|
PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 29425
|
| Min. Negotiated Rate |
$51.77 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Aetna Commercial |
$69.37
|
| Rate for Payer: Aetna Medicare |
$53.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.37
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| Rate for Payer: BCN Medicare Advantage |
$51.77
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$74.55
|
| Rate for Payer: Cofinity Commercial |
$69.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.77
|
| Rate for Payer: Healthscope Commercial |
$95.77
|
| Rate for Payer: Healthscope Commercial |
$82.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.15
|
| Rate for Payer: Nomi Health Commercial |
$62.12
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health Medicare |
$51.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.77
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
|
|
PR APPLICATION SHORT LEG SPLINT CALF FOOT
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 29515
|
| Min. Negotiated Rate |
$47.91 |
| Max. Negotiated Rate |
$88.63 |
| Rate for Payer: Aetna Commercial |
$64.20
|
| Rate for Payer: Aetna Medicare |
$49.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.20
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$47.91
|
| Rate for Payer: BCN Medicare Advantage |
$47.91
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$68.99
|
| Rate for Payer: Cofinity Commercial |
$64.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.91
|
| Rate for Payer: Healthscope Commercial |
$76.66
|
| Rate for Payer: Healthscope Commercial |
$88.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Nomi Health Commercial |
$57.49
|
| Rate for Payer: PACE SWMI |
$47.91
|
| Rate for Payer: PHP Medicare Advantage |
$47.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$47.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.91
|
| Rate for Payer: UHC Medicare Advantage |
$47.91
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99188
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
|
|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$1,066.45 |
| Rate for Payer: Aetna Commercial |
$772.46
|
| Rate for Payer: Aetna Medicare |
$599.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.10
|
| Rate for Payer: BCBS Complete |
$410.00
|
| Rate for Payer: BCBS MAPPO |
$576.46
|
| Rate for Payer: BCN Medicare Advantage |
$576.46
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$830.10
|
| Rate for Payer: Cofinity Commercial |
$772.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.46
|
| Rate for Payer: Healthscope Commercial |
$922.34
|
| Rate for Payer: Healthscope Commercial |
$1,066.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.25
|
| Rate for Payer: Nomi Health Commercial |
$691.75
|
| Rate for Payer: PACE SWMI |
$576.46
|
| Rate for Payer: PHP Medicare Advantage |
$576.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health Medicare |
$576.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.46
|
| Rate for Payer: UHC Medicare Advantage |
$576.46
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$647.04 |
| Max. Negotiated Rate |
$1,197.02 |
| Rate for Payer: Aetna Commercial |
$867.03
|
| Rate for Payer: Aetna Medicare |
$672.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.74
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: BCBS MAPPO |
$647.04
|
| Rate for Payer: BCN Medicare Advantage |
$647.04
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cofinity Commercial |
$867.03
|
| Rate for Payer: Cofinity Commercial |
$931.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.04
|
| Rate for Payer: Healthscope Commercial |
$1,035.26
|
| Rate for Payer: Healthscope Commercial |
$1,197.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,171.95
|
| Rate for Payer: Nomi Health Commercial |
$776.45
|
| Rate for Payer: PACE SWMI |
$647.04
|
| Rate for Payer: PHP Medicare Advantage |
$647.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.95
|
| Rate for Payer: Priority Health Medicare |
$647.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.04
|
| Rate for Payer: UHC Medicare Advantage |
$647.04
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$26.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.62
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$25.09
|
| Rate for Payer: BCN Medicare Advantage |
$25.09
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Cofinity Commercial |
$33.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$40.14
|
| Rate for Payer: Healthscope Commercial |
$46.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.75
|
| Rate for Payer: Nomi Health Commercial |
$30.11
|
| Rate for Payer: PACE SWMI |
$25.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$25.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.09
|
| Rate for Payer: UHC Medicare Advantage |
$25.09
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.51
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| Rate for Payer: BCN Medicare Advantage |
$14.94
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Cofinity Commercial |
$21.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Healthscope Commercial |
$23.90
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.80
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$14.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$25.47 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$14.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.45
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$22.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$33.15
|
| Rate for Payer: Healthscope Commercial |
$28.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.55
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.92
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$24.72 |
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$13.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$1,496.03 |
| Max. Negotiated Rate |
$2,767.66 |
| Rate for Payer: Aetna Commercial |
$2,004.68
|
| Rate for Payer: Aetna Medicare |
$1,555.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,154.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.68
|
| Rate for Payer: BCBS Complete |
$1,558.00
|
| Rate for Payer: BCBS MAPPO |
$1,496.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,496.03
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cofinity Commercial |
$2,154.28
|
| Rate for Payer: Cofinity Commercial |
$2,004.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,496.03
|
| Rate for Payer: Healthscope Commercial |
$2,767.66
|
| Rate for Payer: Healthscope Commercial |
$2,393.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,570.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,531.75
|
| Rate for Payer: Nomi Health Commercial |
$1,795.24
|
| Rate for Payer: PACE SWMI |
$1,496.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,496.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.75
|
| Rate for Payer: Priority Health Medicare |
$1,496.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,496.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,496.03
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Healthscope Commercial |
$78.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.65
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.85
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$78.18
|
| Rate for Payer: Healthscope Commercial |
$67.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.65
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$88.83 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna Commercial |
$119.85
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.65
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$121.26
|
| Rate for Payer: Cofinity Commercial |
$98.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: PHP Commercial |
$119.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health SBD |
$88.83
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Healthscope Commercial |
$344.16
|
| Rate for Payer: Healthscope Commercial |
$297.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.40
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$193.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.88
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Healthscope Commercial |
$297.65
|
| Rate for Payer: Healthscope Commercial |
$344.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.40
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health SBD |
$388.08
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$2,010.17
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$388.08 |
| Max. Negotiated Rate |
$554.40 |
| Rate for Payer: Aetna Commercial |
$523.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.40
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$529.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$431.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Healthscope Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: PHP Commercial |
$523.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health SBD |
$388.08
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Healthscope Commercial |
$128.58
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.70
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$83.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.72
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Healthscope Commercial |
$128.58
|
| Rate for Payer: Healthscope Commercial |
$148.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.70
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna Commercial |
$236.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.70
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$194.60
|
| Rate for Payer: Cofinity Commercial |
$239.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$250.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: PHP Commercial |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health SBD |
$175.14
|
|
