|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.25
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$296.71 |
| Max. Negotiated Rate |
$880.29 |
| Rate for Payer: Aetna Commercial |
$603.95
|
| Rate for Payer: Aetna Medicare |
$468.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.02
|
| Rate for Payer: BCBS Complete |
$311.55
|
| Rate for Payer: BCBS MAPPO |
$450.71
|
| Rate for Payer: BCN Commercial |
$764.90
|
| Rate for Payer: BCN Medicare Advantage |
$450.71
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$649.02
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.71
|
| Rate for Payer: Healthscope Commercial |
$833.81
|
| Rate for Payer: Healthscope Commercial |
$721.14
|
| Rate for Payer: Mclaren Medicaid |
$296.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.25
|
| Rate for Payer: Meridian Medicaid |
$311.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$495.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.29
|
| Rate for Payer: Nomi Health Commercial |
$540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PACE SWMI |
$450.71
|
| Rate for Payer: PHP Medicare Advantage |
$450.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$700.08
|
| Rate for Payer: Priority Health Medicare |
$450.71
|
| Rate for Payer: Priority Health SBD |
$700.08
|
| Rate for Payer: Priority Health Tiered Network |
$700.08
|
| Rate for Payer: Railroad Medicare Medicare |
$450.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$861.09
|
| Rate for Payer: UHC Core |
$861.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$450.71
|
| Rate for Payer: UHC Exchange |
$861.09
|
| Rate for Payer: UHC Medicaid |
$296.71
|
| Rate for Payer: UHCCP Medicaid |
$296.71
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,145.68 |
| Rate for Payer: Aetna Commercial |
$785.44
|
| Rate for Payer: Aetna Medicare |
$609.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.06
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCBS MAPPO |
$586.15
|
| Rate for Payer: BCN Commercial |
$987.00
|
| Rate for Payer: BCN Medicare Advantage |
$586.15
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$844.06
|
| Rate for Payer: Cofinity Commercial |
$785.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.15
|
| Rate for Payer: Healthscope Commercial |
$937.84
|
| Rate for Payer: Healthscope Commercial |
$1,084.38
|
| Rate for Payer: Mclaren Medicaid |
$383.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.46
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$644.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,145.68
|
| Rate for Payer: Nomi Health Commercial |
$703.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,046.25
|
| Rate for Payer: PACE SWMI |
$586.15
|
| Rate for Payer: PHP Medicare Advantage |
$586.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$903.36
|
| Rate for Payer: Priority Health Medicare |
$586.15
|
| Rate for Payer: Priority Health SBD |
$903.36
|
| Rate for Payer: Priority Health Tiered Network |
$903.36
|
| Rate for Payer: Railroad Medicare Medicare |
$586.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.19
|
| Rate for Payer: UHC Core |
$1,123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$586.15
|
| Rate for Payer: UHC Exchange |
$1,123.19
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,779.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,524.94 |
| Rate for Payer: Aetna Commercial |
$1,007.59
|
| Rate for Payer: Aetna Medicare |
$782.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.78
|
| Rate for Payer: BCBS Complete |
$514.39
|
| Rate for Payer: BCBS MAPPO |
$751.93
|
| Rate for Payer: BCN Commercial |
$1,307.20
|
| Rate for Payer: BCN Medicare Advantage |
$751.93
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.78
|
| Rate for Payer: Cofinity Commercial |
$1,007.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.93
|
| Rate for Payer: Healthscope Commercial |
$1,391.07
|
| Rate for Payer: Healthscope Commercial |
$1,203.09
|
| Rate for Payer: Mclaren Medicaid |
$489.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.53
|
| Rate for Payer: Meridian Medicaid |
$514.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$827.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.94
|
| Rate for Payer: Nomi Health Commercial |
$902.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,334.25
|
| Rate for Payer: PACE SWMI |
$751.93
|
| Rate for Payer: PHP Medicare Advantage |
$751.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,196.43
|
| Rate for Payer: Priority Health Medicare |
$751.93
|
| Rate for Payer: Priority Health SBD |
$1,196.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,196.43
|
| Rate for Payer: Railroad Medicare Medicare |
$751.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,514.36
|
| Rate for Payer: UHC Core |
$1,514.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.93
|
| Rate for Payer: UHC Exchange |
$1,514.36
|
| Rate for Payer: UHC Medicaid |
$489.90
|
| Rate for Payer: UHCCP Medicaid |
$489.90
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$416.20 |
| Max. Negotiated Rate |
$1,329.48 |
| Rate for Payer: Aetna Commercial |
$851.96
|
| Rate for Payer: Aetna Medicare |
$661.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.54
|
| Rate for Payer: BCBS Complete |
$437.01
|
| Rate for Payer: BCBS MAPPO |
$635.79
|
| Rate for Payer: BCN Commercial |
$1,148.35
|
| Rate for Payer: BCN Medicare Advantage |
$635.79
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cofinity Commercial |
$915.54
|
| Rate for Payer: Cofinity Commercial |
$851.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.79
|
| Rate for Payer: Healthscope Commercial |
$1,176.21
|
| Rate for Payer: Healthscope Commercial |
$1,017.26
|
| Rate for Payer: Mclaren Medicaid |
$416.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.58
|
| Rate for Payer: Meridian Medicaid |
$437.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$699.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.48
|
| Rate for Payer: Nomi Health Commercial |
$762.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,247.25
|
| Rate for Payer: PACE SWMI |
$635.79
|
| Rate for Payer: PHP Medicare Advantage |
$635.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$416.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,051.03
|
| Rate for Payer: Priority Health Medicare |
$635.79
|
| Rate for Payer: Priority Health SBD |
$1,051.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,051.03
|
| Rate for Payer: Railroad Medicare Medicare |
$635.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.28
|
| Rate for Payer: UHC Core |
$1,320.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$635.79
|
| Rate for Payer: UHC Exchange |
$1,320.28
|
| Rate for Payer: UHC Medicaid |
$416.20
|
| Rate for Payer: UHCCP Medicaid |
$416.20
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$959.49 |
| Max. Negotiated Rate |
$1,370.70 |
| Rate for Payer: Aetna Commercial |
$1,294.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.95
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Advantage |
$1,066.10
|
| Rate for Payer: Cofinity Commercial |
$1,309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Healthscope Commercial |
$1,370.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PHP Commercial |
$1,294.55
|
| Rate for Payer: Priority Health SBD |
$959.49
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,236.87 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$627.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.74
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Commercial |
$1,116.09
|
| Rate for Payer: Mclaren Medicaid |
$395.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.87
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health SBD |
$979.01
|
| Rate for Payer: Priority Health Tiered Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,236.87 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$627.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.74
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Healthscope Commercial |
$965.26
|
| Rate for Payer: Healthscope Commercial |
$1,116.09
|
| Rate for Payer: Mclaren Medicaid |
$395.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.87
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health SBD |
$979.01
|
| Rate for Payer: Priority Health Tiered Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$959.49 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$1,294.55
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,050.16
|
| Rate for Payer: BCN Commercial |
$1,050.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Advantage |
$1,066.10
|
| Rate for Payer: Cofinity Commercial |
$1,309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,370.70
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,294.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$959.49
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,302.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$1,726.50 |
| Rate for Payer: Aetna Commercial |
$911.29
|
| Rate for Payer: Aetna Medicare |
$707.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.30
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS MAPPO |
$680.07
|
| Rate for Payer: BCN Commercial |
$1,231.01
|
| Rate for Payer: BCN Medicare Advantage |
$680.07
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Cofinity Commercial |
$911.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.07
|
| Rate for Payer: Healthscope Commercial |
$1,258.13
|
| Rate for Payer: Healthscope Commercial |
$1,088.11
|
| Rate for Payer: Mclaren Medicaid |
$445.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.07
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$748.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,425.96
|
| Rate for Payer: Nomi Health Commercial |
$816.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,726.50
|
| Rate for Payer: PACE SWMI |
$680.07
|
| Rate for Payer: PHP Medicare Advantage |
$680.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,126.70
|
| Rate for Payer: Priority Health Medicare |
$680.07
|
| Rate for Payer: Priority Health SBD |
$1,126.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,126.70
|
| Rate for Payer: Railroad Medicare Medicare |
$680.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.07
|
| Rate for Payer: UHC Core |
$1,413.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$680.07
|
| Rate for Payer: UHC Exchange |
$1,413.07
|
| Rate for Payer: UHC Medicaid |
$445.60
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$116.51 |
| Max. Negotiated Rate |
$385.74 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Aetna Medicare |
$189.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.30
|
| Rate for Payer: BCBS Complete |
$122.34
|
| Rate for Payer: BCBS MAPPO |
$182.15
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$182.15
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Commercial |
$244.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.15
|
| Rate for Payer: Healthscope Commercial |
$336.98
|
| Rate for Payer: Healthscope Commercial |
$291.44
|
| Rate for Payer: Mclaren Medicaid |
$116.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.26
|
| Rate for Payer: Meridian Medicaid |
$122.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.54
|
| Rate for Payer: Nomi Health Commercial |
$218.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: PACE SWMI |
$182.15
|
| Rate for Payer: PHP Medicare Advantage |
$182.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$293.07
|
| Rate for Payer: Priority Health Medicare |
$182.15
|
| Rate for Payer: Priority Health SBD |
$293.07
|
| Rate for Payer: Priority Health Tiered Network |
$293.07
|
| Rate for Payer: Railroad Medicare Medicare |
$182.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.74
|
| Rate for Payer: UHC Core |
$385.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.15
|
| Rate for Payer: UHC Exchange |
$385.74
|
| Rate for Payer: UHC Medicaid |
$116.51
|
| Rate for Payer: UHCCP Medicaid |
$116.51
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$985.79 |
| Rate for Payer: Aetna Commercial |
$654.52
|
| Rate for Payer: Aetna Medicare |
$507.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.37
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$488.45
|
| Rate for Payer: BCN Commercial |
$857.02
|
| Rate for Payer: BCN Medicare Advantage |
$488.45
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$703.37
|
| Rate for Payer: Cofinity Commercial |
$654.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.45
|
| Rate for Payer: Healthscope Commercial |
$903.63
|
| Rate for Payer: Healthscope Commercial |
$781.52
|
| Rate for Payer: Mclaren Medicaid |
$321.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.87
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$537.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$985.79
|
| Rate for Payer: Nomi Health Commercial |
$586.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.00
|
| Rate for Payer: PACE SWMI |
$488.45
|
| Rate for Payer: PHP Medicare Advantage |
$488.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$784.40
|
| Rate for Payer: Priority Health Medicare |
$488.45
|
| Rate for Payer: Priority Health SBD |
$784.40
|
| Rate for Payer: Priority Health Tiered Network |
$784.40
|
| Rate for Payer: Railroad Medicare Medicare |
$488.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.65
|
| Rate for Payer: UHC Core |
$965.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$488.45
|
| Rate for Payer: UHC Exchange |
$965.65
|
| Rate for Payer: UHC Medicaid |
$321.84
|
| Rate for Payer: UHCCP Medicaid |
$321.84
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,129.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$365.72 |
| Max. Negotiated Rate |
$1,596.75 |
| Rate for Payer: Aetna Commercial |
$747.01
|
| Rate for Payer: Aetna Medicare |
$579.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.76
|
| Rate for Payer: BCBS Complete |
$384.01
|
| Rate for Payer: BCBS MAPPO |
$557.47
|
| Rate for Payer: BCN Commercial |
$1,001.94
|
| Rate for Payer: BCN Medicare Advantage |
$557.47
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cofinity Commercial |
$802.76
|
| Rate for Payer: Cofinity Commercial |
$747.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.47
|
| Rate for Payer: Healthscope Commercial |
$891.95
|
| Rate for Payer: Healthscope Commercial |
$1,031.32
|
| Rate for Payer: Mclaren Medicaid |
$365.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.34
|
| Rate for Payer: Meridian Medicaid |
$384.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,159.96
|
| Rate for Payer: Nomi Health Commercial |
$668.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.75
|
| Rate for Payer: PACE SWMI |
$557.47
|
| Rate for Payer: PHP Medicare Advantage |
$557.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$917.03
|
| Rate for Payer: Priority Health Medicare |
$557.47
|
| Rate for Payer: Priority Health SBD |
$917.03
|
| Rate for Payer: Priority Health Tiered Network |
$917.03
|
| Rate for Payer: Railroad Medicare Medicare |
$557.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.45
|
| Rate for Payer: UHC Core |
$1,146.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$557.47
|
| Rate for Payer: UHC Exchange |
$1,146.45
|
| Rate for Payer: UHC Medicaid |
$365.72
|
| Rate for Payer: UHCCP Medicaid |
$365.72
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,087.99 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$551.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.19
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Healthscope Commercial |
$981.78
|
| Rate for Payer: Healthscope Commercial |
$849.10
|
| Rate for Payer: Mclaren Medicaid |
$348.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.99
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health SBD |
$861.43
|
| Rate for Payer: Priority Health Tiered Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.72
|
| Rate for Payer: UHC Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$842.94 |
| Max. Negotiated Rate |
$1,204.20 |
| Rate for Payer: Aetna Commercial |
$1,137.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.70
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Advantage |
$936.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Healthscope Commercial |
$1,204.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PHP Commercial |
$1,137.30
|
| Rate for Payer: Priority Health SBD |
$842.94
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$842.94 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$1,137.30
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,518.80
|
| Rate for Payer: BCN Commercial |
$1,518.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Advantage |
$936.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,204.20
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,137.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$842.94
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,087.99 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$551.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.19
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Healthscope Commercial |
$981.78
|
| Rate for Payer: Healthscope Commercial |
$849.10
|
| Rate for Payer: Mclaren Medicaid |
$348.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.99
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health SBD |
$861.43
|
| Rate for Payer: Priority Health Tiered Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.72
|
| Rate for Payer: UHC Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$109.78 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.62
|
| Rate for Payer: BCN Commercial |
$109.78
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$559.07
|
| Rate for Payer: Aetna Medicare |
$433.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.07
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$417.22
|
| Rate for Payer: BCN Commercial |
$687.71
|
| Rate for Payer: BCN Medicare Advantage |
$417.22
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.22
|
| Rate for Payer: Healthscope Commercial |
$667.55
|
| Rate for Payer: Healthscope Commercial |
$771.86
|
| Rate for Payer: Mclaren Medicaid |
$274.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.08
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.61
|
| Rate for Payer: Nomi Health Commercial |
$500.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$792.00
|
| Rate for Payer: PACE SWMI |
$417.22
|
| Rate for Payer: PHP Medicare Advantage |
$417.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$735.15
|
| Rate for Payer: Priority Health Medicare |
$417.22
|
| Rate for Payer: Priority Health SBD |
$735.15
|
| Rate for Payer: Priority Health Tiered Network |
$735.15
|
| Rate for Payer: Railroad Medicare Medicare |
$417.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.63
|
| Rate for Payer: UHC Core |
$770.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$417.22
|
| Rate for Payer: UHC Exchange |
$770.63
|
| Rate for Payer: UHC Medicaid |
$274.13
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Medicare |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: BCBS MAPPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$28.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$38.06
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.40
|
| Rate for Payer: Healthscope Commercial |
$45.44
|
| Rate for Payer: Healthscope Commercial |
$52.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.20
|
| Rate for Payer: Nomi Health Commercial |
$34.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
| Rate for Payer: PACE SWMI |
$28.40
|
| Rate for Payer: PHP Medicare Advantage |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.69
|
| Rate for Payer: Priority Health Medicare |
$28.40
|
| Rate for Payer: Priority Health SBD |
$31.69
|
| Rate for Payer: Priority Health Tiered Network |
$31.69
|
| Rate for Payer: Railroad Medicare Medicare |
$28.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$23.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.40
|
| Rate for Payer: UHC Exchange |
$23.22
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.88
|
| Rate for Payer: BCBS MAPPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$22.83
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$32.88
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$36.53
|
| Rate for Payer: Healthscope Commercial |
$42.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.20
|
| Rate for Payer: Nomi Health Commercial |
$27.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
| Rate for Payer: PACE SWMI |
$22.83
|
| Rate for Payer: PHP Medicare Advantage |
$22.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.09
|
| Rate for Payer: Priority Health Medicare |
$22.83
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: Priority Health Tiered Network |
$27.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.83
|
| Rate for Payer: UHC Exchange |
$20.03
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$3,427.50 |
| Rate for Payer: Aetna Commercial |
$1,563.40
|
| Rate for Payer: Aetna Medicare |
$1,213.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,680.08
|
| Rate for Payer: BCBS Complete |
$786.36
|
| Rate for Payer: BCBS MAPPO |
$1,166.72
|
| Rate for Payer: BCN Commercial |
$1,865.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,166.72
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cofinity Commercial |
$1,680.08
|
| Rate for Payer: Cofinity Commercial |
$1,563.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,166.72
|
| Rate for Payer: Healthscope Commercial |
$2,158.43
|
| Rate for Payer: Healthscope Commercial |
$1,866.75
|
| Rate for Payer: Mclaren Medicaid |
$748.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,225.06
|
| Rate for Payer: Meridian Medicaid |
$786.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,283.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,227.21
|
| Rate for Payer: Nomi Health Commercial |
$1,400.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,427.50
|
| Rate for Payer: PACE SWMI |
$1,166.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,166.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$748.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,023.30
|
| Rate for Payer: Priority Health Medicare |
$1,166.72
|
| Rate for Payer: Priority Health SBD |
$2,023.30
|
| Rate for Payer: Priority Health Tiered Network |
$2,023.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,166.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,188.57
|
| Rate for Payer: UHC Core |
$2,188.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,166.72
|
| Rate for Payer: UHC Exchange |
$2,188.57
|
| Rate for Payer: UHC Medicaid |
$748.91
|
| Rate for Payer: UHCCP Medicaid |
$748.91
|
|
