|
PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS 57240
|
| Min. Negotiated Rate |
$587.39 |
| Max. Negotiated Rate |
$1,086.67 |
| Rate for Payer: Aetna Commercial |
$787.10
|
| Rate for Payer: Aetna Medicare |
$610.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$845.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.10
|
| Rate for Payer: BCBS Complete |
$621.20
|
| Rate for Payer: BCBS MAPPO |
$587.39
|
| Rate for Payer: BCN Medicare Advantage |
$587.39
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Cofinity Commercial |
$845.84
|
| Rate for Payer: Cofinity Commercial |
$787.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.39
|
| Rate for Payer: Healthscope Commercial |
$1,086.67
|
| Rate for Payer: Healthscope Commercial |
$939.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,009.45
|
| Rate for Payer: Nomi Health Commercial |
$704.87
|
| Rate for Payer: PACE SWMI |
$587.39
|
| Rate for Payer: PHP Medicare Advantage |
$587.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,009.45
|
| Rate for Payer: Priority Health Medicare |
$587.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.39
|
| Rate for Payer: UHC Medicare Advantage |
$587.39
|
|
|
PR ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,881.00
|
|
|
Service Code
|
HCPCS 22845
|
| Min. Negotiated Rate |
$709.23 |
| Max. Negotiated Rate |
$2,522.65 |
| Rate for Payer: Aetna Commercial |
$950.37
|
| Rate for Payer: Aetna Medicare |
$737.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$950.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,021.29
|
| Rate for Payer: BCBS Complete |
$1,552.40
|
| Rate for Payer: BCBS MAPPO |
$709.23
|
| Rate for Payer: BCN Medicare Advantage |
$709.23
|
| Rate for Payer: Cash Price |
$3,104.80
|
| Rate for Payer: Cash Price |
$3,104.80
|
| Rate for Payer: Cofinity Commercial |
$950.37
|
| Rate for Payer: Cofinity Commercial |
$1,021.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$709.23
|
| Rate for Payer: Healthscope Commercial |
$1,312.08
|
| Rate for Payer: Healthscope Commercial |
$1,134.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,522.65
|
| Rate for Payer: Nomi Health Commercial |
$851.08
|
| Rate for Payer: PACE SWMI |
$709.23
|
| Rate for Payer: PHP Medicare Advantage |
$709.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,522.65
|
| Rate for Payer: Priority Health Medicare |
$709.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$709.23
|
| Rate for Payer: UHC Medicare Advantage |
$709.23
|
|
|
PR ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$4,270.00
|
|
|
Service Code
|
HCPCS 22846
|
| Min. Negotiated Rate |
$739.06 |
| Max. Negotiated Rate |
$2,775.50 |
| Rate for Payer: Aetna Commercial |
$990.34
|
| Rate for Payer: Aetna Medicare |
$768.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,064.25
|
| Rate for Payer: BCBS Complete |
$1,708.00
|
| Rate for Payer: BCBS MAPPO |
$739.06
|
| Rate for Payer: BCN Medicare Advantage |
$739.06
|
| Rate for Payer: Cash Price |
$3,416.00
|
| Rate for Payer: Cash Price |
$3,416.00
|
| Rate for Payer: Cofinity Commercial |
$990.34
|
| Rate for Payer: Cofinity Commercial |
$1,064.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.06
|
| Rate for Payer: Healthscope Commercial |
$1,182.50
|
| Rate for Payer: Healthscope Commercial |
$1,367.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,775.50
|
| Rate for Payer: Nomi Health Commercial |
$886.87
|
| Rate for Payer: PACE SWMI |
$739.06
|
| Rate for Payer: PHP Medicare Advantage |
$739.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,775.50
|
| Rate for Payer: Priority Health Medicare |
$739.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.06
|
| Rate for Payer: UHC Medicare Advantage |
$739.06
|
|
|
PR ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$3,779.00
|
|
|
Service Code
|
HCPCS 22847
|
| Min. Negotiated Rate |
$766.79 |
| Max. Negotiated Rate |
$2,456.35 |
| Rate for Payer: Aetna Commercial |
$1,027.50
|
| Rate for Payer: Aetna Medicare |
$797.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.50
|
| Rate for Payer: BCBS Complete |
$1,511.60
|
| Rate for Payer: BCBS MAPPO |
$766.79
|
| Rate for Payer: BCN Medicare Advantage |
$766.79
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cash Price |
$3,023.20
|
| Rate for Payer: Cofinity Commercial |
$1,104.18
|
| Rate for Payer: Cofinity Commercial |
$1,027.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.79
|
| Rate for Payer: Healthscope Commercial |
$1,418.56
|
| Rate for Payer: Healthscope Commercial |
$1,226.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$805.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,456.35
|
| Rate for Payer: Nomi Health Commercial |
$920.15
|
| Rate for Payer: PACE SWMI |
$766.79
|
| Rate for Payer: PHP Medicare Advantage |
$766.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,456.35
|
| Rate for Payer: Priority Health Medicare |
$766.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.79
|
| Rate for Payer: UHC Medicare Advantage |
$766.79
|
|
|
PR ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$2,577.00
|
|
|
Service Code
|
HCPCS 27418
|
| Min. Negotiated Rate |
$787.55 |
| Max. Negotiated Rate |
$1,675.05 |
| Rate for Payer: Aetna Commercial |
$1,055.32
|
| Rate for Payer: Aetna Medicare |
$819.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.32
|
| Rate for Payer: BCBS Complete |
$1,030.80
|
| Rate for Payer: BCBS MAPPO |
$787.55
|
| Rate for Payer: BCN Medicare Advantage |
$787.55
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cash Price |
$2,061.60
|
| Rate for Payer: Cofinity Commercial |
$1,134.07
|
| Rate for Payer: Cofinity Commercial |
$1,055.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.55
|
| Rate for Payer: Healthscope Commercial |
$1,260.08
|
| Rate for Payer: Healthscope Commercial |
$1,456.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,675.05
|
| Rate for Payer: Nomi Health Commercial |
$945.06
|
| Rate for Payer: PACE SWMI |
$787.55
|
| Rate for Payer: PHP Medicare Advantage |
$787.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,675.05
|
| Rate for Payer: Priority Health Medicare |
$787.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.55
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR ANTICOAG MGMT, EACH SUBSEQ 90 DAYS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 99364
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
|
|
PR ANTICOAG MGMT, INITIAL 90 DAYS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 99363
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
|
|
PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 93793
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$14.23
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.23
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$10.62
|
| Rate for Payer: BCN Medicare Advantage |
$10.62
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$14.23
|
| Rate for Payer: Cofinity Commercial |
$15.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.62
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$16.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.60
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: PACE SWMI |
$10.62
|
| Rate for Payer: PHP Medicare Advantage |
$10.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$10.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.62
|
| Rate for Payer: UHC Medicare Advantage |
$10.62
|
|
|
PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
HCPCS 51840
|
| Min. Negotiated Rate |
$661.88 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$886.92
|
| Rate for Payer: Aetna Medicare |
$688.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.92
|
| Rate for Payer: BCBS Complete |
$983.60
|
| Rate for Payer: BCBS MAPPO |
$661.88
|
| Rate for Payer: BCN Medicare Advantage |
$661.88
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cofinity Commercial |
$953.11
|
| Rate for Payer: Cofinity Commercial |
$886.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.88
|
| Rate for Payer: Healthscope Commercial |
$1,224.48
|
| Rate for Payer: Healthscope Commercial |
$1,059.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,598.35
|
| Rate for Payer: Nomi Health Commercial |
$794.26
|
| Rate for Payer: PACE SWMI |
$661.88
|
| Rate for Payer: PHP Medicare Advantage |
$661.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,598.35
|
| Rate for Payer: Priority Health Medicare |
$661.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.88
|
| Rate for Payer: UHC Medicare Advantage |
$661.88
|
|
|
PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS
|
Professional
|
Both
|
$1,940.00
|
|
|
Service Code
|
HCPCS 33866
|
| Min. Negotiated Rate |
$776.00 |
| Max. Negotiated Rate |
$1,631.83 |
| Rate for Payer: Aetna Commercial |
$1,181.97
|
| Rate for Payer: Aetna Medicare |
$917.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,270.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.97
|
| Rate for Payer: BCBS Complete |
$776.00
|
| Rate for Payer: BCBS MAPPO |
$882.07
|
| Rate for Payer: BCN Medicare Advantage |
$882.07
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cofinity Commercial |
$1,270.18
|
| Rate for Payer: Cofinity Commercial |
$1,181.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.07
|
| Rate for Payer: Healthscope Commercial |
$1,411.31
|
| Rate for Payer: Healthscope Commercial |
$1,631.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$926.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,261.00
|
| Rate for Payer: Nomi Health Commercial |
$1,058.48
|
| Rate for Payer: PACE SWMI |
$882.07
|
| Rate for Payer: PHP Medicare Advantage |
$882.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,261.00
|
| Rate for Payer: Priority Health Medicare |
$882.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.07
|
| Rate for Payer: UHC Medicare Advantage |
$882.07
|
|
|
PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX
|
Professional
|
Both
|
$1,864.00
|
|
|
Service Code
|
HCPCS 33800
|
| Min. Negotiated Rate |
$745.60 |
| Max. Negotiated Rate |
$1,754.71 |
| Rate for Payer: Aetna Commercial |
$1,270.98
|
| Rate for Payer: Aetna Medicare |
$986.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,270.98
|
| Rate for Payer: BCBS Complete |
$745.60
|
| Rate for Payer: BCBS MAPPO |
$948.49
|
| Rate for Payer: BCN Medicare Advantage |
$948.49
|
| Rate for Payer: Cash Price |
$1,491.20
|
| Rate for Payer: Cash Price |
$1,491.20
|
| Rate for Payer: Cofinity Commercial |
$1,365.83
|
| Rate for Payer: Cofinity Commercial |
$1,270.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.49
|
| Rate for Payer: Healthscope Commercial |
$1,754.71
|
| Rate for Payer: Healthscope Commercial |
$1,517.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,211.60
|
| Rate for Payer: Nomi Health Commercial |
$1,138.19
|
| Rate for Payer: PACE SWMI |
$948.49
|
| Rate for Payer: PHP Medicare Advantage |
$948.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,211.60
|
| Rate for Payer: Priority Health Medicare |
$948.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.49
|
| Rate for Payer: UHC Medicare Advantage |
$948.49
|
|
|
PR AORTOPLASTY SUPRAVALVULAR STENOSIS
|
Professional
|
Both
|
$9,378.00
|
|
|
Service Code
|
HCPCS 33417
|
| Min. Negotiated Rate |
$1,603.26 |
| Max. Negotiated Rate |
$6,095.70 |
| Rate for Payer: Aetna Commercial |
$2,148.37
|
| Rate for Payer: Aetna Medicare |
$1,667.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,308.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,148.37
|
| Rate for Payer: BCBS Complete |
$3,751.20
|
| Rate for Payer: BCBS MAPPO |
$1,603.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,603.26
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Cash Price |
$7,502.40
|
| Rate for Payer: Cofinity Commercial |
$2,308.69
|
| Rate for Payer: Cofinity Commercial |
$2,148.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,603.26
|
| Rate for Payer: Healthscope Commercial |
$2,565.22
|
| Rate for Payer: Healthscope Commercial |
$2,966.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,683.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,095.70
|
| Rate for Payer: Nomi Health Commercial |
$1,923.91
|
| Rate for Payer: PACE SWMI |
$1,603.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,603.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,095.70
|
| Rate for Payer: Priority Health Medicare |
$1,603.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,603.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,603.26
|
|
|
PR APNEALINK
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00020
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$346.00 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.25
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$605.50
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health SBD |
$544.95
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$544.95 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Aetna Commercial |
$735.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.25
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$605.50
|
| Rate for Payer: Cofinity Commercial |
$743.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$605.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$692.00
|
| Rate for Payer: Healthscope Commercial |
$778.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$735.25
|
| Rate for Payer: PHP Commercial |
$735.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health SBD |
$544.95
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.15
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$129.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.25
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
|
|
PR APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 44955
|
| Hospital Charge Code |
44955
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$108.08
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.15
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$80.66
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$108.08
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.66
|
| Rate for Payer: Healthscope Commercial |
$149.22
|
| Rate for Payer: Healthscope Commercial |
$129.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.25
|
| Rate for Payer: Nomi Health Commercial |
$96.79
|
| Rate for Payer: PACE SWMI |
$80.66
|
| Rate for Payer: PHP Medicare Advantage |
$80.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$80.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.66
|
| Rate for Payer: UHC Medicare Advantage |
$80.66
|
|
|
PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS
|
Professional
|
Both
|
$2,137.00
|
|
|
Service Code
|
HCPCS 44960
|
| Min. Negotiated Rate |
$853.15 |
| Max. Negotiated Rate |
$1,578.33 |
| Rate for Payer: Aetna Commercial |
$1,143.22
|
| Rate for Payer: Aetna Medicare |
$887.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,228.54
|
| Rate for Payer: BCBS Complete |
$854.80
|
| Rate for Payer: BCBS MAPPO |
$853.15
|
| Rate for Payer: BCN Medicare Advantage |
$853.15
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Cash Price |
$1,709.60
|
| Rate for Payer: Cofinity Commercial |
$1,143.22
|
| Rate for Payer: Cofinity Commercial |
$1,228.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.15
|
| Rate for Payer: Healthscope Commercial |
$1,365.04
|
| Rate for Payer: Healthscope Commercial |
$1,578.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,389.05
|
| Rate for Payer: Nomi Health Commercial |
$1,023.78
|
| Rate for Payer: PACE SWMI |
$853.15
|
| Rate for Payer: PHP Medicare Advantage |
$853.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.05
|
| Rate for Payer: Priority Health Medicare |
$853.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.15
|
| Rate for Payer: UHC Medicare Advantage |
$853.15
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Min. Negotiated Rate |
$624.56 |
| Max. Negotiated Rate |
$1,155.44 |
| Rate for Payer: Aetna Commercial |
$836.91
|
| Rate for Payer: Aetna Medicare |
$649.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.91
|
| Rate for Payer: BCBS Complete |
$695.20
|
| Rate for Payer: BCBS MAPPO |
$624.56
|
| Rate for Payer: BCN Medicare Advantage |
$624.56
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$899.37
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.56
|
| Rate for Payer: Healthscope Commercial |
$999.30
|
| Rate for Payer: Healthscope Commercial |
$1,155.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.70
|
| Rate for Payer: Nomi Health Commercial |
$749.47
|
| Rate for Payer: PACE SWMI |
$624.56
|
| Rate for Payer: PHP Medicare Advantage |
$624.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$624.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.56
|
| Rate for Payer: UHC Medicare Advantage |
$624.56
|
|
|
PR APPENDECTOMY
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$624.56 |
| Max. Negotiated Rate |
$1,155.44 |
| Rate for Payer: Aetna Commercial |
$836.91
|
| Rate for Payer: Aetna Medicare |
$649.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.37
|
| Rate for Payer: BCBS Complete |
$695.20
|
| Rate for Payer: BCBS MAPPO |
$624.56
|
| Rate for Payer: BCN Medicare Advantage |
$624.56
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$899.37
|
| Rate for Payer: Cofinity Commercial |
$836.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.56
|
| Rate for Payer: Healthscope Commercial |
$1,155.44
|
| Rate for Payer: Healthscope Commercial |
$999.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,129.70
|
| Rate for Payer: Nomi Health Commercial |
$749.47
|
| Rate for Payer: PACE SWMI |
$624.56
|
| Rate for Payer: PHP Medicare Advantage |
$624.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$624.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.56
|
| Rate for Payer: UHC Medicare Advantage |
$624.56
|
|
|
PR APPENDECTOMY
|
Facility
|
OP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,094.94 |
| Max. Negotiated Rate |
$17,130.07 |
| Rate for Payer: Aetna Commercial |
$1,477.30
|
| Rate for Payer: Aetna Medicare |
$6,328.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,606.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,606.88
|
| Rate for Payer: BCBS Complete |
$3,424.92
|
| Rate for Payer: BCBS MAPPO |
$6,085.50
|
| Rate for Payer: BCN Medicare Advantage |
$6,085.50
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,494.68
|
| Rate for Payer: Cofinity Commercial |
$1,216.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,085.50
|
| Rate for Payer: Healthscope Commercial |
$1,564.20
|
| Rate for Payer: Mclaren Medicaid |
$3,261.83
|
| Rate for Payer: Mclaren Medicare |
$6,085.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,389.77
|
| Rate for Payer: Meridian Medicaid |
$3,424.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,998.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: PACE Medicare |
$5,781.23
|
| Rate for Payer: PACE SWMI |
$6,085.50
|
| Rate for Payer: PHP Commercial |
$1,477.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,085.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,261.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health Medicare |
$6,085.50
|
| Rate for Payer: Priority Health SBD |
$1,094.94
|
| Rate for Payer: Railroad Medicare Medicare |
$6,085.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,130.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,085.50
|
| Rate for Payer: UHC Medicare Advantage |
$6,085.50
|
| Rate for Payer: UHCCP Medicaid |
$3,426.14
|
| Rate for Payer: VA VA |
$6,085.50
|
|
|
PR APPENDECTOMY
|
Facility
|
IP
|
$1,738.00
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
44950
|
| Min. Negotiated Rate |
$1,094.94 |
| Max. Negotiated Rate |
$1,564.20 |
| Rate for Payer: Aetna Commercial |
$1,477.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,129.70
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$1,216.60
|
| Rate for Payer: Cofinity Commercial |
$1,494.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,216.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,390.40
|
| Rate for Payer: Healthscope Commercial |
$1,564.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,477.30
|
| Rate for Payer: PHP Commercial |
$1,477.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,129.70
|
| Rate for Payer: Priority Health SBD |
$1,094.94
|
|
|
PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 20660
|
| Min. Negotiated Rate |
$236.76 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna Commercial |
$317.26
|
| Rate for Payer: Aetna Medicare |
$246.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.26
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$236.76
|
| Rate for Payer: BCN Medicare Advantage |
$236.76
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$340.93
|
| Rate for Payer: Cofinity Commercial |
$317.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.76
|
| Rate for Payer: Healthscope Commercial |
$378.82
|
| Rate for Payer: Healthscope Commercial |
$438.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.60
|
| Rate for Payer: Nomi Health Commercial |
$284.11
|
| Rate for Payer: PACE SWMI |
$236.76
|
| Rate for Payer: PHP Medicare Advantage |
$236.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$236.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.76
|
| Rate for Payer: UHC Medicare Advantage |
$236.76
|
|
|
PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS
|
Professional
|
Both
|
$660.00
|
|
|
Service Code
|
HCPCS 29325
|
| Min. Negotiated Rate |
$171.43 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna Commercial |
$229.72
|
| Rate for Payer: Aetna Medicare |
$178.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$246.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.72
|
| Rate for Payer: BCBS Complete |
$264.00
|
| Rate for Payer: BCBS MAPPO |
$171.43
|
| Rate for Payer: BCN Medicare Advantage |
$171.43
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cofinity Commercial |
$246.86
|
| Rate for Payer: Cofinity Commercial |
$229.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.43
|
| Rate for Payer: Healthscope Commercial |
$317.15
|
| Rate for Payer: Healthscope Commercial |
$274.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.00
|
| Rate for Payer: Nomi Health Commercial |
$205.72
|
| Rate for Payer: PACE SWMI |
$171.43
|
| Rate for Payer: PHP Medicare Advantage |
$171.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$429.00
|
| Rate for Payer: Priority Health Medicare |
$171.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.43
|
| Rate for Payer: UHC Medicare Advantage |
$171.43
|
|
|
PR APPLICATION CAST ELBOW FINGER SHORT ARM
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 29075
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$130.65 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Medicare |
$62.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.00
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$60.45
|
| Rate for Payer: BCN Medicare Advantage |
$60.45
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Cofinity Commercial |
$81.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.45
|
| Rate for Payer: Healthscope Commercial |
$111.83
|
| Rate for Payer: Healthscope Commercial |
$96.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.65
|
| Rate for Payer: Nomi Health Commercial |
$72.54
|
| Rate for Payer: PACE SWMI |
$60.45
|
| Rate for Payer: PHP Medicare Advantage |
$60.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Medicare |
$60.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.45
|
| Rate for Payer: UHC Medicare Advantage |
$60.45
|
|
