|
PR STERILE SALINE OR WATER
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS A4218
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.75 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.75
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
|
|
PR STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$4,272.00
|
|
|
Service Code
|
HCPCS 21627
|
| Min. Negotiated Rate |
$354.22 |
| Max. Negotiated Rate |
$3,204.00 |
| Rate for Payer: Aetna Commercial |
$723.72
|
| Rate for Payer: Aetna Medicare |
$561.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.72
|
| Rate for Payer: BCBS Complete |
$371.93
|
| Rate for Payer: BCBS MAPPO |
$540.09
|
| Rate for Payer: BCN Commercial |
$830.13
|
| Rate for Payer: BCN Medicare Advantage |
$540.09
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cash Price |
$3,417.60
|
| Rate for Payer: Cofinity Commercial |
$777.73
|
| Rate for Payer: Cofinity Commercial |
$723.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.09
|
| Rate for Payer: Healthscope Commercial |
$999.17
|
| Rate for Payer: Healthscope Commercial |
$864.14
|
| Rate for Payer: Mclaren Medicaid |
$354.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.09
|
| Rate for Payer: Meridian Medicaid |
$371.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$594.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$964.03
|
| Rate for Payer: Nomi Health Commercial |
$648.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,204.00
|
| Rate for Payer: PACE SWMI |
$540.09
|
| Rate for Payer: PHP Medicare Advantage |
$540.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$887.40
|
| Rate for Payer: Priority Health Medicare |
$540.09
|
| Rate for Payer: Priority Health SBD |
$887.40
|
| Rate for Payer: Priority Health Tiered Network |
$887.40
|
| Rate for Payer: Railroad Medicare Medicare |
$540.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$941.41
|
| Rate for Payer: UHC Core |
$941.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$540.09
|
| Rate for Payer: UHC Exchange |
$941.41
|
| Rate for Payer: UHC Medicaid |
$354.22
|
| Rate for Payer: UHCCP Medicaid |
$354.22
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,176.00
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$271.79 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna Commercial |
$579.63
|
| Rate for Payer: Aetna Medicare |
$449.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.89
|
| Rate for Payer: BCBS Complete |
$285.38
|
| Rate for Payer: BCBS MAPPO |
$432.56
|
| Rate for Payer: BCN Commercial |
$717.59
|
| Rate for Payer: BCN Medicare Advantage |
$432.56
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cash Price |
$940.80
|
| Rate for Payer: Cofinity Commercial |
$622.89
|
| Rate for Payer: Cofinity Commercial |
$579.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.56
|
| Rate for Payer: Healthscope Commercial |
$800.24
|
| Rate for Payer: Healthscope Commercial |
$692.10
|
| Rate for Payer: Mclaren Medicaid |
$271.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.19
|
| Rate for Payer: Meridian Medicaid |
$285.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$475.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$870.48
|
| Rate for Payer: Nomi Health Commercial |
$519.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.00
|
| Rate for Payer: PACE SWMI |
$432.56
|
| Rate for Payer: PHP Medicare Advantage |
$432.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$271.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$677.40
|
| Rate for Payer: Priority Health Medicare |
$432.56
|
| Rate for Payer: Priority Health SBD |
$677.40
|
| Rate for Payer: Priority Health Tiered Network |
$677.40
|
| Rate for Payer: Railroad Medicare Medicare |
$432.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$868.09
|
| Rate for Payer: UHC Core |
$868.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$432.56
|
| Rate for Payer: UHC Exchange |
$868.09
|
| Rate for Payer: UHC Medicaid |
$271.79
|
| Rate for Payer: UHCCP Medicaid |
$271.79
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$505.37
|
| Rate for Payer: Aetna Medicare |
$392.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.08
|
| Rate for Payer: BCBS Complete |
$261.89
|
| Rate for Payer: BCBS MAPPO |
$377.14
|
| Rate for Payer: BCN Commercial |
$676.26
|
| Rate for Payer: BCN Medicare Advantage |
$377.14
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cofinity Commercial |
$543.08
|
| Rate for Payer: Cofinity Commercial |
$505.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$377.14
|
| Rate for Payer: Healthscope Commercial |
$697.71
|
| Rate for Payer: Healthscope Commercial |
$603.42
|
| Rate for Payer: Mclaren Medicaid |
$249.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$396.00
|
| Rate for Payer: Meridian Medicaid |
$261.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$414.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.68
|
| Rate for Payer: Nomi Health Commercial |
$452.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,116.00
|
| Rate for Payer: PACE SWMI |
$377.14
|
| Rate for Payer: PHP Medicare Advantage |
$377.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$792.14
|
| Rate for Payer: Priority Health Medicare |
$377.14
|
| Rate for Payer: Priority Health SBD |
$792.14
|
| Rate for Payer: Priority Health Tiered Network |
$792.14
|
| Rate for Payer: Railroad Medicare Medicare |
$377.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,014.94
|
| Rate for Payer: UHC Core |
$1,014.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$377.14
|
| Rate for Payer: UHC Exchange |
$1,014.94
|
| Rate for Payer: UHC Medicaid |
$249.42
|
| Rate for Payer: UHCCP Medicaid |
$249.42
|
|
|
PR STRAIGHT TIP URINE CATHETER
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4351
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Aetna Medicare |
$2.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.72
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.47
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$4.77
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.41
|
| Rate for Payer: Nomi Health Commercial |
$3.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Medicare |
$2.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.84
|
| Rate for Payer: UHC Core |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.58
|
| Rate for Payer: UHC Exchange |
$0.84
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Medicare |
$15.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.10
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS MAPPO |
$15.35
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: BCN Medicare Advantage |
$15.35
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$22.10
|
| Rate for Payer: Cofinity Commercial |
$20.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$24.56
|
| Rate for Payer: Mclaren Medicaid |
$9.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.12
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.41
|
| Rate for Payer: Nomi Health Commercial |
$18.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.00
|
| Rate for Payer: PACE SWMI |
$15.35
|
| Rate for Payer: PHP Medicare Advantage |
$15.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.68
|
| Rate for Payer: Priority Health Medicare |
$15.35
|
| Rate for Payer: Priority Health SBD |
$27.68
|
| Rate for Payer: Priority Health Tiered Network |
$27.68
|
| Rate for Payer: Railroad Medicare Medicare |
$15.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.55
|
| Rate for Payer: UHC Core |
$31.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.35
|
| Rate for Payer: UHC Exchange |
$31.55
|
| Rate for Payer: UHC Medicaid |
$9.80
|
| Rate for Payer: UHCCP Medicaid |
$9.80
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.44
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$15.58
|
| Rate for Payer: BCN Commercial |
$27.89
|
| Rate for Payer: BCN Medicare Advantage |
$15.58
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$22.44
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$28.82
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Mclaren Medicaid |
$10.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.36
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.20
|
| Rate for Payer: Nomi Health Commercial |
$18.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.75
|
| Rate for Payer: PACE SWMI |
$15.58
|
| Rate for Payer: PHP Medicare Advantage |
$15.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.80
|
| Rate for Payer: Priority Health Medicare |
$15.58
|
| Rate for Payer: Priority Health SBD |
$29.80
|
| Rate for Payer: Priority Health Tiered Network |
$29.80
|
| Rate for Payer: Railroad Medicare Medicare |
$15.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.42
|
| Rate for Payer: UHC Core |
$34.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.58
|
| Rate for Payer: UHC Exchange |
$34.42
|
| Rate for Payer: UHC Medicaid |
$10.01
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$79.50 |
| Rate for Payer: Aetna Commercial |
$22.71
|
| Rate for Payer: Aetna Medicare |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.41
|
| Rate for Payer: BCBS Complete |
$11.40
|
| Rate for Payer: BCBS MAPPO |
$16.95
|
| Rate for Payer: BCN Commercial |
$29.38
|
| Rate for Payer: BCN Medicare Advantage |
$16.95
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$24.41
|
| Rate for Payer: Cofinity Commercial |
$22.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.95
|
| Rate for Payer: Healthscope Commercial |
$31.36
|
| Rate for Payer: Healthscope Commercial |
$27.12
|
| Rate for Payer: Mclaren Medicaid |
$10.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.80
|
| Rate for Payer: Meridian Medicaid |
$11.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.30
|
| Rate for Payer: Nomi Health Commercial |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.50
|
| Rate for Payer: PACE SWMI |
$16.95
|
| Rate for Payer: PHP Medicare Advantage |
$16.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.40
|
| Rate for Payer: Priority Health Medicare |
$16.95
|
| Rate for Payer: Priority Health SBD |
$31.40
|
| Rate for Payer: Priority Health Tiered Network |
$31.40
|
| Rate for Payer: Railroad Medicare Medicare |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.82
|
| Rate for Payer: UHC Core |
$36.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.95
|
| Rate for Payer: UHC Exchange |
$36.82
|
| Rate for Payer: UHC Medicaid |
$10.86
|
| Rate for Payer: UHCCP Medicaid |
$10.86
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$6.18 |
| Max. Negotiated Rate |
$45.75 |
| Rate for Payer: Aetna Commercial |
$12.98
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS MAPPO |
$9.69
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: BCN Medicare Advantage |
$9.69
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$17.93
|
| Rate for Payer: Healthscope Commercial |
$15.50
|
| Rate for Payer: Mclaren Medicaid |
$6.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.17
|
| Rate for Payer: Meridian Medicaid |
$6.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Nomi Health Commercial |
$11.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.75
|
| Rate for Payer: PACE SWMI |
$9.69
|
| Rate for Payer: PHP Medicare Advantage |
$9.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$17.56
|
| Rate for Payer: Priority Health Medicare |
$9.69
|
| Rate for Payer: Priority Health SBD |
$17.56
|
| Rate for Payer: Priority Health Tiered Network |
$17.56
|
| Rate for Payer: Railroad Medicare Medicare |
$9.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.39
|
| Rate for Payer: UHC Core |
$20.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.69
|
| Rate for Payer: UHC Exchange |
$20.39
|
| Rate for Payer: UHC Medicaid |
$6.18
|
| Rate for Payer: UHCCP Medicaid |
$6.18
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$73.50 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$24.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.72
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$23.42
|
| Rate for Payer: BCN Commercial |
$30.63
|
| Rate for Payer: BCN Medicare Advantage |
$23.42
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.42
|
| Rate for Payer: Healthscope Commercial |
$43.33
|
| Rate for Payer: Healthscope Commercial |
$37.47
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.59
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.03
|
| Rate for Payer: Nomi Health Commercial |
$28.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.50
|
| Rate for Payer: PACE SWMI |
$23.42
|
| Rate for Payer: PHP Medicare Advantage |
$23.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.52
|
| Rate for Payer: Priority Health Medicare |
$23.42
|
| Rate for Payer: Priority Health SBD |
$41.52
|
| Rate for Payer: Priority Health Tiered Network |
$41.52
|
| Rate for Payer: Railroad Medicare Medicare |
$23.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.75
|
| Rate for Payer: UHC Core |
$48.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.42
|
| Rate for Payer: UHC Exchange |
$48.75
|
| Rate for Payer: UHC Medicaid |
$14.91
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$7,245.00
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$884.16 |
| Max. Negotiated Rate |
$5,433.75 |
| Rate for Payer: Aetna Commercial |
$1,842.02
|
| Rate for Payer: Aetna Medicare |
$1,429.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,842.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,979.48
|
| Rate for Payer: BCBS Complete |
$928.37
|
| Rate for Payer: BCBS MAPPO |
$1,374.64
|
| Rate for Payer: BCN Commercial |
$2,934.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,374.64
|
| Rate for Payer: Cash Price |
$5,796.00
|
| Rate for Payer: Cash Price |
$5,796.00
|
| Rate for Payer: Cofinity Commercial |
$1,979.48
|
| Rate for Payer: Cofinity Commercial |
$1,842.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,374.64
|
| Rate for Payer: Healthscope Commercial |
$2,543.08
|
| Rate for Payer: Healthscope Commercial |
$2,199.42
|
| Rate for Payer: Mclaren Medicaid |
$884.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,443.37
|
| Rate for Payer: Meridian Medicaid |
$928.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,512.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,512.15
|
| Rate for Payer: Nomi Health Commercial |
$1,649.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,433.75
|
| Rate for Payer: PACE SWMI |
$1,374.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,374.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$884.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,466.86
|
| Rate for Payer: Priority Health Medicare |
$1,374.64
|
| Rate for Payer: Priority Health SBD |
$2,466.86
|
| Rate for Payer: Priority Health Tiered Network |
$2,466.86
|
| Rate for Payer: Railroad Medicare Medicare |
$1,374.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,421.65
|
| Rate for Payer: UHC Core |
$2,421.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,374.64
|
| Rate for Payer: UHC Exchange |
$2,421.65
|
| Rate for Payer: UHC Medicaid |
$884.16
|
| Rate for Payer: UHCCP Medicaid |
$884.16
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Aetna Commercial |
$292.01
|
| Rate for Payer: Aetna Medicare |
$226.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.80
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$217.92
|
| Rate for Payer: BCN Commercial |
$354.07
|
| Rate for Payer: BCN Medicare Advantage |
$217.92
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$313.80
|
| Rate for Payer: Cofinity Commercial |
$292.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.92
|
| Rate for Payer: Healthscope Commercial |
$403.15
|
| Rate for Payer: Healthscope Commercial |
$348.67
|
| Rate for Payer: Mclaren Medicaid |
$137.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$228.82
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$239.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.86
|
| Rate for Payer: Nomi Health Commercial |
$261.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$573.75
|
| Rate for Payer: PACE SWMI |
$217.92
|
| Rate for Payer: PHP Medicare Advantage |
$217.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$411.23
|
| Rate for Payer: Priority Health Medicare |
$217.92
|
| Rate for Payer: Priority Health SBD |
$411.23
|
| Rate for Payer: Priority Health Tiered Network |
$411.23
|
| Rate for Payer: Railroad Medicare Medicare |
$217.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.38
|
| Rate for Payer: UHC Core |
$418.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$217.92
|
| Rate for Payer: UHC Exchange |
$418.38
|
| Rate for Payer: UHC Medicaid |
$137.17
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Aetna Commercial |
$193.05
|
| Rate for Payer: Aetna Medicare |
$149.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.46
|
| Rate for Payer: BCBS Complete |
$96.62
|
| Rate for Payer: BCBS MAPPO |
$144.07
|
| Rate for Payer: BCN Commercial |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$144.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$207.46
|
| Rate for Payer: Cofinity Commercial |
$193.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.07
|
| Rate for Payer: Healthscope Commercial |
$266.53
|
| Rate for Payer: Healthscope Commercial |
$230.51
|
| Rate for Payer: Mclaren Medicaid |
$92.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.27
|
| Rate for Payer: Meridian Medicaid |
$96.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$158.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.51
|
| Rate for Payer: Nomi Health Commercial |
$172.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$573.75
|
| Rate for Payer: PACE SWMI |
$144.07
|
| Rate for Payer: PHP Medicare Advantage |
$144.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$299.03
|
| Rate for Payer: Priority Health Medicare |
$144.07
|
| Rate for Payer: Priority Health SBD |
$299.03
|
| Rate for Payer: Priority Health Tiered Network |
$299.03
|
| Rate for Payer: Railroad Medicare Medicare |
$144.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.27
|
| Rate for Payer: UHC Core |
$307.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.07
|
| Rate for Payer: UHC Exchange |
$307.27
|
| Rate for Payer: UHC Medicaid |
$92.02
|
| Rate for Payer: UHCCP Medicaid |
$92.02
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,565.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$6,423.75 |
| Rate for Payer: Aetna Commercial |
$374.05
|
| Rate for Payer: Aetna Medicare |
$290.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.96
|
| Rate for Payer: BCBS Complete |
$184.52
|
| Rate for Payer: BCBS MAPPO |
$279.14
|
| Rate for Payer: BCN Commercial |
$454.16
|
| Rate for Payer: BCN Medicare Advantage |
$279.14
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cofinity Commercial |
$401.96
|
| Rate for Payer: Cofinity Commercial |
$374.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.14
|
| Rate for Payer: Healthscope Commercial |
$516.41
|
| Rate for Payer: Healthscope Commercial |
$446.62
|
| Rate for Payer: Mclaren Medicaid |
$175.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.10
|
| Rate for Payer: Meridian Medicaid |
$184.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$307.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548.42
|
| Rate for Payer: Nomi Health Commercial |
$334.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,423.75
|
| Rate for Payer: PACE SWMI |
$279.14
|
| Rate for Payer: PHP Medicare Advantage |
$279.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$527.50
|
| Rate for Payer: Priority Health Medicare |
$279.14
|
| Rate for Payer: Priority Health SBD |
$527.50
|
| Rate for Payer: Priority Health Tiered Network |
$527.50
|
| Rate for Payer: Railroad Medicare Medicare |
$279.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.43
|
| Rate for Payer: UHC Core |
$539.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$279.14
|
| Rate for Payer: UHC Exchange |
$539.43
|
| Rate for Payer: UHC Medicaid |
$175.73
|
| Rate for Payer: UHCCP Medicaid |
$175.73
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,565.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$127.59 |
| Max. Negotiated Rate |
$6,423.75 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Medicare |
$210.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.97
|
| Rate for Payer: BCBS Complete |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$202.76
|
| Rate for Payer: BCN Commercial |
$329.17
|
| Rate for Payer: BCN Medicare Advantage |
$202.76
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cash Price |
$6,852.00
|
| Rate for Payer: Cofinity Commercial |
$291.97
|
| Rate for Payer: Cofinity Commercial |
$271.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.76
|
| Rate for Payer: Healthscope Commercial |
$375.11
|
| Rate for Payer: Healthscope Commercial |
$324.42
|
| Rate for Payer: Mclaren Medicaid |
$127.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.90
|
| Rate for Payer: Meridian Medicaid |
$133.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$223.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$396.31
|
| Rate for Payer: Nomi Health Commercial |
$243.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,423.75
|
| Rate for Payer: PACE SWMI |
$202.76
|
| Rate for Payer: PHP Medicare Advantage |
$202.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$382.32
|
| Rate for Payer: Priority Health Medicare |
$202.76
|
| Rate for Payer: Priority Health SBD |
$382.32
|
| Rate for Payer: Priority Health Tiered Network |
$382.32
|
| Rate for Payer: Railroad Medicare Medicare |
$202.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.13
|
| Rate for Payer: UHC Core |
$390.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$202.76
|
| Rate for Payer: UHC Exchange |
$390.13
|
| Rate for Payer: UHC Medicaid |
$127.59
|
| Rate for Payer: UHCCP Medicaid |
$127.59
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$64.87
|
| Rate for Payer: Aetna Medicare |
$50.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.71
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$48.41
|
| Rate for Payer: BCN Commercial |
$82.17
|
| Rate for Payer: BCN Medicare Advantage |
$48.41
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$69.71
|
| Rate for Payer: Cofinity Commercial |
$64.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.41
|
| Rate for Payer: Healthscope Commercial |
$89.56
|
| Rate for Payer: Healthscope Commercial |
$77.46
|
| Rate for Payer: Mclaren Medicaid |
$30.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.83
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.92
|
| Rate for Payer: Nomi Health Commercial |
$58.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.25
|
| Rate for Payer: PACE SWMI |
$48.41
|
| Rate for Payer: PHP Medicare Advantage |
$48.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75.20
|
| Rate for Payer: Priority Health Medicare |
$48.41
|
| Rate for Payer: Priority Health SBD |
$75.20
|
| Rate for Payer: Priority Health Tiered Network |
$75.20
|
| Rate for Payer: Railroad Medicare Medicare |
$48.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.06
|
| Rate for Payer: UHC Core |
$99.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.41
|
| Rate for Payer: UHC Exchange |
$99.06
|
| Rate for Payer: UHC Medicaid |
$30.89
|
| Rate for Payer: UHCCP Medicaid |
$30.89
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: Aetna Medicare |
$115.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.32
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS MAPPO |
$110.64
|
| Rate for Payer: BCN Commercial |
$238.72
|
| Rate for Payer: BCN Medicare Advantage |
$110.64
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$159.32
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.64
|
| Rate for Payer: Healthscope Commercial |
$204.68
|
| Rate for Payer: Healthscope Commercial |
$177.02
|
| Rate for Payer: Mclaren Medicaid |
$70.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.17
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.61
|
| Rate for Payer: Nomi Health Commercial |
$132.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.00
|
| Rate for Payer: PACE SWMI |
$110.64
|
| Rate for Payer: PHP Medicare Advantage |
$110.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.70
|
| Rate for Payer: Priority Health Medicare |
$110.64
|
| Rate for Payer: Priority Health SBD |
$200.70
|
| Rate for Payer: Priority Health Tiered Network |
$200.70
|
| Rate for Payer: Railroad Medicare Medicare |
$110.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.24
|
| Rate for Payer: UHC Core |
$198.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.64
|
| Rate for Payer: UHC Exchange |
$198.24
|
| Rate for Payer: UHC Medicaid |
$70.93
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$404.27 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$204.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.22
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$196.68
|
| Rate for Payer: BCN Commercial |
$332.15
|
| Rate for Payer: BCN Medicare Advantage |
$196.68
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$283.22
|
| Rate for Payer: Cofinity Commercial |
$263.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.68
|
| Rate for Payer: Healthscope Commercial |
$363.86
|
| Rate for Payer: Healthscope Commercial |
$314.69
|
| Rate for Payer: Mclaren Medicaid |
$125.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.51
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$216.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.48
|
| Rate for Payer: Nomi Health Commercial |
$236.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.50
|
| Rate for Payer: PACE SWMI |
$196.68
|
| Rate for Payer: PHP Medicare Advantage |
$196.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$304.00
|
| Rate for Payer: Priority Health Medicare |
$196.68
|
| Rate for Payer: Priority Health SBD |
$304.00
|
| Rate for Payer: Priority Health Tiered Network |
$304.00
|
| Rate for Payer: Railroad Medicare Medicare |
$196.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.27
|
| Rate for Payer: UHC Core |
$404.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$196.68
|
| Rate for Payer: UHC Exchange |
$404.27
|
| Rate for Payer: UHC Medicaid |
$125.88
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.29
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.81
|
| Rate for Payer: BCN Commercial |
$83.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.81
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$70.29
|
| Rate for Payer: Cofinity Commercial |
$65.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.81
|
| Rate for Payer: Healthscope Commercial |
$90.30
|
| Rate for Payer: Healthscope Commercial |
$78.10
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.25
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.04
|
| Rate for Payer: Nomi Health Commercial |
$58.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$48.81
|
| Rate for Payer: PHP Medicare Advantage |
$48.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.12
|
| Rate for Payer: Priority Health Medicare |
$48.81
|
| Rate for Payer: Priority Health SBD |
$76.12
|
| Rate for Payer: Priority Health Tiered Network |
$76.12
|
| Rate for Payer: Railroad Medicare Medicare |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.40
|
| Rate for Payer: UHC Core |
$102.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.81
|
| Rate for Payer: UHC Exchange |
$102.40
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: Aetna Medicare |
$86.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$139.44
|
| Rate for Payer: BCN Medicare Advantage |
$83.46
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$120.18
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.46
|
| Rate for Payer: Healthscope Commercial |
$154.40
|
| Rate for Payer: Healthscope Commercial |
$133.54
|
| Rate for Payer: Mclaren Medicaid |
$53.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.63
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.66
|
| Rate for Payer: Nomi Health Commercial |
$100.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.25
|
| Rate for Payer: PACE SWMI |
$83.46
|
| Rate for Payer: PHP Medicare Advantage |
$83.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.62
|
| Rate for Payer: Priority Health Medicare |
$83.46
|
| Rate for Payer: Priority Health SBD |
$127.62
|
| Rate for Payer: Priority Health Tiered Network |
$127.62
|
| Rate for Payer: Railroad Medicare Medicare |
$83.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.78
|
| Rate for Payer: UHC Core |
$168.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.46
|
| Rate for Payer: UHC Exchange |
$168.78
|
| Rate for Payer: UHC Medicaid |
$53.68
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$29.56
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.77
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$22.06
|
| Rate for Payer: BCN Commercial |
$36.85
|
| Rate for Payer: BCN Medicare Advantage |
$22.06
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Cofinity Commercial |
$29.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.06
|
| Rate for Payer: Healthscope Commercial |
$40.81
|
| Rate for Payer: Healthscope Commercial |
$35.30
|
| Rate for Payer: Mclaren Medicaid |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.16
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.53
|
| Rate for Payer: Nomi Health Commercial |
$26.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: PACE SWMI |
$22.06
|
| Rate for Payer: PHP Medicare Advantage |
$22.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.73
|
| Rate for Payer: Priority Health Medicare |
$22.06
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health Tiered Network |
$33.73
|
| Rate for Payer: Railroad Medicare Medicare |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.18
|
| Rate for Payer: UHC Core |
$46.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.06
|
| Rate for Payer: UHC Exchange |
$46.18
|
| Rate for Payer: UHC Medicaid |
$14.06
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$230.68 |
| Max. Negotiated Rate |
$689.28 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Aetna Medicare |
$357.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.83
|
| Rate for Payer: BCBS Complete |
$242.21
|
| Rate for Payer: BCBS MAPPO |
$343.63
|
| Rate for Payer: BCN Commercial |
$565.70
|
| Rate for Payer: BCN Medicare Advantage |
$343.63
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$494.83
|
| Rate for Payer: Cofinity Commercial |
$460.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.63
|
| Rate for Payer: Healthscope Commercial |
$635.72
|
| Rate for Payer: Healthscope Commercial |
$549.81
|
| Rate for Payer: Mclaren Medicaid |
$230.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.81
|
| Rate for Payer: Meridian Medicaid |
$242.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$377.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$654.98
|
| Rate for Payer: Nomi Health Commercial |
$412.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PACE SWMI |
$343.63
|
| Rate for Payer: PHP Medicare Advantage |
$343.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$689.28
|
| Rate for Payer: Priority Health Medicare |
$343.63
|
| Rate for Payer: Priority Health SBD |
$689.28
|
| Rate for Payer: Priority Health Tiered Network |
$689.28
|
| Rate for Payer: Railroad Medicare Medicare |
$343.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.30
|
| Rate for Payer: UHC Core |
$634.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$343.63
|
| Rate for Payer: UHC Exchange |
$634.30
|
| Rate for Payer: UHC Medicaid |
$230.68
|
| Rate for Payer: UHCCP Medicaid |
$230.68
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$884.25 |
| Rate for Payer: Aetna Commercial |
$203.13
|
| Rate for Payer: Aetna Medicare |
$157.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.29
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$151.59
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$151.59
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$218.29
|
| Rate for Payer: Cofinity Commercial |
$203.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.59
|
| Rate for Payer: Healthscope Commercial |
$280.44
|
| Rate for Payer: Healthscope Commercial |
$242.54
|
| Rate for Payer: Mclaren Medicaid |
$97.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.17
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.24
|
| Rate for Payer: Nomi Health Commercial |
$181.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: PACE SWMI |
$151.59
|
| Rate for Payer: PHP Medicare Advantage |
$151.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.83
|
| Rate for Payer: Priority Health Medicare |
$151.59
|
| Rate for Payer: Priority Health SBD |
$251.83
|
| Rate for Payer: Priority Health Tiered Network |
$251.83
|
| Rate for Payer: Railroad Medicare Medicare |
$151.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.84
|
| Rate for Payer: UHC Core |
$311.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.59
|
| Rate for Payer: UHC Exchange |
$311.84
|
| Rate for Payer: UHC Medicaid |
$97.77
|
| Rate for Payer: UHCCP Medicaid |
$97.77
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna Commercial |
$47.07
|
| Rate for Payer: Aetna Medicare |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.59
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS MAPPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: BCN Medicare Advantage |
$35.13
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$47.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.13
|
| Rate for Payer: Healthscope Commercial |
$64.99
|
| Rate for Payer: Healthscope Commercial |
$56.21
|
| Rate for Payer: Mclaren Medicaid |
$22.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.89
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.33
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$35.13
|
| Rate for Payer: PHP Medicare Advantage |
$35.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$35.13
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: Priority Health Tiered Network |
$53.30
|
| Rate for Payer: Railroad Medicare Medicare |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.71
|
| Rate for Payer: UHC Core |
$59.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.13
|
| Rate for Payer: UHC Exchange |
$59.71
|
| Rate for Payer: UHC Medicaid |
$22.58
|
| Rate for Payer: UHCCP Medicaid |
$22.58
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$334.07 |
| Max. Negotiated Rate |
$618.03 |
| Rate for Payer: PHP Medicare Advantage |
$334.07
|
| Rate for Payer: Aetna Commercial |
$447.65
|
| Rate for Payer: Aetna Medicare |
$347.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.06
|
| Rate for Payer: BCBS Complete |
$350.77
|
| Rate for Payer: BCBS MAPPO |
$334.07
|
| Rate for Payer: BCN Commercial |
$568.20
|
| Rate for Payer: BCN Medicare Advantage |
$334.07
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$481.06
|
| Rate for Payer: Cofinity Commercial |
$447.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.07
|
| Rate for Payer: Healthscope Commercial |
$618.03
|
| Rate for Payer: Healthscope Commercial |
$534.51
|
| Rate for Payer: Mclaren Medicaid |
$334.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.77
|
| Rate for Payer: Meridian Medicaid |
$350.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$367.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.97
|
| Rate for Payer: Nomi Health Commercial |
$400.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.75
|
| Rate for Payer: PACE SWMI |
$334.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$598.52
|
| Rate for Payer: Priority Health Medicare |
$334.07
|
| Rate for Payer: Priority Health SBD |
$598.52
|
| Rate for Payer: Priority Health Tiered Network |
$598.52
|
| Rate for Payer: Railroad Medicare Medicare |
$334.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.52
|
| Rate for Payer: UHC Core |
$564.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$334.07
|
| Rate for Payer: UHC Exchange |
$564.52
|
| Rate for Payer: UHC Medicaid |
$334.07
|
| Rate for Payer: UHCCP Medicaid |
$334.07
|
|
