62.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.37
|
| Rate for Payer: Healthscope Commercial |
$74.19
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.95
|
| Rate for Payer: Nomi Health Commercial |
$55.64
|
| Rate for Payer: PACE SWMI |
$46.37
|
| Rate for Payer: PHP Medicare Advantage |
$46.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$46.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.37
|
| Rate for Payer: UHC Medicare Advantage |
$46.37
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$33.54 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Aetna Medicare |
$34.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.94
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$33.54
|
| Rate for Payer: BCN Medicare Advantage |
$33.54
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.54
|
| Rate for Payer: Healthscope Commercial |
$62.05
|
| Rate for Payer: Healthscope Commercial |
$53.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.75
|
| Rate for Payer: Nomi Health Commercial |
$40.25
|
| Rate for Payer: PACE SWMI |
$33.54
|
| Rate for Payer: PHP Medicare Advantage |
$33.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$33.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.54
|
| Rate for Payer: UHC Medicare Advantage |
$33.54
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$219.66 |
| Max. Negotiated Rate |
$406.37 |
| Rate for Payer: Aetna Commercial |
$294.34
|
| Rate for Payer: Aetna Medicare |
$228.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.34
|
| Rate for Payer: BCBS Complete |
$245.20
|
| Rate for Payer: BCBS MAPPO |
$219.66
|
| Rate for Payer: BCN Medicare Advantage |
$219.66
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cofinity Commercial |
$316.31
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.66
|
| Rate for Payer: Healthscope Commercial |
$351.46
|
| Rate for Payer: Healthscope Commercial |
$406.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.45
|
| Rate for Payer: Nomi Health Commercial |
$263.59
|
| Rate for Payer: PACE SWMI |
$219.66
|
| Rate for Payer: PHP Medicare Advantage |
$219.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health Medicare |
$219.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.66
|
| Rate for Payer: UHC Medicare Advantage |
$219.66
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$483.84 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.20
|
| 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 |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| 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 |
$652.80
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$652.80
|
| 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 |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$483.84
|
| 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 RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$483.84 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.20
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: PHP Commercial |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health SBD |
$483.84
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.41
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$381.57
|
| Rate for Payer: Healthscope Commercial |
$441.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.20
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$238.48 |
| Max. Negotiated Rate |
$499.20 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.56
|
| Rate for Payer: BCBS Complete |
$307.20
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Healthscope Commercial |
$441.19
|
| Rate for Payer: Healthscope Commercial |
$381.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.20
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$161.77 |
| Max. Negotiated Rate |
$299.27 |
| Rate for Payer: Aetna Commercial |
$216.77
|
| Rate for Payer: Aetna Medicare |
$168.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.77
|
| Rate for Payer: BCBS Complete |
$162.40
|
| Rate for Payer: BCBS MAPPO |
$161.77
|
| Rate for Payer: BCN Medicare Advantage |
$161.77
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Cofinity Commercial |
$216.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.77
|
| Rate for Payer: Healthscope Commercial |
$258.83
|
| Rate for Payer: Healthscope Commercial |
$299.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.90
|
| Rate for Payer: Nomi Health Commercial |
$194.12
|
| Rate for Payer: PACE SWMI |
$161.77
|
| Rate for Payer: PHP Medicare Advantage |
$161.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health Medicare |
$161.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.77
|
| Rate for Payer: UHC Medicare Advantage |
$161.77
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| 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 |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| 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 |
$278.80
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$278.80
|
| 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 |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| 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 RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$254.13 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$219.79
|
| Rate for Payer: Healthscope Commercial |
$254.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.20
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$254.13 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.08
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Healthscope Commercial |
$254.13
|
| Rate for Payer: Healthscope Commercial |
$219.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.20
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$206.64 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
|
