|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$189.28 |
| Max. Negotiated Rate |
$350.17 |
| Rate for Payer: Aetna Commercial |
$253.64
|
| Rate for Payer: Aetna Medicare |
$196.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.64
|
| Rate for Payer: BCBS Complete |
$205.20
|
| Rate for Payer: BCBS MAPPO |
$189.28
|
| Rate for Payer: BCN Medicare Advantage |
$189.28
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$272.56
|
| Rate for Payer: Cofinity Commercial |
$253.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.28
|
| Rate for Payer: Healthscope Commercial |
$350.17
|
| Rate for Payer: Healthscope Commercial |
$302.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.45
|
| Rate for Payer: Nomi Health Commercial |
$227.14
|
| Rate for Payer: PACE SWMI |
$189.28
|
| Rate for Payer: PHP Medicare Advantage |
$189.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$189.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.28
|
| Rate for Payer: UHC Medicare Advantage |
$189.28
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna Commercial |
$0.75
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.75
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.56
|
| Rate for Payer: BCN Medicare Advantage |
$0.56
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$0.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.56
|
| Rate for Payer: Healthscope Commercial |
$0.90
|
| Rate for Payer: Healthscope Commercial |
$1.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.65
|
| Rate for Payer: Nomi Health Commercial |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.56
|
| Rate for Payer: PHP Medicare Advantage |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$889.31 |
| Rate for Payer: Aetna Commercial |
$644.15
|
| Rate for Payer: Aetna Medicare |
$499.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.22
|
| Rate for Payer: BCBS Complete |
$416.00
|
| Rate for Payer: BCBS MAPPO |
$480.71
|
| Rate for Payer: BCN Medicare Advantage |
$480.71
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cofinity Commercial |
$692.22
|
| Rate for Payer: Cofinity Commercial |
$644.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.71
|
| Rate for Payer: Healthscope Commercial |
$889.31
|
| Rate for Payer: Healthscope Commercial |
$769.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.00
|
| Rate for Payer: Nomi Health Commercial |
$576.85
|
| Rate for Payer: PACE SWMI |
$480.71
|
| Rate for Payer: PHP Medicare Advantage |
$480.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.00
|
| Rate for Payer: Priority Health Medicare |
$480.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.71
|
| Rate for Payer: UHC Medicare Advantage |
$480.71
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$541.60 |
| Max. Negotiated Rate |
$1,153.12 |
| Rate for Payer: Aetna Commercial |
$835.24
|
| Rate for Payer: Aetna Medicare |
$648.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.57
|
| Rate for Payer: BCBS Complete |
$541.60
|
| Rate for Payer: BCBS MAPPO |
$623.31
|
| Rate for Payer: BCN Medicare Advantage |
$623.31
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cofinity Commercial |
$835.24
|
| Rate for Payer: Cofinity Commercial |
$897.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.31
|
| Rate for Payer: Healthscope Commercial |
$1,153.12
|
| Rate for Payer: Healthscope Commercial |
$997.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.10
|
| Rate for Payer: Nomi Health Commercial |
$747.97
|
| Rate for Payer: PACE SWMI |
$623.31
|
| Rate for Payer: PHP Medicare Advantage |
$623.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$880.10
|
| Rate for Payer: Priority Health Medicare |
$623.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.31
|
| Rate for Payer: UHC Medicare Advantage |
$623.31
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$1,530.69 |
| Rate for Payer: Aetna Commercial |
$1,108.72
|
| Rate for Payer: Aetna Medicare |
$860.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.72
|
| Rate for Payer: BCBS Complete |
$690.80
|
| Rate for Payer: BCBS MAPPO |
$827.40
|
| Rate for Payer: BCN Medicare Advantage |
$827.40
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,191.46
|
| Rate for Payer: Cofinity Commercial |
$1,108.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.40
|
| Rate for Payer: Healthscope Commercial |
$1,530.69
|
| Rate for Payer: Healthscope Commercial |
$1,323.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,122.55
|
| Rate for Payer: Nomi Health Commercial |
$992.88
|
| Rate for Payer: PACE SWMI |
$827.40
|
| Rate for Payer: PHP Medicare Advantage |
$827.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.55
|
| Rate for Payer: Priority Health Medicare |
$827.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.40
|
| Rate for Payer: UHC Medicare Advantage |
$827.40
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$1,335.96 |
| Rate for Payer: Aetna Commercial |
$967.67
|
| Rate for Payer: Aetna Medicare |
$751.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$967.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.88
|
| Rate for Payer: BCBS Complete |
$646.00
|
| Rate for Payer: BCBS MAPPO |
$722.14
|
| Rate for Payer: BCN Medicare Advantage |
$722.14
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cofinity Commercial |
$967.67
|
| Rate for Payer: Cofinity Commercial |
$1,039.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.14
|
| Rate for Payer: Healthscope Commercial |
$1,155.42
|
| Rate for Payer: Healthscope Commercial |
$1,335.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,049.75
|
| Rate for Payer: Nomi Health Commercial |
$866.57
|
| Rate for Payer: PACE SWMI |
$722.14
|
| Rate for Payer: PHP Medicare Advantage |
$722.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health Medicare |
$722.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.14
|
| Rate for Payer: UHC Medicare Advantage |
$722.14
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$1,244.24 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.49
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Healthscope Commercial |
$1,244.24
|
| Rate for Payer: Healthscope Commercial |
$1,076.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.35
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health Medicare |
$672.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$931.77 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Cofinity Commercial |
$1,035.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$931.77
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$1,244.24 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.23
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Healthscope Commercial |
$1,244.24
|
| Rate for Payer: Healthscope Commercial |
$1,076.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$961.35
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health Medicare |
$672.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$931.77 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.35
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,035.30
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,035.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health SBD |
$931.77
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$773.52 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Aetna Commercial |
$1,036.52
|
| Rate for Payer: Aetna Medicare |
$804.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,036.52
|
| Rate for Payer: BCBS Complete |
$894.00
|
| Rate for Payer: BCBS MAPPO |
$773.52
|
| Rate for Payer: BCN Medicare Advantage |
$773.52
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.87
|
| Rate for Payer: Cofinity Commercial |
$1,036.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.52
|
| Rate for Payer: Healthscope Commercial |
$1,237.63
|
| Rate for Payer: Healthscope Commercial |
$1,431.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,452.75
|
| Rate for Payer: Nomi Health Commercial |
$928.22
|
| Rate for Payer: PACE SWMI |
$773.52
|
| Rate for Payer: PHP Medicare Advantage |
$773.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.75
|
| Rate for Payer: Priority Health Medicare |
$773.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.52
|
| Rate for Payer: UHC Medicare Advantage |
$773.52
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$380.75 |
| Rate for Payer: Aetna Commercial |
$275.79
|
| Rate for Payer: Aetna Medicare |
$214.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.79
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$205.81
|
| Rate for Payer: BCN Medicare Advantage |
$205.81
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$296.37
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.81
|
| Rate for Payer: Healthscope Commercial |
$380.75
|
| Rate for Payer: Healthscope Commercial |
$329.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.80
|
| Rate for Payer: Nomi Health Commercial |
$246.97
|
| Rate for Payer: PACE SWMI |
$205.81
|
| Rate for Payer: PHP Medicare Advantage |
$205.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$205.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.81
|
| Rate for Payer: UHC Medicare Advantage |
$205.81
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$992.80 |
| Rate for Payer: Aetna Commercial |
$719.11
|
| Rate for Payer: Aetna Medicare |
$558.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.11
|
| Rate for Payer: BCBS Complete |
$467.60
|
| Rate for Payer: BCBS MAPPO |
$536.65
|
| Rate for Payer: BCN Medicare Advantage |
$536.65
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cofinity Commercial |
$772.78
|
| Rate for Payer: Cofinity Commercial |
$719.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.65
|
| Rate for Payer: Healthscope Commercial |
$858.64
|
| Rate for Payer: Healthscope Commercial |
$992.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.85
|
| Rate for Payer: Nomi Health Commercial |
$643.98
|
| Rate for Payer: PACE SWMI |
$536.65
|
| Rate for Payer: PHP Medicare Advantage |
$536.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.85
|
| Rate for Payer: Priority Health Medicare |
$536.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.65
|
| Rate for Payer: UHC Medicare Advantage |
$536.65
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$628.95 |
| Max. Negotiated Rate |
$1,343.55 |
| Rate for Payer: Aetna Commercial |
$842.79
|
| Rate for Payer: Aetna Medicare |
$654.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.79
|
| Rate for Payer: BCBS Complete |
$826.80
|
| Rate for Payer: BCBS MAPPO |
$628.95
|
| Rate for Payer: BCN Medicare Advantage |
$628.95
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cofinity Commercial |
$905.69
|
| Rate for Payer: Cofinity Commercial |
$842.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.95
|
| Rate for Payer: Healthscope Commercial |
$1,163.56
|
| Rate for Payer: Healthscope Commercial |
$1,006.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,343.55
|
| Rate for Payer: Nomi Health Commercial |
$754.74
|
| Rate for Payer: PACE SWMI |
$628.95
|
| Rate for Payer: PHP Medicare Advantage |
$628.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.55
|
| Rate for Payer: Priority Health Medicare |
$628.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.95
|
| Rate for Payer: UHC Medicare Advantage |
$628.95
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$1,093.54 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$614.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.18
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Healthscope Commercial |
$1,093.54
|
| Rate for Payer: Healthscope Commercial |
$945.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.35
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$818.37 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$1,104.15
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.14
|
| Rate for Payer: Cofinity Commercial |
$909.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$1,169.10
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,104.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$818.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,299.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$818.37 |
| Max. Negotiated Rate |
$1,169.10 |
| Rate for Payer: Aetna Commercial |
$1,104.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.35
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.14
|
| Rate for Payer: Cofinity Commercial |
$909.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$909.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,039.20
|
| Rate for Payer: Healthscope Commercial |
$1,169.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,104.15
|
| Rate for Payer: PHP Commercial |
$1,104.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health SBD |
$818.37
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$1,093.54 |
| Rate for Payer: Aetna Commercial |
$792.07
|
| Rate for Payer: Aetna Medicare |
$614.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$792.07
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$591.10
|
| Rate for Payer: BCN Medicare Advantage |
$591.10
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$851.18
|
| Rate for Payer: Cofinity Commercial |
$792.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.10
|
| Rate for Payer: Healthscope Commercial |
$1,093.54
|
| Rate for Payer: Healthscope Commercial |
$945.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.35
|
| Rate for Payer: Nomi Health Commercial |
$709.32
|
| Rate for Payer: PACE SWMI |
$591.10
|
| Rate for Payer: PHP Medicare Advantage |
$591.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$591.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.10
|
| Rate for Payer: UHC Medicare Advantage |
$591.10
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$74.75 |
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.75
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$801.12 |
| Rate for Payer: Aetna Commercial |
$580.27
|
| Rate for Payer: Aetna Medicare |
$450.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.27
|
| Rate for Payer: BCBS Complete |
$410.00
|
| Rate for Payer: BCBS MAPPO |
$433.04
|
| Rate for Payer: BCN Medicare Advantage |
$433.04
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$580.27
|
| Rate for Payer: Cofinity Commercial |
$623.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.04
|
| Rate for Payer: Healthscope Commercial |
$801.12
|
| Rate for Payer: Healthscope Commercial |
$692.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.25
|
| Rate for Payer: Nomi Health Commercial |
$519.65
|
| Rate for Payer: PACE SWMI |
$433.04
|
| Rate for Payer: PHP Medicare Advantage |
$433.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health Medicare |
$433.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.04
|
| Rate for Payer: UHC Medicare Advantage |
$433.04
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$28.29
|
| Rate for Payer: Aetna Medicare |
$21.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.29
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$21.11
|
| Rate for Payer: BCN Medicare Advantage |
$21.11
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$28.29
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.11
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Healthscope Commercial |
$33.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$25.33
|
| Rate for Payer: PACE SWMI |
$21.11
|
| Rate for Payer: PHP Medicare Advantage |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health Medicare |
$21.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.11
|
| Rate for Payer: UHC Medicare Advantage |
$21.11
|
|
