|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,330.61 |
| Rate for Payer: Aetna Commercial |
$963.79
|
| Rate for Payer: Aetna Medicare |
$748.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.72
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$719.25
|
| Rate for Payer: BCN Medicare Advantage |
$719.25
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,035.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.25
|
| Rate for Payer: Healthscope Commercial |
$1,150.80
|
| Rate for Payer: Healthscope Commercial |
$1,330.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,090.05
|
| Rate for Payer: Nomi Health Commercial |
$863.10
|
| Rate for Payer: PACE SWMI |
$719.25
|
| Rate for Payer: PHP Medicare Advantage |
$719.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$719.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.25
|
| Rate for Payer: UHC Medicare Advantage |
$719.25
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$19.91 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$15.49
|
| Rate for Payer: Cofinity Commercial |
$14.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Healthscope Commercial |
$19.91
|
| Rate for Payer: Healthscope Commercial |
$17.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$10.76
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$249.10 |
| Rate for Payer: Aetna Commercial |
$180.43
|
| Rate for Payer: Aetna Medicare |
$140.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$134.65
|
| Rate for Payer: BCN Medicare Advantage |
$134.65
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$193.90
|
| Rate for Payer: Cofinity Commercial |
$180.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.65
|
| Rate for Payer: Healthscope Commercial |
$215.44
|
| Rate for Payer: Healthscope Commercial |
$249.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.75
|
| Rate for Payer: Nomi Health Commercial |
$161.58
|
| Rate for Payer: PACE SWMI |
$134.65
|
| Rate for Payer: PHP Medicare Advantage |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$134.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.65
|
| Rate for Payer: UHC Medicare Advantage |
$134.65
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$215.19 |
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Medicare |
$120.97
|
| Rate for Payer: Aetna Medicare |
$120.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.50
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: Healthscope Commercial |
$215.19
|
| Rate for Payer: Healthscope Commercial |
$186.11
|
| Rate for Payer: Healthscope Commercial |
$186.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$76.39
|
| Rate for Payer: Aetna Medicare |
$59.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.09
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.01
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$82.09
|
| Rate for Payer: Cofinity Commercial |
$76.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.01
|
| Rate for Payer: Healthscope Commercial |
$91.22
|
| Rate for Payer: Healthscope Commercial |
$105.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Nomi Health Commercial |
$68.41
|
| Rate for Payer: PACE SWMI |
$57.01
|
| Rate for Payer: PHP Medicare Advantage |
$57.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$57.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.01
|
| Rate for Payer: UHC Medicare Advantage |
$57.01
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$147.33
|
| Rate for Payer: Healthscope Commercial |
$170.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$372.45
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Medicare |
$118.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.71
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$113.96
|
| Rate for Payer: BCN Medicare Advantage |
$113.96
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Cofinity Commercial |
$152.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.96
|
| Rate for Payer: Healthscope Commercial |
$210.83
|
| Rate for Payer: Healthscope Commercial |
$182.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475.15
|
| Rate for Payer: Nomi Health Commercial |
$136.75
|
| Rate for Payer: PACE SWMI |
$113.96
|
| Rate for Payer: PHP Medicare Advantage |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$113.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.96
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$146.19 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$82.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$79.02
|
| Rate for Payer: BCN Medicare Advantage |
$79.02
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$113.79
|
| Rate for Payer: Cofinity Commercial |
$105.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.02
|
| Rate for Payer: Healthscope Commercial |
$126.43
|
| Rate for Payer: Healthscope Commercial |
$146.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.85
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: PACE SWMI |
$79.02
|
| Rate for Payer: PHP Medicare Advantage |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$79.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.02
|
| Rate for Payer: UHC Medicare Advantage |
$79.02
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$49.77 |
| Rate for Payer: Aetna Commercial |
$36.05
|
| Rate for Payer: Aetna Medicare |
$27.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.74
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$49.77
|
| Rate for Payer: Healthscope Commercial |
$43.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$32.28
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$77.02 |
| Rate for Payer: Aetna Commercial |
$55.78
|
| Rate for Payer: Aetna Medicare |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.95
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$41.63
|
| Rate for Payer: BCN Medicare Advantage |
$41.63
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.63
|
| Rate for Payer: Healthscope Commercial |
$66.61
|
| Rate for Payer: Healthscope Commercial |
$77.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Nomi Health Commercial |
$49.96
|
| Rate for Payer: PACE SWMI |
$41.63
|
| Rate for Payer: PHP Medicare Advantage |
$41.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.63
|
| Rate for Payer: UHC Medicare Advantage |
$41.63
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.94
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS MAPPO |
$152.94
|
| Rate for Payer: BCN Medicare Advantage |
$152.94
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.94
|
| Rate for Payer: Healthscope Commercial |
$282.94
|
| Rate for Payer: Healthscope Commercial |
$244.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$585.00
|
| Rate for Payer: Nomi Health Commercial |
$183.53
|
| Rate for Payer: PACE SWMI |
$152.94
|
| Rate for Payer: PHP Medicare Advantage |
$152.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health Medicare |
$152.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.94
|
| Rate for Payer: UHC Medicare Advantage |
$152.94
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$1,325.23 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Aetna Medicare |
$744.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.53
|
| Rate for Payer: BCBS Complete |
$604.00
|
| Rate for Payer: BCBS MAPPO |
$716.34
|
| Rate for Payer: BCN Medicare Advantage |
$716.34
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cofinity Commercial |
$959.90
|
| Rate for Payer: Cofinity Commercial |
$1,031.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.34
|
| Rate for Payer: Healthscope Commercial |
$1,146.14
|
| Rate for Payer: Healthscope Commercial |
$1,325.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.50
|
| Rate for Payer: Nomi Health Commercial |
$859.61
|
| Rate for Payer: PACE SWMI |
$716.34
|
| Rate for Payer: PHP Medicare Advantage |
$716.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health Medicare |
$716.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.34
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$1,199.34 |
| Rate for Payer: Aetna Commercial |
$868.71
|
| Rate for Payer: Aetna Medicare |
$674.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.71
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$648.29
|
| Rate for Payer: BCN Medicare Advantage |
$648.29
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$933.54
|
| Rate for Payer: Cofinity Commercial |
$868.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.29
|
| Rate for Payer: Healthscope Commercial |
$1,199.34
|
| Rate for Payer: Healthscope Commercial |
$1,037.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$845.65
|
| Rate for Payer: Nomi Health Commercial |
$777.95
|
| Rate for Payer: PACE SWMI |
$648.29
|
| Rate for Payer: PHP Medicare Advantage |
$648.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$648.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$648.29
|
| Rate for Payer: UHC Medicare Advantage |
$648.29
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,617.31 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Aetna Medicare |
$909.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.45
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$874.22
|
| Rate for Payer: BCN Medicare Advantage |
$874.22
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.22
|
| Rate for Payer: Healthscope Commercial |
$1,398.75
|
| Rate for Payer: Healthscope Commercial |
$1,617.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,227.20
|
| Rate for Payer: Nomi Health Commercial |
$1,049.06
|
| Rate for Payer: PACE SWMI |
$874.22
|
| Rate for Payer: PHP Medicare Advantage |
$874.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$874.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.22
|
| Rate for Payer: UHC Medicare Advantage |
$874.22
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$253.38 |
| Max. Negotiated Rate |
$1,753.05 |
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Medicare |
$263.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.53
|
| Rate for Payer: BCBS Complete |
$1,078.80
|
| Rate for Payer: BCBS MAPPO |
$253.38
|
| Rate for Payer: BCN Medicare Advantage |
$253.38
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.38
|
| Rate for Payer: Healthscope Commercial |
$468.75
|
| Rate for Payer: Healthscope Commercial |
$405.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,753.05
|
| Rate for Payer: Nomi Health Commercial |
$304.06
|
| Rate for Payer: PACE SWMI |
$253.38
|
| Rate for Payer: PHP Medicare Advantage |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health Medicare |
$253.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.38
|
| Rate for Payer: UHC Medicare Advantage |
$253.38
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$1,133.26 |
| Max. Negotiated Rate |
$2,096.53 |
| Rate for Payer: Aetna Commercial |
$1,518.57
|
| Rate for Payer: Aetna Medicare |
$1,178.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.57
|
| Rate for Payer: BCBS Complete |
$1,198.80
|
| Rate for Payer: BCBS MAPPO |
$1,133.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.26
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$1,631.89
|
| Rate for Payer: Cofinity Commercial |
$1,518.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.26
|
| Rate for Payer: Healthscope Commercial |
$1,813.22
|
| Rate for Payer: Healthscope Commercial |
$2,096.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,948.05
|
| Rate for Payer: Nomi Health Commercial |
$1,359.91
|
| Rate for Payer: PACE SWMI |
$1,133.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health Medicare |
$1,133.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.26
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$1,116.53 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,496.15
|
| Rate for Payer: Aetna Medicare |
$1,161.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,496.15
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$1,116.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.53
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,607.80
|
| Rate for Payer: Cofinity Commercial |
$1,496.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.53
|
| Rate for Payer: Healthscope Commercial |
$1,786.45
|
| Rate for Payer: Healthscope Commercial |
$2,065.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,075.80
|
| Rate for Payer: Nomi Health Commercial |
$1,339.84
|
| Rate for Payer: PACE SWMI |
$1,116.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$1,116.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.53
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,009.26 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,121.40
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health SBD |
$1,009.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$2,010.17
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,009.26 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.30
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,121.40
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health SBD |
$1,009.26
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,218.04 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.10
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Healthscope Commercial |
$1,053.44
|
| Rate for Payer: Healthscope Commercial |
$1,218.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.30
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,218.04 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.10
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Healthscope Commercial |
$1,053.44
|
| Rate for Payer: Healthscope Commercial |
$1,218.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,041.30
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$125.12 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$130.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.66
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCN Medicare Advantage |
$125.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$180.17
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.12
|
| Rate for Payer: Healthscope Commercial |
$231.47
|
| Rate for Payer: Healthscope Commercial |
$200.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.00
|
| Rate for Payer: Nomi Health Commercial |
$150.14
|
| Rate for Payer: PACE SWMI |
$125.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
|
