|
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 |
$37.49 |
| Max. Negotiated Rate |
$10,564.00 |
| 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 |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$57.01
|
| Rate for Payer: BCBS Trust/PPO |
$517.72
|
| Rate for Payer: BCN Commercial |
$167.13
|
| 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: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.86
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,564.00
|
| 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 Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.47
|
| Rate for Payer: Priority Health Medicare |
$57.01
|
| Rate for Payer: Priority Health Narrow Network |
$79.47
|
| Rate for Payer: Priority Health SBD |
$79.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.01
|
| Rate for Payer: UHC Exchange |
$163.06
|
| Rate for Payer: UHC Medicare Advantage |
$57.01
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$17,057.00 |
| 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 |
$63.07
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCBS Trust/PPO |
$561.29
|
| Rate for Payer: BCN Commercial |
$259.49
|
| 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 |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Healthscope Commercial |
$170.35
|
| Rate for Payer: Healthscope Commercial |
$147.33
|
| Rate for Payer: Mclaren Medicaid |
$60.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,057.00
|
| 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 Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.77
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: Priority Health Narrow Network |
$127.77
|
| Rate for Payer: Priority Health SBD |
$127.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Exchange |
$244.28
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
| Rate for Payer: UHCCP Medicaid |
$60.07
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$20,986.00 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Medicare |
$118.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.10
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$113.96
|
| Rate for Payer: BCBS Trust/PPO |
$525.42
|
| Rate for Payer: BCN Commercial |
$301.51
|
| 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: Mclaren Medicaid |
$74.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.66
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,986.00
|
| 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 Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.22
|
| Rate for Payer: Priority Health Medicare |
$113.96
|
| Rate for Payer: Priority Health Narrow Network |
$156.22
|
| Rate for Payer: Priority Health SBD |
$156.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$307.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.96
|
| Rate for Payer: UHC Exchange |
$307.82
|
| Rate for Payer: UHC Medicare Advantage |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$7,521.00 |
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$3,612.00 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.84
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,612.00
|
| 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 |
$3,806.00 |
| 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: BCBS Trust/PPO |
$1,605.50
|
| Rate for Payer: BCN Commercial |
$40.07
|
| 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 |
$36.05
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$49.76
|
| Rate for Payer: Healthscope Commercial |
$43.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,806.00
|
| 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 HMO/PPO/Tiered Network |
$39.35
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: Priority Health Narrow Network |
$39.35
|
| Rate for Payer: Priority Health SBD |
$39.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Exchange |
$17.89
|
| 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 |
$5,889.00 |
| 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: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCN Commercial |
$62.06
|
| 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 |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| 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 |
$5,889.00
|
| 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 HMO/PPO/Tiered Network |
$61.06
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: Priority Health Narrow Network |
$61.06
|
| Rate for Payer: Priority Health SBD |
$61.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.63
|
| Rate for Payer: UHC Exchange |
$27.70
|
| 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 |
$102.24 |
| Max. Negotiated Rate |
$28,211.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.23
|
| Rate for Payer: BCBS Complete |
$107.35
|
| Rate for Payer: BCBS MAPPO |
$152.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.16
|
| Rate for Payer: BCN Commercial |
$425.15
|
| 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: Mclaren Medicaid |
$102.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.59
|
| Rate for Payer: Meridian Medicaid |
$107.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,211.00
|
| 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 Choice Medicaid |
$102.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.39
|
| Rate for Payer: Priority Health Medicare |
$152.94
|
| Rate for Payer: Priority Health Narrow Network |
$283.39
|
| Rate for Payer: Priority Health SBD |
$283.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.94
|
| Rate for Payer: UHC Exchange |
$286.47
|
| Rate for Payer: UHC Medicare Advantage |
$152.94
|
| Rate for Payer: UHCCP Medicaid |
$102.24
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$480.32 |
| Max. Negotiated Rate |
$132,899.00 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Aetna Medicare |
$744.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.90
|
| Rate for Payer: BCBS Complete |
$504.34
|
| Rate for Payer: BCBS MAPPO |
$716.34
|
| Rate for Payer: BCBS Trust/PPO |
$714.79
|
| Rate for Payer: BCN Commercial |
$1,093.66
|
| 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 |
$1,325.23
|
| Rate for Payer: Healthscope Commercial |
$1,146.14
|
| Rate for Payer: Mclaren Medicaid |
$480.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.16
|
| Rate for Payer: Meridian Medicaid |
$504.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132,899.00
|
| 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 Choice Medicaid |
$480.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,341.75
|
| Rate for Payer: Priority Health Medicare |
$716.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,341.75
|
| Rate for Payer: Priority Health SBD |
$1,341.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$707.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.34
|
| Rate for Payer: UHC Exchange |
$707.77
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
| Rate for Payer: UHCCP Medicaid |
$480.32
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$434.73 |
| Max. Negotiated Rate |
$119,263.00 |
| Rate for Payer: Aetna Commercial |
$868.71
|
| Rate for Payer: Aetna Medicare |
$674.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.54
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS MAPPO |
$648.29
|
| Rate for Payer: BCBS Trust/PPO |
$477.58
|
| Rate for Payer: BCN Commercial |
$983.71
|
| 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: Mclaren Medicaid |
$434.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.70
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119,263.00
|
| 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 Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,205.72
|
| Rate for Payer: Priority Health Medicare |
$648.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,205.72
|
| Rate for Payer: Priority Health SBD |
$1,205.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$648.29
|
| Rate for Payer: UHC Exchange |
$627.93
|
| Rate for Payer: UHC Medicare Advantage |
$648.29
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$584.47 |
| Max. Negotiated Rate |
$162,608.00 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Aetna Medicare |
$909.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.88
|
| Rate for Payer: BCBS Complete |
$613.69
|
| Rate for Payer: BCBS MAPPO |
$874.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,041.81
|
| Rate for Payer: BCN Commercial |
$1,335.07
|
| 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 |
$1,617.31
|
| Rate for Payer: Healthscope Commercial |
$1,398.75
|
| Rate for Payer: Mclaren Medicaid |
$584.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.93
|
| Rate for Payer: Meridian Medicaid |
$613.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162,608.00
|
| 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 Choice Medicaid |
$584.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,632.88
|
| Rate for Payer: Priority Health Medicare |
$874.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,632.88
|
| Rate for Payer: Priority Health SBD |
$1,632.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$888.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.22
|
| Rate for Payer: UHC Exchange |
$888.11
|
| Rate for Payer: UHC Medicare Advantage |
$874.22
|
| Rate for Payer: UHCCP Medicaid |
$584.47
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$166.57 |
| Max. Negotiated Rate |
$46,885.00 |
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Medicare |
$263.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.87
|
| Rate for Payer: BCBS Complete |
$174.90
|
| Rate for Payer: BCBS MAPPO |
$253.38
|
| Rate for Payer: BCBS Trust/PPO |
$538.34
|
| Rate for Payer: BCN Commercial |
$379.70
|
| 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: Mclaren Medicaid |
$166.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.05
|
| Rate for Payer: Meridian Medicaid |
$174.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,885.00
|
| 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 Choice Medicaid |
$166.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.62
|
| Rate for Payer: Priority Health Medicare |
$253.38
|
| Rate for Payer: Priority Health Narrow Network |
$518.62
|
| Rate for Payer: Priority Health SBD |
$518.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.38
|
| Rate for Payer: UHC Exchange |
$383.09
|
| Rate for Payer: UHC Medicare Advantage |
$253.38
|
| Rate for Payer: UHCCP Medicaid |
$166.57
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$566.87 |
| Max. Negotiated Rate |
$208,598.00 |
| Rate for Payer: Aetna Commercial |
$1,518.57
|
| Rate for Payer: Aetna Medicare |
$1,178.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.89
|
| Rate for Payer: BCBS Complete |
$785.23
|
| Rate for Payer: BCBS MAPPO |
$1,133.26
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$1,697.66
|
| 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 |
$2,096.53
|
| Rate for Payer: Healthscope Commercial |
$1,813.22
|
| Rate for Payer: Mclaren Medicaid |
$747.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.92
|
| Rate for Payer: Meridian Medicaid |
$785.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208,598.00
|
| 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 Choice Medicaid |
$747.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,322.80
|
| Rate for Payer: Priority Health Medicare |
$1,133.26
|
| Rate for Payer: Priority Health Narrow Network |
$2,322.80
|
| Rate for Payer: Priority Health SBD |
$2,322.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,083.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.26
|
| Rate for Payer: UHC Exchange |
$1,083.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.26
|
| Rate for Payer: UHCCP Medicaid |
$747.84
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$482.87 |
| Max. Negotiated Rate |
$205,963.00 |
| Rate for Payer: Aetna Commercial |
$1,496.15
|
| Rate for Payer: Aetna Medicare |
$1,161.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,496.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.80
|
| Rate for Payer: BCBS Complete |
$774.72
|
| Rate for Payer: BCBS MAPPO |
$1,116.53
|
| Rate for Payer: BCBS Trust/PPO |
$482.87
|
| Rate for Payer: BCN Commercial |
$1,677.15
|
| 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 |
$2,065.58
|
| Rate for Payer: Healthscope Commercial |
$1,786.45
|
| Rate for Payer: Mclaren Medicaid |
$737.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.36
|
| Rate for Payer: Meridian Medicaid |
$774.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205,963.00
|
| 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 Choice Medicaid |
$737.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,293.50
|
| Rate for Payer: Priority Health Medicare |
$1,116.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,293.50
|
| Rate for Payer: Priority Health SBD |
$2,293.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,041.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.53
|
| Rate for Payer: UHC Exchange |
$1,041.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.53
|
| Rate for Payer: UHCCP Medicaid |
$737.83
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$1,620.00 |
| Rate for Payer: Aetna Commercial |
$8.90
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.90
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,620.00
|
| 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 |
$728.51 |
| Max. Negotiated Rate |
$11,273.70 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$3,730.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,483.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,483.69
|
| Rate for Payer: BCBS Complete |
$2,018.74
|
| Rate for Payer: BCBS MAPPO |
$3,586.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.94
|
| Rate for Payer: BCN Commercial |
$2,753.94
|
| Rate for Payer: BCN Medicare Advantage |
$3,586.95
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Cofinity Commercial |
$1,121.40
|
| 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 |
$3,586.95
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Mclaren Medicaid |
$1,922.61
|
| Rate for Payer: Mclaren Medicare |
$3,586.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,766.30
|
| Rate for Payer: Meridian Medicaid |
$2,018.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,124.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$7,532.60
|
| Rate for Payer: PACE Medicare |
$3,407.60
|
| Rate for Payer: PACE SWMI |
$3,586.95
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,586.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,922.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,273.70
|
| Rate for Payer: Priority Health Medicare |
$3,586.95
|
| Rate for Payer: Priority Health Narrow Network |
$9,018.96
|
| Rate for Payer: Priority Health SBD |
$1,009.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,586.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.51
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,586.95
|
| Rate for Payer: UHC Medicare Advantage |
$3,586.95
|
| Rate for Payer: UHCCP Medicaid |
$2,019.45
|
| Rate for Payer: VA VA |
$3,586.95
|
|
|
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 |
$138.90 |
| Max. Negotiated Rate |
$121,399.00 |
| 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 |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| 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 |
$1,218.04
|
| Rate for Payer: Healthscope Commercial |
$1,053.44
|
| Rate for Payer: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121,399.00
|
| 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 Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.99
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: Priority Health Narrow Network |
$935.99
|
| Rate for Payer: Priority Health SBD |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$1,022.79
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
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 |
$138.90 |
| Max. Negotiated Rate |
$121,399.00 |
| 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 |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,237.82
|
| 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: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121,399.00
|
| 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 Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$935.99
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: Priority Health Narrow Network |
$935.99
|
| Rate for Payer: Priority Health SBD |
$935.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,022.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$1,022.79
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
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 EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$23,549.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$130.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.17
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$306.40
|
| 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: Mclaren Medicaid |
$83.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,549.00
|
| 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 Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.00
|
| Rate for Payer: Priority Health Medicare |
$125.12
|
| Rate for Payer: Priority Health Narrow Network |
$177.00
|
| Rate for Payer: Priority Health SBD |
$177.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Exchange |
$300.00
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$755.76 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,261.16
|
| Rate for Payer: BCN Commercial |
$2,261.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Cofinity Commercial |
$1,506.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,506.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$1,355.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.76
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,355.76 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.80
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,506.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health SBD |
$1,355.76
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$126,092.00 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.43
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.72
|
| Rate for Payer: Healthscope Commercial |
$1,093.81
|
| Rate for Payer: Mclaren Medicaid |
$461.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126,092.00
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.21
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: Priority Health Narrow Network |
$971.21
|
| Rate for Payer: Priority Health SBD |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$902.37
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$126,092.00 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.43
|
| Rate for Payer: BCBS Complete |
$484.87
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,273.98
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Healthscope Commercial |
$1,264.72
|
| Rate for Payer: Healthscope Commercial |
$1,093.81
|
| Rate for Payer: Mclaren Medicaid |
$461.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Meridian Medicaid |
$484.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126,092.00
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$461.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$971.21
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: Priority Health Narrow Network |
$971.21
|
| Rate for Payer: Priority Health SBD |
$971.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$902.37
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UHCCP Medicaid |
$461.78
|
|
