|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$113.46 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$152.04
|
| Rate for Payer: Aetna Medicare |
$118.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.38
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$113.46
|
| Rate for Payer: BCN Medicare Advantage |
$113.46
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$152.04
|
| Rate for Payer: Cofinity Commercial |
$163.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.46
|
| Rate for Payer: Healthscope Commercial |
$181.54
|
| Rate for Payer: Healthscope Commercial |
$209.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.95
|
| Rate for Payer: Nomi Health Commercial |
$136.15
|
| Rate for Payer: PACE SWMI |
$113.46
|
| Rate for Payer: PHP Medicare Advantage |
$113.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$113.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.46
|
| Rate for Payer: UHC Medicare Advantage |
$113.46
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$231.18 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: Aetna Medicare |
$129.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.45
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$124.96
|
| Rate for Payer: BCN Medicare Advantage |
$124.96
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$179.94
|
| Rate for Payer: Cofinity Commercial |
$167.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.96
|
| Rate for Payer: Healthscope Commercial |
$231.18
|
| Rate for Payer: Healthscope Commercial |
$199.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: PACE SWMI |
$124.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$124.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.96
|
| Rate for Payer: UHC Medicare Advantage |
$124.96
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$146.52
|
| Rate for Payer: Aetna Medicare |
$113.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.52
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$109.34
|
| Rate for Payer: BCN Medicare Advantage |
$109.34
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.34
|
| Rate for Payer: Healthscope Commercial |
$174.94
|
| Rate for Payer: Healthscope Commercial |
$202.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$248.95
|
| Rate for Payer: Nomi Health Commercial |
$131.21
|
| Rate for Payer: PACE SWMI |
$109.34
|
| Rate for Payer: PHP Medicare Advantage |
$109.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$109.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.34
|
| Rate for Payer: UHC Medicare Advantage |
$109.34
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$320.79 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$429.86
|
| Rate for Payer: Aetna Medicare |
$333.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.86
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$320.79
|
| Rate for Payer: BCN Medicare Advantage |
$320.79
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$461.94
|
| Rate for Payer: Cofinity Commercial |
$429.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.79
|
| Rate for Payer: Healthscope Commercial |
$593.46
|
| Rate for Payer: Healthscope Commercial |
$513.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$609.70
|
| Rate for Payer: Nomi Health Commercial |
$384.95
|
| Rate for Payer: PACE SWMI |
$320.79
|
| Rate for Payer: PHP Medicare Advantage |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.79
|
| Rate for Payer: UHC Medicare Advantage |
$320.79
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$289.20 |
| Max. Negotiated Rate |
$701.65 |
| Rate for Payer: Aetna Commercial |
$508.22
|
| Rate for Payer: Aetna Medicare |
$394.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.22
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$379.27
|
| Rate for Payer: BCN Medicare Advantage |
$379.27
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$546.15
|
| Rate for Payer: Cofinity Commercial |
$508.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.27
|
| Rate for Payer: Healthscope Commercial |
$606.83
|
| Rate for Payer: Healthscope Commercial |
$701.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$469.95
|
| Rate for Payer: Nomi Health Commercial |
$455.12
|
| Rate for Payer: PACE SWMI |
$379.27
|
| Rate for Payer: PHP Medicare Advantage |
$379.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$379.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.27
|
| Rate for Payer: UHC Medicare Advantage |
$379.27
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,236.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$1,430.75 |
| Max. Negotiated Rate |
$2,753.40 |
| Rate for Payer: Aetna Commercial |
$1,917.20
|
| Rate for Payer: Aetna Medicare |
$1,487.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,060.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.20
|
| Rate for Payer: BCBS Complete |
$1,694.40
|
| Rate for Payer: BCBS MAPPO |
$1,430.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.75
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cofinity Commercial |
$2,060.28
|
| Rate for Payer: Cofinity Commercial |
$1,917.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.75
|
| Rate for Payer: Healthscope Commercial |
$2,289.20
|
| Rate for Payer: Healthscope Commercial |
$2,646.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,502.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,753.40
|
| Rate for Payer: Nomi Health Commercial |
$1,716.90
|
| Rate for Payer: PACE SWMI |
$1,430.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.40
|
| Rate for Payer: Priority Health Medicare |
$1,430.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,430.75
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,790.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
|
|
PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99485
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99379
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$925.11 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,239.65
|
| Rate for Payer: Aetna Medicare |
$962.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,239.65
|
| Rate for Payer: BCBS Complete |
$1,296.00
|
| Rate for Payer: BCBS MAPPO |
$925.11
|
| Rate for Payer: BCN Medicare Advantage |
$925.11
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,332.16
|
| Rate for Payer: Cofinity Commercial |
$1,239.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.11
|
| Rate for Payer: Healthscope Commercial |
$1,711.45
|
| Rate for Payer: Healthscope Commercial |
$1,480.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,106.00
|
| Rate for Payer: Nomi Health Commercial |
$1,110.13
|
| Rate for Payer: PACE SWMI |
$925.11
|
| Rate for Payer: PHP Medicare Advantage |
$925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health Medicare |
$925.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.11
|
| Rate for Payer: UHC Medicare Advantage |
$925.11
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$1,428.35 |
| Rate for Payer: Aetna Commercial |
$1,034.59
|
| Rate for Payer: Aetna Medicare |
$802.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.59
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$772.08
|
| Rate for Payer: BCN Medicare Advantage |
$772.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$1,111.80
|
| Rate for Payer: Cofinity Commercial |
$1,034.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.08
|
| Rate for Payer: Healthscope Commercial |
$1,235.33
|
| Rate for Payer: Healthscope Commercial |
$1,428.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$949.00
|
| Rate for Payer: Nomi Health Commercial |
$926.50
|
| Rate for Payer: PACE SWMI |
$772.08
|
| Rate for Payer: PHP Medicare Advantage |
$772.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health Medicare |
$772.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.08
|
| Rate for Payer: UHC Medicare Advantage |
$772.08
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$616.44 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare |
$346.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.50
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$333.21
|
| Rate for Payer: BCN Medicare Advantage |
$333.21
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$479.82
|
| Rate for Payer: Cofinity Commercial |
$446.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.21
|
| Rate for Payer: Healthscope Commercial |
$533.14
|
| Rate for Payer: Healthscope Commercial |
$616.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.40
|
| Rate for Payer: Nomi Health Commercial |
$399.85
|
| Rate for Payer: PACE SWMI |
$333.21
|
| Rate for Payer: PHP Medicare Advantage |
$333.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$333.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.21
|
| Rate for Payer: UHC Medicare Advantage |
$333.21
|
|
|
PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99374
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$582.01 |
| Rate for Payer: Aetna Commercial |
$421.56
|
| Rate for Payer: Aetna Medicare |
$327.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.02
|
| Rate for Payer: BCBS Complete |
$293.60
|
| Rate for Payer: BCBS MAPPO |
$314.60
|
| Rate for Payer: BCN Medicare Advantage |
$314.60
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$421.56
|
| Rate for Payer: Cofinity Commercial |
$453.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.60
|
| Rate for Payer: Healthscope Commercial |
$503.36
|
| Rate for Payer: Healthscope Commercial |
$582.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.10
|
| Rate for Payer: Nomi Health Commercial |
$377.52
|
| Rate for Payer: PACE SWMI |
$314.60
|
| Rate for Payer: PHP Medicare Advantage |
$314.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health Medicare |
$314.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.60
|
| Rate for Payer: UHC Medicare Advantage |
$314.60
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 31825
|
| Min. Negotiated Rate |
$412.40 |
| Max. Negotiated Rate |
$855.50 |
| Rate for Payer: Aetna Commercial |
$619.66
|
| Rate for Payer: Aetna Medicare |
$480.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.66
|
| Rate for Payer: BCBS Complete |
$412.40
|
| Rate for Payer: BCBS MAPPO |
$462.43
|
| Rate for Payer: BCN Medicare Advantage |
$462.43
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$665.90
|
| Rate for Payer: Cofinity Commercial |
$619.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.43
|
| Rate for Payer: Healthscope Commercial |
$855.50
|
| Rate for Payer: Healthscope Commercial |
$739.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$485.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.15
|
| Rate for Payer: Nomi Health Commercial |
$554.92
|
| Rate for Payer: PACE SWMI |
$462.43
|
| Rate for Payer: PHP Medicare Advantage |
$462.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health Medicare |
$462.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.43
|
| Rate for Payer: UHC Medicare Advantage |
$462.43
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$2,977.00
|
|
|
Service Code
|
HCPCS 29828
|
| Min. Negotiated Rate |
$881.73 |
| Max. Negotiated Rate |
$1,935.05 |
| Rate for Payer: Aetna Commercial |
$1,181.52
|
| Rate for Payer: Aetna Medicare |
$917.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.52
|
| Rate for Payer: BCBS Complete |
$1,190.80
|
| Rate for Payer: BCBS MAPPO |
$881.73
|
| Rate for Payer: BCN Medicare Advantage |
$881.73
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,269.69
|
| Rate for Payer: Cofinity Commercial |
$1,181.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.73
|
| Rate for Payer: Healthscope Commercial |
$1,410.77
|
| Rate for Payer: Healthscope Commercial |
$1,631.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.05
|
| Rate for Payer: Nomi Health Commercial |
$1,058.08
|
| Rate for Payer: PACE SWMI |
$881.73
|
| Rate for Payer: PHP Medicare Advantage |
$881.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health Medicare |
$881.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.73
|
| Rate for Payer: UHC Medicare Advantage |
$881.73
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Professional
|
Both
|
$2,977.00
|
|
|
Service Code
|
HCPCS 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$881.73 |
| Max. Negotiated Rate |
$1,935.05 |
| Rate for Payer: Aetna Commercial |
$1,181.52
|
| Rate for Payer: Aetna Medicare |
$917.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.69
|
| Rate for Payer: BCBS Complete |
$1,190.80
|
| Rate for Payer: BCBS MAPPO |
$881.73
|
| Rate for Payer: BCN Medicare Advantage |
$881.73
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,269.69
|
| Rate for Payer: Cofinity Commercial |
$1,181.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.73
|
| Rate for Payer: Healthscope Commercial |
$1,410.77
|
| Rate for Payer: Healthscope Commercial |
$1,631.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,935.05
|
| Rate for Payer: Nomi Health Commercial |
$1,058.08
|
| Rate for Payer: PACE SWMI |
$881.73
|
| Rate for Payer: PHP Medicare Advantage |
$881.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health Medicare |
$881.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.73
|
| Rate for Payer: UHC Medicare Advantage |
$881.73
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Facility
|
OP
|
$2,977.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$1,875.51 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Commercial |
$2,530.45
|
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$2,083.90
|
| Rate for Payer: Cofinity Commercial |
$2,560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,083.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Healthscope Commercial |
$2,679.30
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.45
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Commercial |
$2,530.45
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Priority Health SBD |
$1,875.51
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS
|
Facility
|
IP
|
$2,977.00
|
|
|
Service Code
|
CPT 29828
|
| Hospital Charge Code |
29828
|
| Min. Negotiated Rate |
$1,875.51 |
| Max. Negotiated Rate |
$2,679.30 |
| Rate for Payer: Aetna Commercial |
$2,530.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.05
|
| Rate for Payer: Cash Price |
$2,381.60
|
| Rate for Payer: Cofinity Commercial |
$2,083.90
|
| Rate for Payer: Cofinity Commercial |
$2,560.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,083.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,381.60
|
| Rate for Payer: Healthscope Commercial |
$2,679.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,530.45
|
| Rate for Payer: PHP Commercial |
$2,530.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,935.05
|
| Rate for Payer: Priority Health SBD |
$1,875.51
|
|
