|
PR RPLCMT/IRRIGATION VENTRICULAR CATHETER
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 62225
|
| Min. Negotiated Rate |
$354.86 |
| Max. Negotiated Rate |
$96,246.00 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$551.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.23
|
| Rate for Payer: BCBS Complete |
$372.60
|
| Rate for Payer: BCBS MAPPO |
$530.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,401.05
|
| Rate for Payer: BCN Commercial |
$1,103.00
|
| Rate for Payer: BCN Medicare Advantage |
$530.02
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$763.23
|
| Rate for Payer: Cofinity Commercial |
$710.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.02
|
| Rate for Payer: Healthscope Commercial |
$980.54
|
| Rate for Payer: Healthscope Commercial |
$848.03
|
| Rate for Payer: Mclaren Medicaid |
$354.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.52
|
| Rate for Payer: Meridian Medicaid |
$372.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96,246.00
|
| Rate for Payer: Nomi Health Commercial |
$636.02
|
| Rate for Payer: PACE SWMI |
$530.02
|
| Rate for Payer: PHP Medicare Advantage |
$530.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.37
|
| Rate for Payer: Priority Health Medicare |
$530.02
|
| Rate for Payer: Priority Health Narrow Network |
$938.37
|
| Rate for Payer: Priority Health SBD |
$938.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.02
|
| Rate for Payer: UHC Exchange |
$491.48
|
| Rate for Payer: UHC Medicare Advantage |
$530.02
|
| Rate for Payer: UHCCP Medicaid |
$354.86
|
|
|
PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 69717
|
| Min. Negotiated Rate |
$359.97 |
| Max. Negotiated Rate |
$98,953.00 |
| Rate for Payer: Aetna Commercial |
$710.90
|
| Rate for Payer: Aetna Medicare |
$551.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.95
|
| Rate for Payer: BCBS Complete |
$377.97
|
| Rate for Payer: BCBS MAPPO |
$530.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,881.80
|
| Rate for Payer: BCN Commercial |
$822.45
|
| Rate for Payer: BCN Medicare Advantage |
$530.52
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cofinity Commercial |
$763.95
|
| Rate for Payer: Cofinity Commercial |
$710.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.52
|
| Rate for Payer: Healthscope Commercial |
$981.46
|
| Rate for Payer: Healthscope Commercial |
$848.83
|
| Rate for Payer: Mclaren Medicaid |
$359.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.05
|
| Rate for Payer: Meridian Medicaid |
$377.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98,953.00
|
| Rate for Payer: Nomi Health Commercial |
$636.62
|
| Rate for Payer: PACE SWMI |
$530.52
|
| Rate for Payer: PHP Medicare Advantage |
$530.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,469.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.46
|
| Rate for Payer: Priority Health Medicare |
$530.52
|
| Rate for Payer: Priority Health Narrow Network |
$822.46
|
| Rate for Payer: Priority Health SBD |
$822.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,126.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.52
|
| Rate for Payer: UHC Exchange |
$1,126.58
|
| Rate for Payer: UHC Medicare Advantage |
$530.52
|
| Rate for Payer: UHCCP Medicaid |
$359.97
|
|
|
PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT
|
Professional
|
Both
|
$4,753.00
|
|
|
Service Code
|
HCPCS 33405
|
| Min. Negotiated Rate |
$683.09 |
| Max. Negotiated Rate |
$401,809.00 |
| Rate for Payer: Aetna Commercial |
$2,915.28
|
| Rate for Payer: Aetna Medicare |
$2,262.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,915.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.84
|
| Rate for Payer: BCBS Complete |
$1,498.00
|
| Rate for Payer: BCBS MAPPO |
$2,175.58
|
| Rate for Payer: BCBS Trust/PPO |
$683.09
|
| Rate for Payer: BCN Commercial |
$3,251.17
|
| Rate for Payer: BCN Medicare Advantage |
$2,175.58
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cash Price |
$3,802.40
|
| Rate for Payer: Cofinity Commercial |
$3,132.84
|
| Rate for Payer: Cofinity Commercial |
$2,915.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,175.58
|
| Rate for Payer: Healthscope Commercial |
$4,024.82
|
| Rate for Payer: Healthscope Commercial |
$3,480.93
|
| Rate for Payer: Mclaren Medicaid |
$1,426.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,284.36
|
| Rate for Payer: Meridian Medicaid |
$1,498.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401,809.00
|
| Rate for Payer: Nomi Health Commercial |
$2,610.70
|
| Rate for Payer: PACE SWMI |
$2,175.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,175.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,426.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,089.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,550.46
|
| Rate for Payer: Priority Health Medicare |
$2,175.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,550.46
|
| Rate for Payer: Priority Health SBD |
$3,550.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,694.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,175.58
|
| Rate for Payer: UHC Exchange |
$3,694.65
|
| Rate for Payer: UHC Medicare Advantage |
$2,175.58
|
| Rate for Payer: UHCCP Medicaid |
$1,426.67
|
|
|
PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS
|
Professional
|
Both
|
$3,555.00
|
|
|
Service Code
|
HCPCS 62230
|
| Min. Negotiated Rate |
$549.75 |
| Max. Negotiated Rate |
$152,116.00 |
| Rate for Payer: Aetna Commercial |
$1,113.20
|
| Rate for Payer: Aetna Medicare |
$863.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,196.28
|
| Rate for Payer: BCBS Complete |
$577.24
|
| Rate for Payer: BCBS MAPPO |
$830.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,261.05
|
| Rate for Payer: BCN Commercial |
$1,726.70
|
| Rate for Payer: BCN Medicare Advantage |
$830.75
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cash Price |
$2,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,196.28
|
| Rate for Payer: Cofinity Commercial |
$1,113.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.75
|
| Rate for Payer: Healthscope Commercial |
$1,536.89
|
| Rate for Payer: Healthscope Commercial |
$1,329.20
|
| Rate for Payer: Mclaren Medicaid |
$549.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.29
|
| Rate for Payer: Meridian Medicaid |
$577.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152,116.00
|
| Rate for Payer: Nomi Health Commercial |
$996.90
|
| Rate for Payer: PACE SWMI |
$830.75
|
| Rate for Payer: PHP Medicare Advantage |
$830.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,310.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,462.73
|
| Rate for Payer: Priority Health Medicare |
$830.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,462.73
|
| Rate for Payer: Priority Health SBD |
$1,462.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,000.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$830.75
|
| Rate for Payer: UHC Exchange |
$1,000.00
|
| Rate for Payer: UHC Medicare Advantage |
$830.75
|
| Rate for Payer: UHCCP Medicaid |
$549.75
|
|
|
PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP
|
Professional
|
Both
|
$3,924.00
|
|
|
Service Code
|
HCPCS 20822
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$313,758.00 |
| Rate for Payer: Aetna Commercial |
$2,281.78
|
| Rate for Payer: Aetna Medicare |
$1,770.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,281.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,452.06
|
| Rate for Payer: BCBS Complete |
$1,199.22
|
| Rate for Payer: BCBS MAPPO |
$1,702.82
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$2,584.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,702.82
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cash Price |
$3,139.20
|
| Rate for Payer: Cofinity Commercial |
$2,452.06
|
| Rate for Payer: Cofinity Commercial |
$2,281.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,702.82
|
| Rate for Payer: Healthscope Commercial |
$3,150.22
|
| Rate for Payer: Healthscope Commercial |
$2,724.51
|
| Rate for Payer: Mclaren Medicaid |
$1,142.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,787.96
|
| Rate for Payer: Meridian Medicaid |
$1,199.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313,758.00
|
| Rate for Payer: Nomi Health Commercial |
$2,043.38
|
| Rate for Payer: PACE SWMI |
$1,702.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,702.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,142.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,550.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,709.18
|
| Rate for Payer: Priority Health Medicare |
$1,702.82
|
| Rate for Payer: Priority Health Narrow Network |
$2,709.18
|
| Rate for Payer: Priority Health SBD |
$2,709.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,971.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,702.82
|
| Rate for Payer: UHC Exchange |
$2,971.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,702.82
|
| Rate for Payer: UHCCP Medicaid |
$1,142.11
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
OP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$681.93 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,516.33
|
| Rate for Payer: BCN Commercial |
$1,516.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Cofinity Commercial |
$790.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$711.27
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.93
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Hospital Charge Code |
49553
|
| Min. Negotiated Rate |
$409.81 |
| Max. Negotiated Rate |
$113,420.00 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.44
|
| Rate for Payer: BCBS Complete |
$430.30
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$928.49
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$986.05
|
| Rate for Payer: Healthscope Commercial |
$1,140.12
|
| Rate for Payer: Mclaren Medicaid |
$409.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Meridian Medicaid |
$430.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,420.00
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,139.49
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.49
|
| Rate for Payer: Priority Health SBD |
$1,139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$645.36
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP Medicaid |
$409.81
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
HCPCS 49553
|
| Min. Negotiated Rate |
$409.81 |
| Max. Negotiated Rate |
$113,420.00 |
| Rate for Payer: Aetna Commercial |
$825.82
|
| Rate for Payer: Aetna Medicare |
$640.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.44
|
| Rate for Payer: BCBS Complete |
$430.30
|
| Rate for Payer: BCBS MAPPO |
$616.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$928.49
|
| Rate for Payer: BCN Medicare Advantage |
$616.28
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$887.44
|
| Rate for Payer: Cofinity Commercial |
$825.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.28
|
| Rate for Payer: Healthscope Commercial |
$986.05
|
| Rate for Payer: Healthscope Commercial |
$1,140.12
|
| Rate for Payer: Mclaren Medicaid |
$409.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.09
|
| Rate for Payer: Meridian Medicaid |
$430.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,420.00
|
| Rate for Payer: Nomi Health Commercial |
$739.54
|
| Rate for Payer: PACE SWMI |
$616.28
|
| Rate for Payer: PHP Medicare Advantage |
$616.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$409.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,139.49
|
| Rate for Payer: Priority Health Medicare |
$616.28
|
| Rate for Payer: Priority Health Narrow Network |
$1,139.49
|
| Rate for Payer: Priority Health SBD |
$1,139.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$645.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$616.28
|
| Rate for Payer: UHC Exchange |
$645.36
|
| Rate for Payer: UHC Medicare Advantage |
$616.28
|
| Rate for Payer: UHCCP Medicaid |
$409.81
|
|
|
PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED
|
Facility
|
IP
|
$1,129.00
|
|
|
Service Code
|
CPT 49553
|
| Hospital Charge Code |
49553
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$711.27 |
| Max. Negotiated Rate |
$1,016.10 |
| Rate for Payer: Aetna Commercial |
$959.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.85
|
| Rate for Payer: Cash Price |
$903.20
|
| Rate for Payer: Cofinity Commercial |
$790.30
|
| Rate for Payer: Cofinity Commercial |
$970.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.20
|
| Rate for Payer: Healthscope Commercial |
$1,016.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.65
|
| Rate for Payer: PHP Commercial |
$959.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.85
|
| Rate for Payer: Priority Health SBD |
$711.27
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$103,592.00 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.40
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: BCN Commercial |
$848.35
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$902.67
|
| Rate for Payer: Healthscope Commercial |
$1,043.71
|
| Rate for Payer: Mclaren Medicaid |
$375.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103,592.00
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,042.25
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,042.25
|
| Rate for Payer: Priority Health SBD |
$1,042.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$609.01
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 49550
|
| Hospital Charge Code |
49550
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$103,592.00 |
| Rate for Payer: Aetna Commercial |
$755.99
|
| Rate for Payer: Aetna Medicare |
$586.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$812.40
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$564.17
|
| Rate for Payer: BCBS Trust/PPO |
$6,312.66
|
| Rate for Payer: BCN Commercial |
$848.35
|
| Rate for Payer: BCN Medicare Advantage |
$564.17
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$812.40
|
| Rate for Payer: Cofinity Commercial |
$755.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$564.17
|
| Rate for Payer: Healthscope Commercial |
$902.67
|
| Rate for Payer: Healthscope Commercial |
$1,043.71
|
| Rate for Payer: Mclaren Medicaid |
$375.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$592.38
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103,592.00
|
| Rate for Payer: Nomi Health Commercial |
$677.00
|
| Rate for Payer: PACE SWMI |
$564.17
|
| Rate for Payer: PHP Medicare Advantage |
$564.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,042.25
|
| Rate for Payer: Priority Health Medicare |
$564.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,042.25
|
| Rate for Payer: Priority Health SBD |
$1,042.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$564.17
|
| Rate for Payer: UHC Exchange |
$609.01
|
| Rate for Payer: UHC Medicare Advantage |
$564.17
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health SBD |
$544.32
|
|
|
PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
49550
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$544.32 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,516.33
|
| Rate for Payer: BCN Commercial |
$1,516.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$743.04
|
| Rate for Payer: Cofinity Commercial |
$604.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$604.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$691.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$777.60
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$734.40
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$734.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$544.32
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.39
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
PR RPR 1ST INCAL/VNT HERNIA INCARCERATED
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 49561
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Medicare |
$1,121.50
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Min. Negotiated Rate |
$381.06 |
| Max. Negotiated Rate |
$105,323.00 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.27
|
| Rate for Payer: BCBS Complete |
$400.11
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: BCN Commercial |
$863.01
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Healthscope Commercial |
$915.86
|
| Rate for Payer: Healthscope Commercial |
$1,058.96
|
| Rate for Payer: Mclaren Medicaid |
$381.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Meridian Medicaid |
$400.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105,323.00
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.15
|
| Rate for Payer: Priority Health Medicare |
$572.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,060.15
|
| Rate for Payer: Priority Health SBD |
$1,060.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Exchange |
$788.22
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
| Rate for Payer: UHCCP Medicaid |
$381.06
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,048.95 |
| Max. Negotiated Rate |
$1,498.50 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.25
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,165.50
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,165.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health SBD |
$1,048.95
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 49507
|
| Hospital Charge Code |
49507
|
| Min. Negotiated Rate |
$381.06 |
| Max. Negotiated Rate |
$105,323.00 |
| Rate for Payer: Aetna Commercial |
$767.03
|
| Rate for Payer: Aetna Medicare |
$595.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.27
|
| Rate for Payer: BCBS Complete |
$400.11
|
| Rate for Payer: BCBS MAPPO |
$572.41
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: BCN Commercial |
$863.01
|
| Rate for Payer: BCN Medicare Advantage |
$572.41
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$824.27
|
| Rate for Payer: Cofinity Commercial |
$767.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.41
|
| Rate for Payer: Healthscope Commercial |
$915.86
|
| Rate for Payer: Healthscope Commercial |
$1,058.96
|
| Rate for Payer: Mclaren Medicaid |
$381.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.03
|
| Rate for Payer: Meridian Medicaid |
$400.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105,323.00
|
| Rate for Payer: Nomi Health Commercial |
$686.89
|
| Rate for Payer: PACE SWMI |
$572.41
|
| Rate for Payer: PHP Medicare Advantage |
$572.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,060.15
|
| Rate for Payer: Priority Health Medicare |
$572.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,060.15
|
| Rate for Payer: Priority Health SBD |
$1,060.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$788.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.41
|
| Rate for Payer: UHC Exchange |
$788.22
|
| Rate for Payer: UHC Medicare Advantage |
$572.41
|
| Rate for Payer: UHCCP Medicaid |
$381.06
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> INCARCERATED
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
49507
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$633.74 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$1,415.25
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,340.72
|
| Rate for Payer: BCN Commercial |
$2,340.72
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.90
|
| Rate for Payer: Cofinity Commercial |
$1,165.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,165.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$1,498.50
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$1,415.25
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$1,048.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$633.74
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
OP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$563.58 |
| Max. Negotiated Rate |
$10,867.50 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: Aetna Medicare |
$3,596.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,322.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,322.12
|
| Rate for Payer: BCBS Complete |
$1,945.99
|
| Rate for Payer: BCBS MAPPO |
$3,457.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,190.09
|
| Rate for Payer: BCN Commercial |
$2,190.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,457.70
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Cofinity Commercial |
$1,181.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,181.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,457.70
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Mclaren Medicaid |
$1,853.33
|
| Rate for Payer: Mclaren Medicare |
$3,457.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,630.58
|
| Rate for Payer: Meridian Medicaid |
$1,945.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,976.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: Nomi Health Commercial |
$7,261.17
|
| Rate for Payer: PACE Medicare |
$3,284.82
|
| Rate for Payer: PACE SWMI |
$3,457.70
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: PHP Medicare Advantage |
$3,457.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,853.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,867.50
|
| Rate for Payer: Priority Health Medicare |
$3,457.70
|
| Rate for Payer: Priority Health Narrow Network |
$8,694.00
|
| Rate for Payer: Priority Health SBD |
$1,063.44
|
| Rate for Payer: Railroad Medicare Medicare |
$3,457.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.58
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,457.70
|
| Rate for Payer: UHC Medicare Advantage |
$3,457.70
|
| Rate for Payer: UHCCP Medicaid |
$1,946.69
|
| Rate for Payer: VA VA |
$3,457.70
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49505
|
| Min. Negotiated Rate |
$339.52 |
| Max. Negotiated Rate |
$93,602.00 |
| Rate for Payer: Aetna Commercial |
$682.72
|
| Rate for Payer: Aetna Medicare |
$529.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.67
|
| Rate for Payer: BCBS Complete |
$356.50
|
| Rate for Payer: BCBS MAPPO |
$509.49
|
| Rate for Payer: BCBS Trust/PPO |
$749.13
|
| Rate for Payer: BCN Commercial |
$767.71
|
| Rate for Payer: BCN Medicare Advantage |
$509.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$733.67
|
| Rate for Payer: Cofinity Commercial |
$682.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.49
|
| Rate for Payer: Healthscope Commercial |
$942.56
|
| Rate for Payer: Healthscope Commercial |
$815.18
|
| Rate for Payer: Mclaren Medicaid |
$339.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.96
|
| Rate for Payer: Meridian Medicaid |
$356.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93,602.00
|
| Rate for Payer: Nomi Health Commercial |
$611.39
|
| Rate for Payer: PACE SWMI |
$509.49
|
| Rate for Payer: PHP Medicare Advantage |
$509.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$943.81
|
| Rate for Payer: Priority Health Medicare |
$509.49
|
| Rate for Payer: Priority Health Narrow Network |
$943.81
|
| Rate for Payer: Priority Health SBD |
$943.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.49
|
| Rate for Payer: UHC Exchange |
$682.78
|
| Rate for Payer: UHC Medicare Advantage |
$509.49
|
| Rate for Payer: UHCCP Medicaid |
$339.52
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Facility
|
IP
|
$1,688.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
49505
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,063.44 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,434.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.20
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,451.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,181.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,350.40
|
| Rate for Payer: Healthscope Commercial |
$1,519.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,434.80
|
| Rate for Payer: PHP Commercial |
$1,434.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health SBD |
$1,063.44
|
|
|
PR RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
HCPCS 49505
|
| Hospital Charge Code |
49505
|
| Min. Negotiated Rate |
$339.52 |
| Max. Negotiated Rate |
$93,602.00 |
| Rate for Payer: Aetna Commercial |
$682.72
|
| Rate for Payer: Aetna Medicare |
$529.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.67
|
| Rate for Payer: BCBS Complete |
$356.50
|
| Rate for Payer: BCBS MAPPO |
$509.49
|
| Rate for Payer: BCBS Trust/PPO |
$749.13
|
| Rate for Payer: BCN Commercial |
$767.71
|
| Rate for Payer: BCN Medicare Advantage |
$509.49
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cash Price |
$1,350.40
|
| Rate for Payer: Cofinity Commercial |
$733.67
|
| Rate for Payer: Cofinity Commercial |
$682.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.49
|
| Rate for Payer: Healthscope Commercial |
$942.56
|
| Rate for Payer: Healthscope Commercial |
$815.18
|
| Rate for Payer: Mclaren Medicaid |
$339.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.96
|
| Rate for Payer: Meridian Medicaid |
$356.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93,602.00
|
| Rate for Payer: Nomi Health Commercial |
$611.39
|
| Rate for Payer: PACE SWMI |
$509.49
|
| Rate for Payer: PHP Medicare Advantage |
$509.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$943.81
|
| Rate for Payer: Priority Health Medicare |
$509.49
|
| Rate for Payer: Priority Health Narrow Network |
$943.81
|
| Rate for Payer: Priority Health SBD |
$943.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$682.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.49
|
| Rate for Payer: UHC Exchange |
$682.78
|
| Rate for Payer: UHC Medicare Advantage |
$509.49
|
| Rate for Payer: UHCCP Medicaid |
$339.52
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS INCARCERATED
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 49501
|
| Min. Negotiated Rate |
$393.84 |
| Max. Negotiated Rate |
$108,747.00 |
| Rate for Payer: Aetna Commercial |
$793.36
|
| Rate for Payer: Aetna Medicare |
$615.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.57
|
| Rate for Payer: BCBS Complete |
$413.53
|
| Rate for Payer: BCBS MAPPO |
$592.06
|
| Rate for Payer: BCBS Trust/PPO |
$622.87
|
| Rate for Payer: BCN Commercial |
$890.86
|
| Rate for Payer: BCN Medicare Advantage |
$592.06
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$852.57
|
| Rate for Payer: Cofinity Commercial |
$793.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.06
|
| Rate for Payer: Healthscope Commercial |
$947.30
|
| Rate for Payer: Healthscope Commercial |
$1,095.31
|
| Rate for Payer: Mclaren Medicaid |
$393.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.66
|
| Rate for Payer: Meridian Medicaid |
$413.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108,747.00
|
| Rate for Payer: Nomi Health Commercial |
$710.47
|
| Rate for Payer: PACE SWMI |
$592.06
|
| Rate for Payer: PHP Medicare Advantage |
$592.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,094.76
|
| Rate for Payer: Priority Health Medicare |
$592.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,094.76
|
| Rate for Payer: Priority Health SBD |
$1,094.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$600.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.06
|
| Rate for Payer: UHC Exchange |
$600.82
|
| Rate for Payer: UHC Medicare Advantage |
$592.06
|
| Rate for Payer: UHCCP Medicaid |
$393.84
|
|
|
PR RPR 1ST INGUN HRNA AGE 6 MO-5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 49500
|
| Min. Negotiated Rate |
$270.94 |
| Max. Negotiated Rate |
$74,288.00 |
| Rate for Payer: Aetna Commercial |
$541.49
|
| Rate for Payer: Aetna Medicare |
$420.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.90
|
| Rate for Payer: BCBS Complete |
$284.49
|
| Rate for Payer: BCBS MAPPO |
$404.10
|
| Rate for Payer: BCBS Trust/PPO |
$542.04
|
| Rate for Payer: BCN Commercial |
$612.31
|
| Rate for Payer: BCN Medicare Advantage |
$404.10
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cofinity Commercial |
$581.90
|
| Rate for Payer: Cofinity Commercial |
$541.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.10
|
| Rate for Payer: Healthscope Commercial |
$747.58
|
| Rate for Payer: Healthscope Commercial |
$646.56
|
| Rate for Payer: Mclaren Medicaid |
$270.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.30
|
| Rate for Payer: Meridian Medicaid |
$284.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74,288.00
|
| Rate for Payer: Nomi Health Commercial |
$484.92
|
| Rate for Payer: PACE SWMI |
$404.10
|
| Rate for Payer: PHP Medicare Advantage |
$404.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.09
|
| Rate for Payer: Priority Health Medicare |
$404.10
|
| Rate for Payer: Priority Health Narrow Network |
$754.09
|
| Rate for Payer: Priority Health SBD |
$754.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.10
|
| Rate for Payer: UHC Exchange |
$479.93
|
| Rate for Payer: UHC Medicare Advantage |
$404.10
|
| Rate for Payer: UHCCP Medicaid |
$270.94
|
|
|
PR RPR 1ST INGUN HRNA FULL TERM INFT <6 MO INCARCER
|
Professional
|
Both
|
$1,799.00
|
|
|
Service Code
|
HCPCS 49496
|
| Min. Negotiated Rate |
$399.59 |
| Max. Negotiated Rate |
$110,180.00 |
| Rate for Payer: Aetna Commercial |
$804.25
|
| Rate for Payer: Aetna Medicare |
$624.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.27
|
| Rate for Payer: BCBS Complete |
$419.57
|
| Rate for Payer: BCBS MAPPO |
$600.19
|
| Rate for Payer: BCBS Trust/PPO |
$704.75
|
| Rate for Payer: BCN Commercial |
$903.08
|
| Rate for Payer: BCN Medicare Advantage |
$600.19
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cash Price |
$1,439.20
|
| Rate for Payer: Cofinity Commercial |
$864.27
|
| Rate for Payer: Cofinity Commercial |
$804.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.19
|
| Rate for Payer: Healthscope Commercial |
$960.30
|
| Rate for Payer: Healthscope Commercial |
$1,110.35
|
| Rate for Payer: Mclaren Medicaid |
$399.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.20
|
| Rate for Payer: Meridian Medicaid |
$419.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,180.00
|
| Rate for Payer: Nomi Health Commercial |
$720.23
|
| Rate for Payer: PACE SWMI |
$600.19
|
| Rate for Payer: PHP Medicare Advantage |
$600.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,111.46
|
| Rate for Payer: Priority Health Medicare |
$600.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,111.46
|
| Rate for Payer: Priority Health SBD |
$1,111.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.19
|
| Rate for Payer: UHC Exchange |
$702.87
|
| Rate for Payer: UHC Medicare Advantage |
$600.19
|
| Rate for Payer: UHCCP Medicaid |
$399.59
|
|
