|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$237.33 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$318.02
|
| Rate for Payer: Aetna Medicare |
$246.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.02
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$237.33
|
| Rate for Payer: BCN Medicare Advantage |
$237.33
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$341.76
|
| Rate for Payer: Cofinity Commercial |
$318.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.33
|
| Rate for Payer: Healthscope Commercial |
$379.73
|
| Rate for Payer: Healthscope Commercial |
$439.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,397.50
|
| Rate for Payer: Nomi Health Commercial |
$284.80
|
| Rate for Payer: PACE SWMI |
$237.33
|
| Rate for Payer: PHP Medicare Advantage |
$237.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$237.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.33
|
| Rate for Payer: UHC Medicare Advantage |
$237.33
|
|
|
PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 53448
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$2,249.90 |
| Rate for Payer: Aetna Commercial |
$1,629.65
|
| Rate for Payer: Aetna Medicare |
$1,264.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,751.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,629.65
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,216.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,216.16
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,751.27
|
| Rate for Payer: Cofinity Commercial |
$1,629.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,216.16
|
| Rate for Payer: Healthscope Commercial |
$2,249.90
|
| Rate for Payer: Healthscope Commercial |
$1,945.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Nomi Health Commercial |
$1,459.39
|
| Rate for Payer: PACE SWMI |
$1,216.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,216.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,216.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,216.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,216.16
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$852.40 |
| Max. Negotiated Rate |
$1,817.61 |
| Rate for Payer: Aetna Commercial |
$1,316.54
|
| Rate for Payer: Aetna Medicare |
$1,021.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,414.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,316.54
|
| Rate for Payer: BCBS Complete |
$852.40
|
| Rate for Payer: BCBS MAPPO |
$982.49
|
| Rate for Payer: BCN Medicare Advantage |
$982.49
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cofinity Commercial |
$1,414.79
|
| Rate for Payer: Cofinity Commercial |
$1,316.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$982.49
|
| Rate for Payer: Healthscope Commercial |
$1,571.98
|
| Rate for Payer: Healthscope Commercial |
$1,817.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,031.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.15
|
| Rate for Payer: Nomi Health Commercial |
$1,178.99
|
| Rate for Payer: PACE SWMI |
$982.49
|
| Rate for Payer: PHP Medicare Advantage |
$982.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.15
|
| Rate for Payer: Priority Health Medicare |
$982.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$982.49
|
| Rate for Payer: UHC Medicare Advantage |
$982.49
|
|
|
PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Professional
|
Both
|
$2,515.00
|
|
|
Service Code
|
HCPCS 53447
|
| Min. Negotiated Rate |
$769.69 |
| Max. Negotiated Rate |
$1,634.75 |
| Rate for Payer: Aetna Commercial |
$1,031.38
|
| Rate for Payer: Aetna Medicare |
$800.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.38
|
| Rate for Payer: BCBS Complete |
$1,006.00
|
| Rate for Payer: BCBS MAPPO |
$769.69
|
| Rate for Payer: BCN Medicare Advantage |
$769.69
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cash Price |
$2,012.00
|
| Rate for Payer: Cofinity Commercial |
$1,108.35
|
| Rate for Payer: Cofinity Commercial |
$1,031.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.69
|
| Rate for Payer: Healthscope Commercial |
$1,423.93
|
| Rate for Payer: Healthscope Commercial |
$1,231.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$808.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,634.75
|
| Rate for Payer: Nomi Health Commercial |
$923.63
|
| Rate for Payer: PACE SWMI |
$769.69
|
| Rate for Payer: PHP Medicare Advantage |
$769.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,634.75
|
| Rate for Payer: Priority Health Medicare |
$769.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$769.69
|
| Rate for Payer: UHC Medicare Advantage |
$769.69
|
|
|
PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD
|
Professional
|
Both
|
$2,290.00
|
|
|
Service Code
|
HCPCS 54417
|
| Min. Negotiated Rate |
$859.39 |
| Max. Negotiated Rate |
$1,589.87 |
| Rate for Payer: Aetna Commercial |
$1,151.58
|
| Rate for Payer: Aetna Medicare |
$893.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,237.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,151.58
|
| Rate for Payer: BCBS Complete |
$916.00
|
| Rate for Payer: BCBS MAPPO |
$859.39
|
| Rate for Payer: BCN Medicare Advantage |
$859.39
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cash Price |
$1,832.00
|
| Rate for Payer: Cofinity Commercial |
$1,237.52
|
| Rate for Payer: Cofinity Commercial |
$1,151.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$859.39
|
| Rate for Payer: Healthscope Commercial |
$1,375.02
|
| Rate for Payer: Healthscope Commercial |
$1,589.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$902.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,488.50
|
| Rate for Payer: Nomi Health Commercial |
$1,031.27
|
| Rate for Payer: PACE SWMI |
$859.39
|
| Rate for Payer: PHP Medicare Advantage |
$859.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,488.50
|
| Rate for Payer: Priority Health Medicare |
$859.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$859.39
|
| Rate for Payer: UHC Medicare Advantage |
$859.39
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$78.46 |
| Max. Negotiated Rate |
$779.35 |
| Rate for Payer: Aetna Commercial |
$105.14
|
| Rate for Payer: Aetna Medicare |
$81.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.14
|
| Rate for Payer: BCBS Complete |
$479.60
|
| Rate for Payer: BCBS MAPPO |
$78.46
|
| Rate for Payer: BCN Medicare Advantage |
$78.46
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cofinity Commercial |
$112.98
|
| Rate for Payer: Cofinity Commercial |
$105.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.46
|
| Rate for Payer: Healthscope Commercial |
$145.15
|
| Rate for Payer: Healthscope Commercial |
$125.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$779.35
|
| Rate for Payer: Nomi Health Commercial |
$94.15
|
| Rate for Payer: PACE SWMI |
$78.46
|
| Rate for Payer: PHP Medicare Advantage |
$78.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.35
|
| Rate for Payer: Priority Health Medicare |
$78.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.46
|
| Rate for Payer: UHC Medicare Advantage |
$78.46
|
|
|
PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 69711
|
| Min. Negotiated Rate |
$679.20 |
| Max. Negotiated Rate |
$1,451.21 |
| Rate for Payer: Aetna Commercial |
$1,051.15
|
| Rate for Payer: Aetna Medicare |
$815.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,051.15
|
| Rate for Payer: BCBS Complete |
$679.20
|
| Rate for Payer: BCBS MAPPO |
$784.44
|
| Rate for Payer: BCN Medicare Advantage |
$784.44
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$1,129.59
|
| Rate for Payer: Cofinity Commercial |
$1,051.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.44
|
| Rate for Payer: Healthscope Commercial |
$1,255.10
|
| Rate for Payer: Healthscope Commercial |
$1,451.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$823.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.70
|
| Rate for Payer: Nomi Health Commercial |
$941.33
|
| Rate for Payer: PACE SWMI |
$784.44
|
| Rate for Payer: PHP Medicare Advantage |
$784.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health Medicare |
$784.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$784.44
|
| Rate for Payer: UHC Medicare Advantage |
$784.44
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$1,145.82 |
| Rate for Payer: Aetna Commercial |
$829.94
|
| Rate for Payer: Aetna Medicare |
$644.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.94
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$619.36
|
| Rate for Payer: BCN Medicare Advantage |
$619.36
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$891.88
|
| Rate for Payer: Cofinity Commercial |
$829.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.36
|
| Rate for Payer: Healthscope Commercial |
$990.98
|
| Rate for Payer: Healthscope Commercial |
$1,145.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.25
|
| Rate for Payer: Nomi Health Commercial |
$743.23
|
| Rate for Payer: PACE SWMI |
$619.36
|
| Rate for Payer: PHP Medicare Advantage |
$619.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$619.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.36
|
| Rate for Payer: UHC Medicare Advantage |
$619.36
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$458.00 |
| Max. Negotiated Rate |
$1,145.82 |
| Rate for Payer: Aetna Commercial |
$829.94
|
| Rate for Payer: Aetna Medicare |
$644.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.88
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$619.36
|
| Rate for Payer: BCN Medicare Advantage |
$619.36
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$891.88
|
| Rate for Payer: Cofinity Commercial |
$829.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.36
|
| Rate for Payer: Healthscope Commercial |
$1,145.82
|
| Rate for Payer: Healthscope Commercial |
$990.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$650.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.25
|
| Rate for Payer: Nomi Health Commercial |
$743.23
|
| Rate for Payer: PACE SWMI |
$619.36
|
| Rate for Payer: PHP Medicare Advantage |
$619.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$619.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$619.36
|
| Rate for Payer: UHC Medicare Advantage |
$619.36
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Facility
|
IP
|
$1,145.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$721.35 |
| Max. Negotiated Rate |
$1,030.50 |
| Rate for Payer: Aetna Commercial |
$973.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.25
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$801.50
|
| Rate for Payer: Cofinity Commercial |
$984.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$801.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.00
|
| Rate for Payer: Healthscope Commercial |
$1,030.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.25
|
| Rate for Payer: PHP Commercial |
$973.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health SBD |
$721.35
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Facility
|
OP
|
$1,145.00
|
|
|
Service Code
|
CPT 19330
|
| Hospital Charge Code |
19330
|
| Min. Negotiated Rate |
$721.35 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$973.25
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$801.50
|
| Rate for Payer: Cofinity Commercial |
$984.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$801.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$916.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$1,030.50
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.25
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$973.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$721.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$20.41
|
| Rate for Payer: Aetna Medicare |
$15.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.41
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$15.23
|
| Rate for Payer: BCN Medicare Advantage |
$15.23
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$20.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$24.37
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.25
|
| Rate for Payer: Nomi Health Commercial |
$18.28
|
| Rate for Payer: PACE SWMI |
$15.23
|
| Rate for Payer: PHP Medicare Advantage |
$15.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$15.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.23
|
| Rate for Payer: UHC Medicare Advantage |
$15.23
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health SBD |
$110.25
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
11200
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$132.65 |
| Rate for Payer: Aetna Commercial |
$96.08
|
| Rate for Payer: Aetna Medicare |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.08
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$71.70
|
| Rate for Payer: BCN Medicare Advantage |
$71.70
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$103.25
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.70
|
| Rate for Payer: Healthscope Commercial |
$132.65
|
| Rate for Payer: Healthscope Commercial |
$114.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.75
|
| Rate for Payer: Nomi Health Commercial |
$86.04
|
| Rate for Payer: PACE SWMI |
$71.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$71.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.70
|
| Rate for Payer: UHC Medicare Advantage |
$71.70
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$132.65 |
| Rate for Payer: Aetna Commercial |
$96.08
|
| Rate for Payer: Aetna Medicare |
$74.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.25
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$71.70
|
| Rate for Payer: BCN Medicare Advantage |
$71.70
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Commercial |
$103.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.70
|
| Rate for Payer: Healthscope Commercial |
$132.65
|
| Rate for Payer: Healthscope Commercial |
$114.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.75
|
| Rate for Payer: Nomi Health Commercial |
$86.04
|
| Rate for Payer: PACE SWMI |
$71.70
|
| Rate for Payer: PHP Medicare Advantage |
$71.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$71.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.70
|
| Rate for Payer: UHC Medicare Advantage |
$71.70
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$148.75
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$122.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$157.50
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.75
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$148.75
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$110.25
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$834.37 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$1,118.06
|
| Rate for Payer: Aetna Medicare |
$867.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,201.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.06
|
| Rate for Payer: BCBS Complete |
$1,576.80
|
| Rate for Payer: BCBS MAPPO |
$834.37
|
| Rate for Payer: BCN Medicare Advantage |
$834.37
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$1,201.49
|
| Rate for Payer: Cofinity Commercial |
$1,118.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.37
|
| Rate for Payer: Healthscope Commercial |
$1,334.99
|
| Rate for Payer: Healthscope Commercial |
$1,543.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,562.30
|
| Rate for Payer: Nomi Health Commercial |
$1,001.24
|
| Rate for Payer: PACE SWMI |
$834.37
|
| Rate for Payer: PHP Medicare Advantage |
$834.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health Medicare |
$834.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.37
|
| Rate for Payer: UHC Medicare Advantage |
$834.37
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$1,183.65 |
| Rate for Payer: Aetna Commercial |
$426.33
|
| Rate for Payer: Aetna Medicare |
$330.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.33
|
| Rate for Payer: BCBS Complete |
$728.40
|
| Rate for Payer: BCBS MAPPO |
$318.16
|
| Rate for Payer: BCN Medicare Advantage |
$318.16
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cofinity Commercial |
$458.15
|
| Rate for Payer: Cofinity Commercial |
$426.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.16
|
| Rate for Payer: Healthscope Commercial |
$588.60
|
| Rate for Payer: Healthscope Commercial |
$509.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,183.65
|
| Rate for Payer: Nomi Health Commercial |
$381.79
|
| Rate for Payer: PACE SWMI |
$318.16
|
| Rate for Payer: PHP Medicare Advantage |
$318.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health Medicare |
$318.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.16
|
| Rate for Payer: UHC Medicare Advantage |
$318.16
|
|
|
PR RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 62365
|
| Min. Negotiated Rate |
$288.07 |
| Max. Negotiated Rate |
$985.40 |
| Rate for Payer: Aetna Commercial |
$386.01
|
| Rate for Payer: Aetna Medicare |
$299.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.01
|
| Rate for Payer: BCBS Complete |
$606.40
|
| Rate for Payer: BCBS MAPPO |
$288.07
|
| Rate for Payer: BCN Medicare Advantage |
$288.07
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$414.82
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.07
|
| Rate for Payer: Healthscope Commercial |
$460.91
|
| Rate for Payer: Healthscope Commercial |
$532.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$985.40
|
| Rate for Payer: Nomi Health Commercial |
$345.68
|
| Rate for Payer: PACE SWMI |
$288.07
|
| Rate for Payer: PHP Medicare Advantage |
$288.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$985.40
|
| Rate for Payer: Priority Health Medicare |
$288.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$288.07
|
| Rate for Payer: UHC Medicare Advantage |
$288.07
|
|
|
PR RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD
|
Professional
|
Both
|
$1,628.00
|
|
|
Service Code
|
HCPCS 26392
|
| Min. Negotiated Rate |
$651.20 |
| Max. Negotiated Rate |
$1,736.93 |
| Rate for Payer: Aetna Commercial |
$1,258.10
|
| Rate for Payer: Aetna Medicare |
$976.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.10
|
| Rate for Payer: BCBS Complete |
$651.20
|
| Rate for Payer: BCBS MAPPO |
$938.88
|
| Rate for Payer: BCN Medicare Advantage |
$938.88
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,351.99
|
| Rate for Payer: Cofinity Commercial |
$1,258.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$938.88
|
| Rate for Payer: Healthscope Commercial |
$1,736.93
|
| Rate for Payer: Healthscope Commercial |
$1,502.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$985.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,058.20
|
| Rate for Payer: Nomi Health Commercial |
$1,126.66
|
| Rate for Payer: PACE SWMI |
$938.88
|
| Rate for Payer: PHP Medicare Advantage |
$938.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.20
|
| Rate for Payer: Priority Health Medicare |
$938.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$938.88
|
| Rate for Payer: UHC Medicare Advantage |
$938.88
|
|
|
PR RMVL THIERSCH WIRE/SUTURE ANAL CANAL
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
HCPCS 46754
|
| Min. Negotiated Rate |
$188.80 |
| Max. Negotiated Rate |
$424.63 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$238.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.57
|
| Rate for Payer: BCBS Complete |
$188.80
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cash Price |
$377.60
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Healthscope Commercial |
$367.25
|
| Rate for Payer: Healthscope Commercial |
$424.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.80
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.80
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
|
|
PR RMVL TRANSVNS PM ELTRD 1 LEAD SYS ATR/VENTR
|
Professional
|
Both
|
$1,678.00
|
|
|
Service Code
|
HCPCS 33234
|
| Min. Negotiated Rate |
$459.28 |
| Max. Negotiated Rate |
$1,090.70 |
| Rate for Payer: Aetna Commercial |
$615.44
|
| Rate for Payer: Aetna Medicare |
$477.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.44
|
| Rate for Payer: BCBS Complete |
$671.20
|
| Rate for Payer: BCBS MAPPO |
$459.28
|
| Rate for Payer: BCN Medicare Advantage |
$459.28
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cash Price |
$1,342.40
|
| Rate for Payer: Cofinity Commercial |
$661.36
|
| Rate for Payer: Cofinity Commercial |
$615.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.28
|
| Rate for Payer: Healthscope Commercial |
$849.67
|
| Rate for Payer: Healthscope Commercial |
$734.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,090.70
|
| Rate for Payer: Nomi Health Commercial |
$551.14
|
| Rate for Payer: PACE SWMI |
$459.28
|
| Rate for Payer: PHP Medicare Advantage |
$459.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.70
|
| Rate for Payer: Priority Health Medicare |
$459.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.28
|
| Rate for Payer: UHC Medicare Advantage |
$459.28
|
|
|
PR RMVL TRANSVNS PM ELTRD DUAL LEAD SYS
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 33235
|
| Min. Negotiated Rate |
$530.80 |
| Max. Negotiated Rate |
$1,114.90 |
| Rate for Payer: Aetna Commercial |
$807.55
|
| Rate for Payer: Aetna Medicare |
$626.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.55
|
| Rate for Payer: BCBS Complete |
$530.80
|
| Rate for Payer: BCBS MAPPO |
$602.65
|
| Rate for Payer: BCN Medicare Advantage |
$602.65
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$867.82
|
| Rate for Payer: Cofinity Commercial |
$807.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.65
|
| Rate for Payer: Healthscope Commercial |
$1,114.90
|
| Rate for Payer: Healthscope Commercial |
$964.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.55
|
| Rate for Payer: Nomi Health Commercial |
$723.18
|
| Rate for Payer: PACE SWMI |
$602.65
|
| Rate for Payer: PHP Medicare Advantage |
$602.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health Medicare |
$602.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.65
|
| Rate for Payer: UHC Medicare Advantage |
$602.65
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
36590
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$451.08 |
| Max. Negotiated Rate |
$644.40 |
| Rate for Payer: Aetna Commercial |
$608.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$465.40
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$501.20
|
| Rate for Payer: Cofinity Commercial |
$615.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$501.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$572.80
|
| Rate for Payer: Healthscope Commercial |
$644.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.60
|
| Rate for Payer: PHP Commercial |
$608.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health SBD |
$451.08
|
|
|
PR RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36590
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$241.08
|
| Rate for Payer: Aetna Medicare |
$187.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.08
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$179.91
|
| Rate for Payer: BCN Medicare Advantage |
$179.91
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$259.07
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.91
|
| Rate for Payer: Healthscope Commercial |
$332.83
|
| Rate for Payer: Healthscope Commercial |
$287.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.40
|
| Rate for Payer: Nomi Health Commercial |
$215.89
|
| Rate for Payer: PACE SWMI |
$179.91
|
| Rate for Payer: PHP Medicare Advantage |
$179.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$179.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.91
|
| Rate for Payer: UHC Medicare Advantage |
$179.91
|
|
