|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$895.06 |
| Max. Negotiated Rate |
$2,541.50 |
| Rate for Payer: Aetna Commercial |
$1,199.38
|
| Rate for Payer: Aetna Medicare |
$930.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,199.38
|
| Rate for Payer: BCBS Complete |
$1,564.00
|
| Rate for Payer: BCBS MAPPO |
$895.06
|
| Rate for Payer: BCN Medicare Advantage |
$895.06
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.89
|
| Rate for Payer: Cofinity Commercial |
$1,199.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.06
|
| Rate for Payer: Healthscope Commercial |
$1,655.86
|
| Rate for Payer: Healthscope Commercial |
$1,432.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,541.50
|
| Rate for Payer: Nomi Health Commercial |
$1,074.07
|
| Rate for Payer: PACE SWMI |
$895.06
|
| Rate for Payer: PHP Medicare Advantage |
$895.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,541.50
|
| Rate for Payer: Priority Health Medicare |
$895.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$895.06
|
| Rate for Payer: UHC Medicare Advantage |
$895.06
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$2,479.00
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$309.66 |
| Max. Negotiated Rate |
$1,611.35 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$322.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.94
|
| Rate for Payer: BCBS Complete |
$991.60
|
| Rate for Payer: BCBS MAPPO |
$309.66
|
| Rate for Payer: BCN Medicare Advantage |
$309.66
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cofinity Commercial |
$445.91
|
| Rate for Payer: Cofinity Commercial |
$414.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.66
|
| Rate for Payer: Healthscope Commercial |
$495.46
|
| Rate for Payer: Healthscope Commercial |
$572.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,611.35
|
| Rate for Payer: Nomi Health Commercial |
$371.59
|
| Rate for Payer: PACE SWMI |
$309.66
|
| Rate for Payer: PHP Medicare Advantage |
$309.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,611.35
|
| Rate for Payer: Priority Health Medicare |
$309.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.66
|
| Rate for Payer: UHC Medicare Advantage |
$309.66
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,396.85 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: Aetna Medicare |
$477.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.86
|
| Rate for Payer: BCBS Complete |
$859.60
|
| Rate for Payer: BCBS MAPPO |
$459.60
|
| Rate for Payer: BCN Medicare Advantage |
$459.60
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cofinity Commercial |
$661.82
|
| Rate for Payer: Cofinity Commercial |
$615.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.60
|
| Rate for Payer: Healthscope Commercial |
$735.36
|
| Rate for Payer: Healthscope Commercial |
$850.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,396.85
|
| Rate for Payer: Nomi Health Commercial |
$551.52
|
| Rate for Payer: PACE SWMI |
$459.60
|
| Rate for Payer: PHP Medicare Advantage |
$459.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.85
|
| Rate for Payer: Priority Health Medicare |
$459.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.60
|
| Rate for Payer: UHC Medicare Advantage |
$459.60
|
|
|
PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 00528
|
|
Hospital Revenue Code
|
990
|
| 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 TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$460.26 |
| Max. Negotiated Rate |
$952.25 |
| Rate for Payer: Aetna Commercial |
$616.75
|
| Rate for Payer: Aetna Medicare |
$478.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.77
|
| Rate for Payer: BCBS Complete |
$586.00
|
| Rate for Payer: BCBS MAPPO |
$460.26
|
| Rate for Payer: BCN Medicare Advantage |
$460.26
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cofinity Commercial |
$616.75
|
| Rate for Payer: Cofinity Commercial |
$662.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.26
|
| Rate for Payer: Healthscope Commercial |
$736.42
|
| Rate for Payer: Healthscope Commercial |
$851.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$952.25
|
| Rate for Payer: Nomi Health Commercial |
$552.31
|
| Rate for Payer: PACE SWMI |
$460.26
|
| Rate for Payer: PHP Medicare Advantage |
$460.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.25
|
| Rate for Payer: Priority Health Medicare |
$460.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.26
|
| Rate for Payer: UHC Medicare Advantage |
$460.26
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,713.12 |
| Rate for Payer: Aetna Commercial |
$1,240.85
|
| Rate for Payer: Aetna Medicare |
$963.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.85
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$926.01
|
| Rate for Payer: BCN Medicare Advantage |
$926.01
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.45
|
| Rate for Payer: Cofinity Commercial |
$1,240.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.01
|
| Rate for Payer: Healthscope Commercial |
$1,713.12
|
| Rate for Payer: Healthscope Commercial |
$1,481.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$978.25
|
| Rate for Payer: Nomi Health Commercial |
$1,111.21
|
| Rate for Payer: PACE SWMI |
$926.01
|
| Rate for Payer: PHP Medicare Advantage |
$926.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$926.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.01
|
| Rate for Payer: UHC Medicare Advantage |
$926.01
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,473.12 |
| Rate for Payer: Aetna Commercial |
$1,067.02
|
| Rate for Payer: Aetna Medicare |
$828.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,146.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.02
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$796.28
|
| Rate for Payer: BCN Medicare Advantage |
$796.28
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$1,146.64
|
| Rate for Payer: Cofinity Commercial |
$1,067.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.28
|
| Rate for Payer: Healthscope Commercial |
$1,274.05
|
| Rate for Payer: Healthscope Commercial |
$1,473.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,123.85
|
| Rate for Payer: Nomi Health Commercial |
$955.54
|
| Rate for Payer: PACE SWMI |
$796.28
|
| Rate for Payer: PHP Medicare Advantage |
$796.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$796.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.28
|
| Rate for Payer: UHC Medicare Advantage |
$796.28
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$1,626.21 |
| Rate for Payer: Aetna Commercial |
$1,177.90
|
| Rate for Payer: Aetna Medicare |
$914.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.90
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$879.03
|
| Rate for Payer: BCN Medicare Advantage |
$879.03
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Cofinity Commercial |
$1,177.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.03
|
| Rate for Payer: Healthscope Commercial |
$1,626.21
|
| Rate for Payer: Healthscope Commercial |
$1,406.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,181.05
|
| Rate for Payer: Nomi Health Commercial |
$1,054.84
|
| Rate for Payer: PACE SWMI |
$879.03
|
| Rate for Payer: PHP Medicare Advantage |
$879.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$879.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.03
|
| Rate for Payer: UHC Medicare Advantage |
$879.03
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,474.36 |
| Rate for Payer: Aetna Commercial |
$1,067.91
|
| Rate for Payer: Aetna Medicare |
$828.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.91
|
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: BCBS MAPPO |
$796.95
|
| Rate for Payer: BCN Medicare Advantage |
$796.95
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,147.61
|
| Rate for Payer: Cofinity Commercial |
$1,067.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.95
|
| Rate for Payer: Healthscope Commercial |
$1,275.12
|
| Rate for Payer: Healthscope Commercial |
$1,474.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.55
|
| Rate for Payer: Nomi Health Commercial |
$956.34
|
| Rate for Payer: PACE SWMI |
$796.95
|
| Rate for Payer: PHP Medicare Advantage |
$796.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health Medicare |
$796.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.95
|
| Rate for Payer: UHC Medicare Advantage |
$796.95
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$828.71 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,110.47
|
| Rate for Payer: Aetna Medicare |
$861.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.47
|
| Rate for Payer: BCBS Complete |
$1,405.60
|
| Rate for Payer: BCBS MAPPO |
$828.71
|
| Rate for Payer: BCN Medicare Advantage |
$828.71
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,193.34
|
| Rate for Payer: Cofinity Commercial |
$1,110.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.71
|
| Rate for Payer: Healthscope Commercial |
$1,533.11
|
| Rate for Payer: Healthscope Commercial |
$1,325.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$870.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,284.10
|
| Rate for Payer: Nomi Health Commercial |
$994.45
|
| Rate for Payer: PACE SWMI |
$828.71
|
| Rate for Payer: PHP Medicare Advantage |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health Medicare |
$828.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.71
|
| Rate for Payer: UHC Medicare Advantage |
$828.71
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$299.07 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$400.75
|
| Rate for Payer: Aetna Medicare |
$311.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.75
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$299.07
|
| Rate for Payer: BCN Medicare Advantage |
$299.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$430.66
|
| Rate for Payer: Cofinity Commercial |
$400.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.07
|
| Rate for Payer: Healthscope Commercial |
$478.51
|
| Rate for Payer: Healthscope Commercial |
$553.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.25
|
| Rate for Payer: Nomi Health Commercial |
$358.88
|
| Rate for Payer: PACE SWMI |
$299.07
|
| Rate for Payer: PHP Medicare Advantage |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$299.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.07
|
| Rate for Payer: UHC Medicare Advantage |
$299.07
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$1,181.03 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,582.58
|
| Rate for Payer: Aetna Medicare |
$1,228.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.58
|
| Rate for Payer: BCBS Complete |
$1,642.40
|
| Rate for Payer: BCBS MAPPO |
$1,181.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,181.03
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,700.68
|
| Rate for Payer: Cofinity Commercial |
$1,582.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,181.03
|
| Rate for Payer: Healthscope Commercial |
$2,184.91
|
| Rate for Payer: Healthscope Commercial |
$1,889.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,240.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,668.90
|
| Rate for Payer: Nomi Health Commercial |
$1,417.24
|
| Rate for Payer: PACE SWMI |
$1,181.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,181.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health Medicare |
$1,181.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,181.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.03
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,182.67 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,584.78
|
| Rate for Payer: Aetna Medicare |
$1,229.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.78
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.67
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.04
|
| Rate for Payer: Cofinity Commercial |
$1,584.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.67
|
| Rate for Payer: Healthscope Commercial |
$1,892.27
|
| Rate for Payer: Healthscope Commercial |
$2,187.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,256.15
|
| Rate for Payer: Nomi Health Commercial |
$1,419.20
|
| Rate for Payer: PACE SWMI |
$1,182.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$1,182.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.67
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$688.29 |
| Rate for Payer: Aetna Commercial |
$498.55
|
| Rate for Payer: Aetna Medicare |
$386.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.55
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$372.05
|
| Rate for Payer: BCN Medicare Advantage |
$372.05
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$498.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.05
|
| Rate for Payer: Healthscope Commercial |
$688.29
|
| Rate for Payer: Healthscope Commercial |
$595.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Nomi Health Commercial |
$446.46
|
| Rate for Payer: PACE SWMI |
$372.05
|
| Rate for Payer: PHP Medicare Advantage |
$372.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$372.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$676.16 |
| Rate for Payer: Aetna Commercial |
$489.76
|
| Rate for Payer: Aetna Medicare |
$380.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.76
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$365.49
|
| Rate for Payer: BCN Medicare Advantage |
$365.49
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Cofinity Commercial |
$489.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.49
|
| Rate for Payer: Healthscope Commercial |
$584.78
|
| Rate for Payer: Healthscope Commercial |
$676.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Nomi Health Commercial |
$438.59
|
| Rate for Payer: PACE SWMI |
$365.49
|
| Rate for Payer: PHP Medicare Advantage |
$365.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.49
|
| Rate for Payer: UHC Medicare Advantage |
$365.49
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$229.53 |
| Max. Negotiated Rate |
$424.63 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$238.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.57
|
| Rate for Payer: BCBS Complete |
$254.00
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Healthscope Commercial |
$424.63
|
| Rate for Payer: Healthscope Commercial |
$367.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$412.75
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$505.88 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$284.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.42
|
| Rate for Payer: BCBS Complete |
$248.40
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Healthscope Commercial |
$437.52
|
| Rate for Payer: Healthscope Commercial |
$505.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.65
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.45
|
| Rate for Payer: UHC Medicare Advantage |
$273.45
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$831.15 |
| Rate for Payer: Aetna Commercial |
$602.02
|
| Rate for Payer: Aetna Medicare |
$467.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.02
|
| Rate for Payer: BCBS Complete |
$400.00
|
| Rate for Payer: BCBS MAPPO |
$449.27
|
| Rate for Payer: BCN Medicare Advantage |
$449.27
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$646.95
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.27
|
| Rate for Payer: Healthscope Commercial |
$831.15
|
| Rate for Payer: Healthscope Commercial |
$718.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$650.00
|
| Rate for Payer: Nomi Health Commercial |
$539.12
|
| Rate for Payer: PACE SWMI |
$449.27
|
| Rate for Payer: PHP Medicare Advantage |
$449.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Medicare |
$449.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.27
|
| Rate for Payer: UHC Medicare Advantage |
$449.27
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$890.05 |
| Max. Negotiated Rate |
$4,195.75 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.67
|
| Rate for Payer: BCBS Complete |
$2,582.00
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Healthscope Commercial |
$1,424.08
|
| Rate for Payer: Healthscope Commercial |
$1,646.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,195.75
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,195.75
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$349.04 |
| Max. Negotiated Rate |
$645.72 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.71
|
| Rate for Payer: BCBS Complete |
$349.20
|
| Rate for Payer: BCBS MAPPO |
$349.04
|
| Rate for Payer: BCN Medicare Advantage |
$349.04
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Cofinity Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.04
|
| Rate for Payer: Healthscope Commercial |
$645.72
|
| Rate for Payer: Healthscope Commercial |
$558.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$567.45
|
| Rate for Payer: Nomi Health Commercial |
$418.85
|
| Rate for Payer: PACE SWMI |
$349.04
|
| Rate for Payer: PHP Medicare Advantage |
$349.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health Medicare |
$349.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.04
|
| Rate for Payer: UHC Medicare Advantage |
$349.04
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.04
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$332.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.50
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$296.10 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$179.89 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.05
|
| Rate for Payer: BCBS Complete |
$188.00
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Healthscope Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$332.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.50
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$296.10 |
| Max. Negotiated Rate |
$1,680.50 |
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$620.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$746.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$746.25
|
| Rate for Payer: BCBS Complete |
$335.99
|
| Rate for Payer: BCBS MAPPO |
$597.00
|
| Rate for Payer: BCN Medicare Advantage |
$597.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Mclaren Medicaid |
$319.99
|
| Rate for Payer: Mclaren Medicare |
$597.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$626.85
|
| Rate for Payer: Meridian Medicaid |
$335.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$686.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: PACE Medicare |
$567.15
|
| Rate for Payer: PACE SWMI |
$597.00
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: PHP Medicare Advantage |
$597.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health Medicare |
$597.00
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: Railroad Medicare Medicare |
$597.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,680.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.00
|
| Rate for Payer: UHC Medicare Advantage |
$597.00
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| Rate for Payer: VA VA |
$597.00
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$133.22 |
| Max. Negotiated Rate |
$246.46 |
| Rate for Payer: Aetna Commercial |
$178.51
|
| Rate for Payer: Aetna Medicare |
$138.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.51
|
| Rate for Payer: BCBS Complete |
$139.60
|
| Rate for Payer: BCBS MAPPO |
$133.22
|
| Rate for Payer: BCN Medicare Advantage |
$133.22
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$191.84
|
| Rate for Payer: Cofinity Commercial |
$178.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.22
|
| Rate for Payer: Healthscope Commercial |
$246.46
|
| Rate for Payer: Healthscope Commercial |
$213.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.85
|
| Rate for Payer: Nomi Health Commercial |
$159.86
|
| Rate for Payer: PACE SWMI |
$133.22
|
| Rate for Payer: PHP Medicare Advantage |
$133.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health Medicare |
$133.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.22
|
| Rate for Payer: UHC Medicare Advantage |
$133.22
|
|
