|
PR ABDOMINOPLASTY W/ BREAST AUGMENT
|
Professional
|
Both
|
$7,446.00
|
|
|
Service Code
|
HCPCS 00256
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,978.40 |
| Max. Negotiated Rate |
$4,839.90 |
| Rate for Payer: Aetna Medicare |
$3,723.00
|
| Rate for Payer: BCBS Complete |
$2,978.40
|
| Rate for Payer: Cash Price |
$5,956.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,839.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,839.90
|
|
|
PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL
|
Professional
|
Both
|
$2,628.00
|
|
|
Service Code
|
HCPCS 51845
|
| Min. Negotiated Rate |
$557.77 |
| Max. Negotiated Rate |
$1,708.20 |
| Rate for Payer: Aetna Commercial |
$747.41
|
| Rate for Payer: Aetna Medicare |
$580.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.19
|
| Rate for Payer: BCBS Complete |
$1,051.20
|
| Rate for Payer: BCBS MAPPO |
$557.77
|
| Rate for Payer: BCN Medicare Advantage |
$557.77
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cofinity Commercial |
$803.19
|
| Rate for Payer: Cofinity Commercial |
$747.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$892.43
|
| Rate for Payer: Healthscope Commercial |
$1,031.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,708.20
|
| Rate for Payer: Nomi Health Commercial |
$669.32
|
| Rate for Payer: PACE SWMI |
$557.77
|
| Rate for Payer: PHP Medicare Advantage |
$557.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.20
|
| Rate for Payer: Priority Health Medicare |
$557.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.77
|
| Rate for Payer: UHC Medicare Advantage |
$557.77
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$100.28 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$104.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.40
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$100.28
|
| Rate for Payer: BCN Medicare Advantage |
$100.28
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Cofinity Commercial |
$144.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.28
|
| Rate for Payer: Healthscope Commercial |
$160.45
|
| Rate for Payer: Healthscope Commercial |
$185.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.75
|
| Rate for Payer: Nomi Health Commercial |
$120.34
|
| Rate for Payer: PACE SWMI |
$100.28
|
| Rate for Payer: PHP Medicare Advantage |
$100.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health Medicare |
$100.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.28
|
| Rate for Payer: UHC Medicare Advantage |
$100.28
|
|
|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$169.00 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.90
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS MAPPO |
$69.33
|
| Rate for Payer: BCN Medicare Advantage |
$69.33
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$92.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.33
|
| Rate for Payer: Healthscope Commercial |
$128.26
|
| Rate for Payer: Healthscope Commercial |
$110.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.00
|
| Rate for Payer: Nomi Health Commercial |
$83.20
|
| Rate for Payer: PACE SWMI |
$69.33
|
| Rate for Payer: PHP Medicare Advantage |
$69.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health Medicare |
$69.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.33
|
| Rate for Payer: UHC Medicare Advantage |
$69.33
|
|
|
PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN
|
Professional
|
Both
|
$876.00
|
|
|
Service Code
|
HCPCS 93657
|
| Min. Negotiated Rate |
$291.34 |
| Max. Negotiated Rate |
$569.40 |
| Rate for Payer: Aetna Commercial |
$390.40
|
| Rate for Payer: Aetna Medicare |
$302.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.40
|
| Rate for Payer: BCBS Complete |
$350.40
|
| Rate for Payer: BCBS MAPPO |
$291.34
|
| Rate for Payer: BCN Medicare Advantage |
$291.34
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cofinity Commercial |
$419.53
|
| Rate for Payer: Cofinity Commercial |
$390.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.34
|
| Rate for Payer: Healthscope Commercial |
$466.14
|
| Rate for Payer: Healthscope Commercial |
$538.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.40
|
| Rate for Payer: Nomi Health Commercial |
$349.61
|
| Rate for Payer: PACE SWMI |
$291.34
|
| Rate for Payer: PHP Medicare Advantage |
$291.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.40
|
| Rate for Payer: Priority Health Medicare |
$291.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.34
|
| Rate for Payer: UHC Medicare Advantage |
$291.34
|
|
|
PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
|
Professional
|
Both
|
$7,268.00
|
|
|
Service Code
|
HCPCS 20982
|
| Min. Negotiated Rate |
$351.15 |
| Max. Negotiated Rate |
$4,724.20 |
| Rate for Payer: Aetna Commercial |
$470.54
|
| Rate for Payer: Aetna Medicare |
$365.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.54
|
| Rate for Payer: BCBS Complete |
$2,907.20
|
| Rate for Payer: BCBS MAPPO |
$351.15
|
| Rate for Payer: BCN Medicare Advantage |
$351.15
|
| Rate for Payer: Cash Price |
$5,814.40
|
| Rate for Payer: Cash Price |
$5,814.40
|
| Rate for Payer: Cofinity Commercial |
$505.66
|
| Rate for Payer: Cofinity Commercial |
$470.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.15
|
| Rate for Payer: Healthscope Commercial |
$649.63
|
| Rate for Payer: Healthscope Commercial |
$561.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,724.20
|
| Rate for Payer: Nomi Health Commercial |
$421.38
|
| Rate for Payer: PACE SWMI |
$351.15
|
| Rate for Payer: PHP Medicare Advantage |
$351.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,724.20
|
| Rate for Payer: Priority Health Medicare |
$351.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.15
|
| Rate for Payer: UHC Medicare Advantage |
$351.15
|
|
|
PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS
|
Professional
|
Both
|
$3,766.00
|
|
|
Service Code
|
HCPCS 33256
|
| Min. Negotiated Rate |
$1,506.40 |
| Max. Negotiated Rate |
$3,407.76 |
| Rate for Payer: Aetna Commercial |
$2,468.32
|
| Rate for Payer: Aetna Medicare |
$1,915.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,468.32
|
| Rate for Payer: BCBS Complete |
$1,506.40
|
| Rate for Payer: BCBS MAPPO |
$1,842.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,842.03
|
| Rate for Payer: Cash Price |
$3,012.80
|
| Rate for Payer: Cash Price |
$3,012.80
|
| Rate for Payer: Cofinity Commercial |
$2,652.52
|
| Rate for Payer: Cofinity Commercial |
$2,468.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,842.03
|
| Rate for Payer: Healthscope Commercial |
$2,947.25
|
| Rate for Payer: Healthscope Commercial |
$3,407.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,934.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,447.90
|
| Rate for Payer: Nomi Health Commercial |
$2,210.44
|
| Rate for Payer: PACE SWMI |
$1,842.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,842.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,447.90
|
| Rate for Payer: Priority Health Medicare |
$1,842.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,842.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,842.03
|
|
|
PR ABLATION & RECONSTRUCTION ATRIA LIMITED
|
Professional
|
Both
|
$3,359.00
|
|
|
Service Code
|
HCPCS 33254
|
| Min. Negotiated Rate |
$1,303.39 |
| Max. Negotiated Rate |
$2,411.27 |
| Rate for Payer: Aetna Commercial |
$1,746.54
|
| Rate for Payer: Aetna Medicare |
$1,355.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,746.54
|
| Rate for Payer: BCBS Complete |
$1,343.60
|
| Rate for Payer: BCBS MAPPO |
$1,303.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.39
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cash Price |
$2,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,876.88
|
| Rate for Payer: Cofinity Commercial |
$1,746.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.39
|
| Rate for Payer: Healthscope Commercial |
$2,411.27
|
| Rate for Payer: Healthscope Commercial |
$2,085.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,183.35
|
| Rate for Payer: Nomi Health Commercial |
$1,564.07
|
| Rate for Payer: PACE SWMI |
$1,303.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,183.35
|
| Rate for Payer: Priority Health Medicare |
$1,303.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.39
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$186.43 |
| Max. Negotiated Rate |
$362.05 |
| Rate for Payer: Aetna Commercial |
$249.82
|
| Rate for Payer: Aetna Medicare |
$193.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.82
|
| Rate for Payer: BCBS Complete |
$222.80
|
| Rate for Payer: BCBS MAPPO |
$186.43
|
| Rate for Payer: BCN Medicare Advantage |
$186.43
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cofinity Commercial |
$268.46
|
| Rate for Payer: Cofinity Commercial |
$249.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.43
|
| Rate for Payer: Healthscope Commercial |
$298.29
|
| Rate for Payer: Healthscope Commercial |
$344.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.05
|
| Rate for Payer: Nomi Health Commercial |
$223.72
|
| Rate for Payer: PACE SWMI |
$186.43
|
| Rate for Payer: PHP Medicare Advantage |
$186.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.05
|
| Rate for Payer: Priority Health Medicare |
$186.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.43
|
| Rate for Payer: UHC Medicare Advantage |
$186.43
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$137.54 |
| Max. Negotiated Rate |
$254.45 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Medicare |
$143.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.30
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: BCBS MAPPO |
$137.54
|
| Rate for Payer: BCN Medicare Advantage |
$137.54
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Cofinity Commercial |
$184.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.54
|
| Rate for Payer: Healthscope Commercial |
$254.45
|
| Rate for Payer: Healthscope Commercial |
$220.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.80
|
| Rate for Payer: Nomi Health Commercial |
$165.05
|
| Rate for Payer: PACE SWMI |
$137.54
|
| Rate for Payer: PHP Medicare Advantage |
$137.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health Medicare |
$137.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.54
|
| Rate for Payer: UHC Medicare Advantage |
$137.54
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$441.66
|
|
|
Service Code
|
HCPCS 15786
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$287.08 |
| Rate for Payer: Aetna Commercial |
$171.52
|
| Rate for Payer: Aetna Medicare |
$133.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.52
|
| Rate for Payer: BCBS Complete |
$176.66
|
| Rate for Payer: BCBS MAPPO |
$128.00
|
| Rate for Payer: BCN Medicare Advantage |
$128.00
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Cofinity Commercial |
$171.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$236.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.08
|
| Rate for Payer: Nomi Health Commercial |
$153.60
|
| Rate for Payer: PACE SWMI |
$128.00
|
| Rate for Payer: PHP Medicare Advantage |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.08
|
| Rate for Payer: Priority Health Medicare |
$128.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.00
|
| Rate for Payer: UHC Medicare Advantage |
$128.00
|
|
|
PR ABRASION 1 LESION
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$103.87 |
| Max. Negotiated Rate |
$545.50 |
| Rate for Payer: Aetna Commercial |
$375.70
|
| Rate for Payer: Aetna Medicare |
$201.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.24
|
| Rate for Payer: BCBS Complete |
$109.07
|
| Rate for Payer: BCBS MAPPO |
$193.79
|
| Rate for Payer: BCN Medicare Advantage |
$193.79
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$380.12
|
| Rate for Payer: Cofinity Commercial |
$309.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.79
|
| Rate for Payer: Healthscope Commercial |
$397.80
|
| Rate for Payer: Mclaren Medicaid |
$103.87
|
| Rate for Payer: Mclaren Medicare |
$193.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.48
|
| Rate for Payer: Meridian Medicaid |
$109.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.70
|
| Rate for Payer: PACE Medicare |
$184.10
|
| Rate for Payer: PACE SWMI |
$193.79
|
| Rate for Payer: PHP Commercial |
$375.70
|
| Rate for Payer: PHP Medicare Advantage |
$193.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health Medicare |
$193.79
|
| Rate for Payer: Priority Health SBD |
$278.46
|
| Rate for Payer: Railroad Medicare Medicare |
$193.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.79
|
| Rate for Payer: UHC Medicare Advantage |
$193.79
|
| Rate for Payer: UHCCP Medicaid |
$109.10
|
| Rate for Payer: VA VA |
$193.79
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$441.66
|
|
|
Service Code
|
HCPCS 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$287.08 |
| Rate for Payer: Aetna Commercial |
$171.52
|
| Rate for Payer: Aetna Medicare |
$133.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.32
|
| Rate for Payer: BCBS Complete |
$176.66
|
| Rate for Payer: BCBS MAPPO |
$128.00
|
| Rate for Payer: BCN Medicare Advantage |
$128.00
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cash Price |
$353.33
|
| Rate for Payer: Cofinity Commercial |
$184.32
|
| Rate for Payer: Cofinity Commercial |
$171.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.00
|
| Rate for Payer: Healthscope Commercial |
$204.80
|
| Rate for Payer: Healthscope Commercial |
$236.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.08
|
| Rate for Payer: Nomi Health Commercial |
$153.60
|
| Rate for Payer: PACE SWMI |
$128.00
|
| Rate for Payer: PHP Medicare Advantage |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.08
|
| Rate for Payer: Priority Health Medicare |
$128.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.00
|
| Rate for Payer: UHC Medicare Advantage |
$128.00
|
|
|
PR ABRASION 1 LESION
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 15786
|
| Hospital Charge Code |
15786
|
| Min. Negotiated Rate |
$278.46 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Commercial |
$375.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.30
|
| Rate for Payer: Cash Price |
$353.60
|
| Rate for Payer: Cofinity Commercial |
$309.40
|
| Rate for Payer: Cofinity Commercial |
$380.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.60
|
| Rate for Payer: Healthscope Commercial |
$397.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.70
|
| Rate for Payer: PHP Commercial |
$375.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.30
|
| Rate for Payer: Priority Health SBD |
$278.46
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$790.40 |
| Max. Negotiated Rate |
$1,965.55 |
| Rate for Payer: Aetna Commercial |
$1,423.70
|
| Rate for Payer: Aetna Medicare |
$1,104.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,529.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.70
|
| Rate for Payer: BCBS Complete |
$790.40
|
| Rate for Payer: BCBS MAPPO |
$1,062.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,062.46
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$1,529.94
|
| Rate for Payer: Cofinity Commercial |
$1,423.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,062.46
|
| Rate for Payer: Healthscope Commercial |
$1,965.55
|
| Rate for Payer: Healthscope Commercial |
$1,699.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,115.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,284.40
|
| Rate for Payer: Nomi Health Commercial |
$1,274.95
|
| Rate for Payer: PACE SWMI |
$1,062.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,062.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,284.40
|
| Rate for Payer: Priority Health Medicare |
$1,062.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,062.46
|
| Rate for Payer: UHC Medicare Advantage |
$1,062.46
|
|
|
PR ACNE SURGERY
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$66.25
|
| Rate for Payer: Aetna Medicare |
$51.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.25
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$49.44
|
| Rate for Payer: BCN Medicare Advantage |
$49.44
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$71.19
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.44
|
| Rate for Payer: Healthscope Commercial |
$79.10
|
| Rate for Payer: Healthscope Commercial |
$91.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$59.33
|
| Rate for Payer: PACE SWMI |
$49.44
|
| Rate for Payer: PHP Medicare Advantage |
$49.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$49.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.44
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Aetna Commercial |
$36.31
|
| Rate for Payer: Aetna Medicare |
$28.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.31
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$27.10
|
| Rate for Payer: BCN Medicare Advantage |
$27.10
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$36.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.10
|
| Rate for Payer: Healthscope Commercial |
$50.13
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.70
|
| Rate for Payer: Nomi Health Commercial |
$32.52
|
| Rate for Payer: PACE SWMI |
$27.10
|
| Rate for Payer: PHP Medicare Advantage |
$27.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$27.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.10
|
| Rate for Payer: UHC Medicare Advantage |
$27.10
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,143.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$457.20 |
| Max. Negotiated Rate |
$1,105.06 |
| Rate for Payer: Aetna Commercial |
$800.42
|
| Rate for Payer: Aetna Medicare |
$621.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.42
|
| Rate for Payer: BCBS Complete |
$457.20
|
| Rate for Payer: BCBS MAPPO |
$597.33
|
| Rate for Payer: BCN Medicare Advantage |
$597.33
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cofinity Commercial |
$860.16
|
| Rate for Payer: Cofinity Commercial |
$800.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.33
|
| Rate for Payer: Healthscope Commercial |
$1,105.06
|
| Rate for Payer: Healthscope Commercial |
$955.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.95
|
| Rate for Payer: Nomi Health Commercial |
$716.80
|
| Rate for Payer: PACE SWMI |
$597.33
|
| Rate for Payer: PHP Medicare Advantage |
$597.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.95
|
| Rate for Payer: Priority Health Medicare |
$597.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.33
|
| Rate for Payer: UHC Medicare Advantage |
$597.33
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$218.41 |
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.01
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Complete |
$241.60
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Healthscope Commercial |
$218.41
|
| Rate for Payer: Healthscope Commercial |
$218.41
|
| Rate for Payer: Healthscope Commercial |
$188.90
|
| Rate for Payer: Healthscope Commercial |
$188.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$392.60
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$118.06
|
| Rate for Payer: Priority Health Medicare |
$118.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00673
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00674
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$376.22 |
| Rate for Payer: Aetna Commercial |
$272.50
|
| Rate for Payer: Aetna Medicare |
$211.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.84
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$203.36
|
| Rate for Payer: BCN Medicare Advantage |
$203.36
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$272.50
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.36
|
| Rate for Payer: Healthscope Commercial |
$376.22
|
| Rate for Payer: Healthscope Commercial |
$325.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$246.35
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: PACE SWMI |
$203.36
|
| Rate for Payer: PHP Medicare Advantage |
$203.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$203.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.36
|
| Rate for Payer: UHC Medicare Advantage |
$203.36
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$220.41 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$295.35
|
| Rate for Payer: Aetna Medicare |
$229.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.35
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: BCBS MAPPO |
$220.41
|
| Rate for Payer: BCN Medicare Advantage |
$220.41
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$317.39
|
| Rate for Payer: Cofinity Commercial |
$295.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.41
|
| Rate for Payer: Healthscope Commercial |
$407.76
|
| Rate for Payer: Healthscope Commercial |
$352.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.90
|
| Rate for Payer: Nomi Health Commercial |
$264.49
|
| Rate for Payer: PACE SWMI |
$220.41
|
| Rate for Payer: PHP Medicare Advantage |
$220.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health Medicare |
$220.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.41
|
| Rate for Payer: UHC Medicare Advantage |
$220.41
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$235.43 |
| Max. Negotiated Rate |
$435.55 |
| Rate for Payer: Aetna Commercial |
$315.48
|
| Rate for Payer: Aetna Medicare |
$244.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.48
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS MAPPO |
$235.43
|
| Rate for Payer: BCN Medicare Advantage |
$235.43
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$339.02
|
| Rate for Payer: Cofinity Commercial |
$315.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.43
|
| Rate for Payer: Healthscope Commercial |
$376.69
|
| Rate for Payer: Healthscope Commercial |
$435.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.55
|
| Rate for Payer: Nomi Health Commercial |
$282.52
|
| Rate for Payer: PACE SWMI |
$235.43
|
| Rate for Payer: PHP Medicare Advantage |
$235.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health Medicare |
$235.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.43
|
| Rate for Payer: UHC Medicare Advantage |
$235.43
|
|
