|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,023.12 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.60
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Advantage |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: Priority Health SBD |
$1,023.12
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$274.56 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$566.71
|
| Rate for Payer: Aetna Medicare |
$439.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.00
|
| Rate for Payer: BCBS Complete |
$288.29
|
| Rate for Payer: BCBS MAPPO |
$422.92
|
| Rate for Payer: BCN Commercial |
$668.79
|
| Rate for Payer: BCN Medicare Advantage |
$422.92
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$609.00
|
| Rate for Payer: Cofinity Commercial |
$566.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.92
|
| Rate for Payer: Healthscope Commercial |
$782.40
|
| Rate for Payer: Healthscope Commercial |
$676.67
|
| Rate for Payer: Mclaren Medicaid |
$274.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.07
|
| Rate for Payer: Meridian Medicaid |
$288.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$465.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.32
|
| Rate for Payer: Nomi Health Commercial |
$507.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE SWMI |
$422.92
|
| Rate for Payer: PHP Medicare Advantage |
$422.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$889.87
|
| Rate for Payer: Priority Health Medicare |
$422.92
|
| Rate for Payer: Priority Health SBD |
$889.87
|
| Rate for Payer: Priority Health Tiered Network |
$889.87
|
| Rate for Payer: Railroad Medicare Medicare |
$422.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.06
|
| Rate for Payer: UHC Core |
$772.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$422.92
|
| Rate for Payer: UHC Exchange |
$772.06
|
| Rate for Payer: UHC Medicaid |
$274.56
|
| Rate for Payer: UHCCP Medicaid |
$274.56
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,023.12 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,398.09
|
| Rate for Payer: BCN Commercial |
$2,398.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Advantage |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$1,023.12
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38510
|
| Hospital Charge Code |
38510
|
| Min. Negotiated Rate |
$241.12 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$500.44
|
| Rate for Payer: Aetna Medicare |
$388.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.78
|
| Rate for Payer: BCBS Complete |
$253.18
|
| Rate for Payer: BCBS MAPPO |
$373.46
|
| Rate for Payer: BCN Commercial |
$629.95
|
| Rate for Payer: BCN Medicare Advantage |
$373.46
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$537.78
|
| Rate for Payer: Cofinity Commercial |
$500.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.46
|
| Rate for Payer: Healthscope Commercial |
$690.90
|
| Rate for Payer: Healthscope Commercial |
$597.54
|
| Rate for Payer: Mclaren Medicaid |
$241.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.13
|
| Rate for Payer: Meridian Medicaid |
$253.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.30
|
| Rate for Payer: Nomi Health Commercial |
$448.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE SWMI |
$373.46
|
| Rate for Payer: PHP Medicare Advantage |
$373.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$838.19
|
| Rate for Payer: Priority Health Medicare |
$373.46
|
| Rate for Payer: Priority Health SBD |
$838.19
|
| Rate for Payer: Priority Health Tiered Network |
$838.19
|
| Rate for Payer: Railroad Medicare Medicare |
$373.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.24
|
| Rate for Payer: UHC Core |
$737.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.46
|
| Rate for Payer: UHC Exchange |
$737.24
|
| Rate for Payer: UHC Medicaid |
$241.12
|
| Rate for Payer: UHCCP Medicaid |
$241.12
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,023.12 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.60
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Advantage |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: Priority Health SBD |
$1,023.12
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Professional
|
Both
|
$1,624.00
|
|
|
Service Code
|
HCPCS 38510
|
| Min. Negotiated Rate |
$241.12 |
| Max. Negotiated Rate |
$1,218.00 |
| Rate for Payer: Aetna Commercial |
$500.44
|
| Rate for Payer: Aetna Medicare |
$388.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.78
|
| Rate for Payer: BCBS Complete |
$253.18
|
| Rate for Payer: BCBS MAPPO |
$373.46
|
| Rate for Payer: BCN Commercial |
$629.95
|
| Rate for Payer: BCN Medicare Advantage |
$373.46
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Commercial |
$537.78
|
| Rate for Payer: Cofinity Commercial |
$500.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.46
|
| Rate for Payer: Healthscope Commercial |
$690.90
|
| Rate for Payer: Healthscope Commercial |
$597.54
|
| Rate for Payer: Mclaren Medicaid |
$241.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.13
|
| Rate for Payer: Meridian Medicaid |
$253.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$410.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.30
|
| Rate for Payer: Nomi Health Commercial |
$448.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE SWMI |
$373.46
|
| Rate for Payer: PHP Medicare Advantage |
$373.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$241.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$838.19
|
| Rate for Payer: Priority Health Medicare |
$373.46
|
| Rate for Payer: Priority Health SBD |
$838.19
|
| Rate for Payer: Priority Health Tiered Network |
$838.19
|
| Rate for Payer: Railroad Medicare Medicare |
$373.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.24
|
| Rate for Payer: UHC Core |
$737.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$373.46
|
| Rate for Payer: UHC Exchange |
$737.24
|
| Rate for Payer: UHC Medicaid |
$241.12
|
| Rate for Payer: UHCCP Medicaid |
$241.12
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 38510
|
| Hospital Charge Code |
38510
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,023.12 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$1,380.40
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,985.47
|
| Rate for Payer: BCN Commercial |
$2,985.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cofinity Advantage |
$1,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,396.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,299.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$1,461.60
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,380.40
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,218.00
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$1,380.40
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$1,023.12
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR BX/EXC LYMPH NODE OPEN INT MAMMARY NODE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 38530
|
| Min. Negotiated Rate |
$338.46 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$697.60
|
| Rate for Payer: Aetna Medicare |
$541.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$749.66
|
| Rate for Payer: BCBS Complete |
$355.38
|
| Rate for Payer: BCBS MAPPO |
$520.60
|
| Rate for Payer: BCN Commercial |
$862.00
|
| Rate for Payer: BCN Medicare Advantage |
$520.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$749.66
|
| Rate for Payer: Cofinity Commercial |
$697.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$520.60
|
| Rate for Payer: Healthscope Commercial |
$963.11
|
| Rate for Payer: Healthscope Commercial |
$832.96
|
| Rate for Payer: Mclaren Medicaid |
$338.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$546.63
|
| Rate for Payer: Meridian Medicaid |
$355.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$572.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,000.84
|
| Rate for Payer: Nomi Health Commercial |
$624.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$520.60
|
| Rate for Payer: PHP Medicare Advantage |
$520.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,146.97
|
| Rate for Payer: Priority Health Medicare |
$520.60
|
| Rate for Payer: Priority Health SBD |
$1,146.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,146.97
|
| Rate for Payer: Railroad Medicare Medicare |
$520.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.57
|
| Rate for Payer: UHC Core |
$992.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$520.60
|
| Rate for Payer: UHC Exchange |
$992.57
|
| Rate for Payer: UHC Medicaid |
$338.46
|
| Rate for Payer: UHCCP Medicaid |
$338.46
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 38500
|
| Hospital Charge Code |
38500
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$323.45
|
| Rate for Payer: Aetna Medicare |
$251.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.59
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$241.38
|
| Rate for Payer: BCN Commercial |
$384.94
|
| Rate for Payer: BCN Medicare Advantage |
$241.38
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$323.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.38
|
| Rate for Payer: Healthscope Commercial |
$446.55
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.45
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.63
|
| Rate for Payer: Nomi Health Commercial |
$289.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PACE SWMI |
$241.38
|
| Rate for Payer: PHP Medicare Advantage |
$241.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$241.38
|
| Rate for Payer: Priority Health SBD |
$512.20
|
| Rate for Payer: Priority Health Tiered Network |
$512.20
|
| Rate for Payer: Railroad Medicare Medicare |
$241.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.82
|
| Rate for Payer: UHC Core |
$448.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$241.38
|
| Rate for Payer: UHC Exchange |
$448.82
|
| Rate for Payer: UHC Medicaid |
$156.56
|
| Rate for Payer: UHCCP Medicaid |
$156.56
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 38500
|
| Min. Negotiated Rate |
$156.56 |
| Max. Negotiated Rate |
$731.25 |
| Rate for Payer: Aetna Commercial |
$323.45
|
| Rate for Payer: Aetna Medicare |
$251.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.59
|
| Rate for Payer: BCBS Complete |
$164.39
|
| Rate for Payer: BCBS MAPPO |
$241.38
|
| Rate for Payer: BCN Commercial |
$384.94
|
| Rate for Payer: BCN Medicare Advantage |
$241.38
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$323.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.38
|
| Rate for Payer: Healthscope Commercial |
$446.55
|
| Rate for Payer: Healthscope Commercial |
$386.21
|
| Rate for Payer: Mclaren Medicaid |
$156.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.45
|
| Rate for Payer: Meridian Medicaid |
$164.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$454.63
|
| Rate for Payer: Nomi Health Commercial |
$289.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PACE SWMI |
$241.38
|
| Rate for Payer: PHP Medicare Advantage |
$241.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$512.20
|
| Rate for Payer: Priority Health Medicare |
$241.38
|
| Rate for Payer: Priority Health SBD |
$512.20
|
| Rate for Payer: Priority Health Tiered Network |
$512.20
|
| Rate for Payer: Railroad Medicare Medicare |
$241.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$448.82
|
| Rate for Payer: UHC Core |
$448.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$241.38
|
| Rate for Payer: UHC Exchange |
$448.82
|
| Rate for Payer: UHC Medicaid |
$156.56
|
| Rate for Payer: UHCCP Medicaid |
$156.56
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Aetna Commercial |
$828.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.75
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Advantage |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$838.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.00
|
| Rate for Payer: Healthscope Commercial |
$877.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PHP Commercial |
$828.75
|
| Rate for Payer: Priority Health SBD |
$614.25
|
|
|
PR BX/EXC LYMPH NODE OPEN SUPERFICIAL
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT 38500
|
| Hospital Charge Code |
38500
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$614.25 |
| Max. Negotiated Rate |
$12,616.62 |
| Rate for Payer: Aetna Commercial |
$828.75
|
| Rate for Payer: Aetna Medicare |
$4,057.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,876.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,876.69
|
| Rate for Payer: BCBS Complete |
$2,142.62
|
| Rate for Payer: BCBS MAPPO |
$3,901.35
|
| Rate for Payer: BCBS Trust/PPO |
$2,377.78
|
| Rate for Payer: BCN Commercial |
$2,377.78
|
| Rate for Payer: BCN Medicare Advantage |
$3,901.35
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Advantage |
$682.50
|
| Rate for Payer: Cofinity Commercial |
$838.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$780.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,901.35
|
| Rate for Payer: Healthscope Commercial |
$877.50
|
| Rate for Payer: Mclaren Medicaid |
$2,040.41
|
| Rate for Payer: Mclaren Medicare |
$3,901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,096.42
|
| Rate for Payer: Meridian Medicaid |
$4,096.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,486.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4,291.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.75
|
| Rate for Payer: Nomi Health Commercial |
$11,704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$731.25
|
| Rate for Payer: PACE Medicare |
$3,706.28
|
| Rate for Payer: PACE SWMI |
$3,901.35
|
| Rate for Payer: PHP Commercial |
$828.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,901.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,040.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,616.62
|
| Rate for Payer: Priority Health Medicare |
$3,901.35
|
| Rate for Payer: Priority Health SBD |
$614.25
|
| Rate for Payer: Priority Health Tiered Network |
$10,093.30
|
| Rate for Payer: Railroad Medicare Medicare |
$3,901.35
|
| Rate for Payer: UHC Medicaid |
$2,040.41
|
| Rate for Payer: UHCCP Medicaid |
$2,040.41
|
| Rate for Payer: VA VA |
$3,901.35
|
|
|
PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD
|
Professional
|
Both
|
$1,902.00
|
|
|
Service Code
|
HCPCS 38520
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Aetna Commercial |
$580.47
|
| Rate for Payer: Aetna Medicare |
$450.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.79
|
| Rate for Payer: BCBS Complete |
$295.22
|
| Rate for Payer: BCBS MAPPO |
$433.19
|
| Rate for Payer: BCN Commercial |
$709.63
|
| Rate for Payer: BCN Medicare Advantage |
$433.19
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cofinity Commercial |
$623.79
|
| Rate for Payer: Cofinity Commercial |
$580.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.19
|
| Rate for Payer: Healthscope Commercial |
$801.40
|
| Rate for Payer: Healthscope Commercial |
$693.10
|
| Rate for Payer: Mclaren Medicaid |
$281.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$454.85
|
| Rate for Payer: Meridian Medicaid |
$295.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$476.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$832.37
|
| Rate for Payer: Nomi Health Commercial |
$519.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,426.50
|
| Rate for Payer: PACE SWMI |
$433.19
|
| Rate for Payer: PHP Medicare Advantage |
$433.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$944.21
|
| Rate for Payer: Priority Health Medicare |
$433.19
|
| Rate for Payer: Priority Health SBD |
$944.21
|
| Rate for Payer: Priority Health Tiered Network |
$944.21
|
| Rate for Payer: Railroad Medicare Medicare |
$433.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$817.31
|
| Rate for Payer: UHC Core |
$817.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$433.19
|
| Rate for Payer: UHC Exchange |
$817.31
|
| Rate for Payer: UHC Medicaid |
$281.16
|
| Rate for Payer: UHCCP Medicaid |
$281.16
|
|
|
PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 44100
|
| Min. Negotiated Rate |
$58.36 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Commercial |
$121.63
|
| Rate for Payer: Aetna Medicare |
$94.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.71
|
| Rate for Payer: BCBS Complete |
$61.28
|
| Rate for Payer: BCBS MAPPO |
$90.77
|
| Rate for Payer: BCN Commercial |
$156.37
|
| Rate for Payer: BCN Medicare Advantage |
$90.77
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$130.71
|
| Rate for Payer: Cofinity Commercial |
$121.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.77
|
| Rate for Payer: Healthscope Commercial |
$167.92
|
| Rate for Payer: Healthscope Commercial |
$145.23
|
| Rate for Payer: Mclaren Medicaid |
$58.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.31
|
| Rate for Payer: Meridian Medicaid |
$61.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.16
|
| Rate for Payer: Nomi Health Commercial |
$108.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PACE SWMI |
$90.77
|
| Rate for Payer: PHP Medicare Advantage |
$90.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.53
|
| Rate for Payer: Priority Health Medicare |
$90.77
|
| Rate for Payer: Priority Health SBD |
$190.53
|
| Rate for Payer: Priority Health Tiered Network |
$190.53
|
| Rate for Payer: Railroad Medicare Medicare |
$90.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.58
|
| Rate for Payer: UHC Core |
$190.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$90.77
|
| Rate for Payer: UHC Exchange |
$190.58
|
| Rate for Payer: UHC Medicaid |
$58.36
|
| Rate for Payer: UHCCP Medicaid |
$58.36
|
|
|
PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 47001
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$124.94
|
| Rate for Payer: Aetna Medicare |
$96.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.27
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS MAPPO |
$93.24
|
| Rate for Payer: BCN Commercial |
$154.87
|
| Rate for Payer: BCN Medicare Advantage |
$93.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$134.27
|
| Rate for Payer: Cofinity Commercial |
$124.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.24
|
| Rate for Payer: Healthscope Commercial |
$172.49
|
| Rate for Payer: Healthscope Commercial |
$149.18
|
| Rate for Payer: Mclaren Medicaid |
$59.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.90
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.54
|
| Rate for Payer: Nomi Health Commercial |
$111.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.25
|
| Rate for Payer: PACE SWMI |
$93.24
|
| Rate for Payer: PHP Medicare Advantage |
$93.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$188.71
|
| Rate for Payer: Priority Health Medicare |
$93.24
|
| Rate for Payer: Priority Health SBD |
$188.71
|
| Rate for Payer: Priority Health Tiered Network |
$188.71
|
| Rate for Payer: Railroad Medicare Medicare |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.24
|
| Rate for Payer: UHC Core |
$187.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.24
|
| Rate for Payer: UHC Exchange |
$187.24
|
| Rate for Payer: UHC Medicaid |
$59.00
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
|
|
PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 42806
|
| Min. Negotiated Rate |
$82.01 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$165.64
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.00
|
| Rate for Payer: BCBS Complete |
$86.11
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCN Commercial |
$214.13
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$178.00
|
| Rate for Payer: Cofinity Commercial |
$165.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$228.68
|
| Rate for Payer: Healthscope Commercial |
$197.78
|
| Rate for Payer: Mclaren Medicaid |
$82.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Meridian Medicaid |
$86.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.32
|
| Rate for Payer: Nomi Health Commercial |
$148.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.00
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$260.91
|
| Rate for Payer: Priority Health Medicare |
$123.61
|
| Rate for Payer: Priority Health SBD |
$260.91
|
| Rate for Payer: Priority Health Tiered Network |
$260.91
|
| Rate for Payer: Railroad Medicare Medicare |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.83
|
| Rate for Payer: UHC Core |
$228.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$123.61
|
| Rate for Payer: UHC Exchange |
$228.83
|
| Rate for Payer: UHC Medicaid |
$82.01
|
| Rate for Payer: UHCCP Medicaid |
$82.01
|
|
|
PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 19102
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna Medicare |
$213.00
|
| Rate for Payer: BCBS Complete |
$170.40
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.50
|
|
|
PR BX PROSTATE EA ADDL MRI-US FUSION/IN-BORE CT/MRI
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 55715
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$87.37 |
| Rate for Payer: Aetna Commercial |
$63.06
|
| Rate for Payer: Aetna Medicare |
$48.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.77
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$47.06
|
| Rate for Payer: BCN Medicare Advantage |
$47.06
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$67.77
|
| Rate for Payer: Cofinity Commercial |
$63.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.06
|
| Rate for Payer: Healthscope Commercial |
$87.06
|
| Rate for Payer: Healthscope Commercial |
$75.30
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.41
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.45
|
| Rate for Payer: Nomi Health Commercial |
$56.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.75
|
| Rate for Payer: PACE SWMI |
$47.06
|
| Rate for Payer: PHP Medicare Advantage |
$47.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.44
|
| Rate for Payer: Priority Health Medicare |
$47.06
|
| Rate for Payer: Priority Health SBD |
$69.44
|
| Rate for Payer: Priority Health Tiered Network |
$69.44
|
| Rate for Payer: Railroad Medicare Medicare |
$47.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.37
|
| Rate for Payer: UHC Core |
$87.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.06
|
| Rate for Payer: UHC Exchange |
$87.37
|
| Rate for Payer: UHC Medicaid |
$30.03
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
PR BX PROSTATE TRANSRECTAL MRI-US GID TRGT LES 1ST
|
Professional
|
Both
|
$879.00
|
|
|
Service Code
|
HCPCS 55711
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Aetna Commercial |
$179.45
|
| Rate for Payer: Aetna Medicare |
$139.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.84
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$133.92
|
| Rate for Payer: BCN Medicare Advantage |
$133.92
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cash Price |
$703.20
|
| Rate for Payer: Cofinity Commercial |
$192.84
|
| Rate for Payer: Cofinity Commercial |
$179.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.92
|
| Rate for Payer: Healthscope Commercial |
$247.75
|
| Rate for Payer: Healthscope Commercial |
$214.27
|
| Rate for Payer: Mclaren Medicaid |
$86.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.62
|
| Rate for Payer: Meridian Medicaid |
$90.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$571.35
|
| Rate for Payer: Nomi Health Commercial |
$160.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$659.25
|
| Rate for Payer: PACE SWMI |
$133.92
|
| Rate for Payer: PHP Medicare Advantage |
$133.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$199.95
|
| Rate for Payer: Priority Health Medicare |
$133.92
|
| Rate for Payer: Priority Health SBD |
$199.95
|
| Rate for Payer: Priority Health Tiered Network |
$199.95
|
| Rate for Payer: Railroad Medicare Medicare |
$133.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.06
|
| Rate for Payer: UHC Core |
$249.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$133.92
|
| Rate for Payer: UHC Exchange |
$249.06
|
| Rate for Payer: UHC Medicaid |
$86.48
|
| Rate for Payer: UHCCP Medicaid |
$86.48
|
|
|
PR BX PROSTATE TRANSRECTAL US GID W/MRI FUS GDN 1ST
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 55708
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$312.24 |
| Rate for Payer: Aetna Commercial |
$224.95
|
| Rate for Payer: Aetna Medicare |
$174.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.73
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$167.87
|
| Rate for Payer: BCN Medicare Advantage |
$167.87
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$241.73
|
| Rate for Payer: Cofinity Commercial |
$224.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.87
|
| Rate for Payer: Healthscope Commercial |
$310.56
|
| Rate for Payer: Healthscope Commercial |
$268.59
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.26
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.90
|
| Rate for Payer: Nomi Health Commercial |
$201.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.50
|
| Rate for Payer: PACE SWMI |
$167.87
|
| Rate for Payer: PHP Medicare Advantage |
$167.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$250.18
|
| Rate for Payer: Priority Health Medicare |
$167.87
|
| Rate for Payer: Priority Health SBD |
$250.18
|
| Rate for Payer: Priority Health Tiered Network |
$250.18
|
| Rate for Payer: Railroad Medicare Medicare |
$167.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.24
|
| Rate for Payer: UHC Core |
$312.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.87
|
| Rate for Payer: UHC Exchange |
$312.24
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PR BX PRST8 NDL STRTCTC SATURATION SAMPLING IMG GID
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 55706
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$659.36 |
| Rate for Payer: Aetna Commercial |
$270.18
|
| Rate for Payer: Aetna Medicare |
$209.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.35
|
| Rate for Payer: BCBS Complete |
$136.21
|
| Rate for Payer: BCBS MAPPO |
$201.63
|
| Rate for Payer: BCN Commercial |
$565.70
|
| Rate for Payer: BCN Medicare Advantage |
$201.63
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$290.35
|
| Rate for Payer: Cofinity Commercial |
$270.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.63
|
| Rate for Payer: Healthscope Commercial |
$373.02
|
| Rate for Payer: Healthscope Commercial |
$322.61
|
| Rate for Payer: Mclaren Medicaid |
$129.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$211.71
|
| Rate for Payer: Meridian Medicaid |
$136.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$221.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$659.36
|
| Rate for Payer: Nomi Health Commercial |
$241.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.00
|
| Rate for Payer: PACE SWMI |
$201.63
|
| Rate for Payer: PHP Medicare Advantage |
$201.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$616.24
|
| Rate for Payer: Priority Health Medicare |
$201.63
|
| Rate for Payer: Priority Health SBD |
$616.24
|
| Rate for Payer: Priority Health Tiered Network |
$616.24
|
| Rate for Payer: Railroad Medicare Medicare |
$201.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$654.73
|
| Rate for Payer: UHC Core |
$654.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$201.63
|
| Rate for Payer: UHC Exchange |
$654.73
|
| Rate for Payer: UHC Medicaid |
$129.72
|
| Rate for Payer: UHCCP Medicaid |
$129.72
|
|
|
PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 35681
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Aetna Medicare |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.79
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$72.98
|
| Rate for Payer: BCN Commercial |
$115.53
|
| Rate for Payer: BCN Medicare Advantage |
$72.98
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$97.79
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.98
|
| Rate for Payer: Healthscope Commercial |
$135.01
|
| Rate for Payer: Healthscope Commercial |
$116.77
|
| Rate for Payer: Mclaren Medicaid |
$45.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.63
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.43
|
| Rate for Payer: Nomi Health Commercial |
$87.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.25
|
| Rate for Payer: PACE SWMI |
$72.98
|
| Rate for Payer: PHP Medicare Advantage |
$72.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$124.23
|
| Rate for Payer: Priority Health Medicare |
$72.98
|
| Rate for Payer: Priority Health SBD |
$124.23
|
| Rate for Payer: Priority Health Tiered Network |
$124.23
|
| Rate for Payer: Railroad Medicare Medicare |
$72.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.14
|
| Rate for Payer: UHC Core |
$146.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.98
|
| Rate for Payer: UHC Exchange |
$146.14
|
| Rate for Payer: UHC Medicaid |
$45.80
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC
|
Professional
|
Both
|
$3,404.00
|
|
|
Service Code
|
HCPCS 35632
|
| Min. Negotiated Rate |
$1,046.26 |
| Max. Negotiated Rate |
$3,256.44 |
| Rate for Payer: Aetna Commercial |
$2,231.49
|
| Rate for Payer: Aetna Medicare |
$1,731.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,231.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,398.02
|
| Rate for Payer: BCBS Complete |
$1,098.57
|
| Rate for Payer: BCBS MAPPO |
$1,665.29
|
| Rate for Payer: BCN Commercial |
$2,638.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,665.29
|
| Rate for Payer: Cash Price |
$2,723.20
|
| Rate for Payer: Cash Price |
$2,723.20
|
| Rate for Payer: Cofinity Commercial |
$2,398.02
|
| Rate for Payer: Cofinity Commercial |
$2,231.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,665.29
|
| Rate for Payer: Healthscope Commercial |
$3,080.79
|
| Rate for Payer: Healthscope Commercial |
$2,664.46
|
| Rate for Payer: Mclaren Medicaid |
$1,046.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,748.55
|
| Rate for Payer: Meridian Medicaid |
$1,098.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,831.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,208.75
|
| Rate for Payer: Nomi Health Commercial |
$1,998.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,553.00
|
| Rate for Payer: PACE SWMI |
$1,665.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,665.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,837.17
|
| Rate for Payer: Priority Health Medicare |
$1,665.29
|
| Rate for Payer: Priority Health SBD |
$2,837.17
|
| Rate for Payer: Priority Health Tiered Network |
$2,837.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,665.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,256.44
|
| Rate for Payer: UHC Core |
$3,256.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,665.29
|
| Rate for Payer: UHC Exchange |
$3,256.44
|
| Rate for Payer: UHC Medicaid |
$1,046.26
|
| Rate for Payer: UHCCP Medicaid |
$1,046.26
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC
|
Professional
|
Both
|
$3,813.00
|
|
|
Service Code
|
HCPCS 35633
|
| Min. Negotiated Rate |
$1,149.35 |
| Max. Negotiated Rate |
$3,571.23 |
| Rate for Payer: Aetna Commercial |
$2,447.43
|
| Rate for Payer: Aetna Medicare |
$1,899.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,447.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,630.07
|
| Rate for Payer: BCBS Complete |
$1,206.82
|
| Rate for Payer: BCBS MAPPO |
$1,826.44
|
| Rate for Payer: BCN Commercial |
$2,883.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,826.44
|
| Rate for Payer: Cash Price |
$3,050.40
|
| Rate for Payer: Cash Price |
$3,050.40
|
| Rate for Payer: Cofinity Commercial |
$2,630.07
|
| Rate for Payer: Cofinity Commercial |
$2,447.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,826.44
|
| Rate for Payer: Healthscope Commercial |
$3,378.91
|
| Rate for Payer: Healthscope Commercial |
$2,922.30
|
| Rate for Payer: Mclaren Medicaid |
$1,149.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,917.76
|
| Rate for Payer: Meridian Medicaid |
$1,206.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,009.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,519.41
|
| Rate for Payer: Nomi Health Commercial |
$2,191.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,859.75
|
| Rate for Payer: PACE SWMI |
$1,826.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,826.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,149.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,101.18
|
| Rate for Payer: Priority Health Medicare |
$1,826.44
|
| Rate for Payer: Priority Health SBD |
$3,101.18
|
| Rate for Payer: Priority Health Tiered Network |
$3,101.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,826.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,571.23
|
| Rate for Payer: UHC Core |
$3,571.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,826.44
|
| Rate for Payer: UHC Exchange |
$3,571.23
|
| Rate for Payer: UHC Medicaid |
$1,149.35
|
| Rate for Payer: UHCCP Medicaid |
$1,149.35
|
|
|
PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL
|
Professional
|
Both
|
$3,329.00
|
|
|
Service Code
|
HCPCS 35634
|
| Min. Negotiated Rate |
$1,024.10 |
| Max. Negotiated Rate |
$3,186.78 |
| Rate for Payer: Aetna Commercial |
$2,184.03
|
| Rate for Payer: Aetna Medicare |
$1,695.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,184.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,347.01
|
| Rate for Payer: BCBS Complete |
$1,075.31
|
| Rate for Payer: BCBS MAPPO |
$1,629.87
|
| Rate for Payer: BCN Commercial |
$2,582.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,629.87
|
| Rate for Payer: Cash Price |
$2,663.20
|
| Rate for Payer: Cash Price |
$2,663.20
|
| Rate for Payer: Cofinity Commercial |
$2,347.01
|
| Rate for Payer: Cofinity Commercial |
$2,184.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,629.87
|
| Rate for Payer: Healthscope Commercial |
$3,015.26
|
| Rate for Payer: Healthscope Commercial |
$2,607.79
|
| Rate for Payer: Mclaren Medicaid |
$1,024.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,711.36
|
| Rate for Payer: Meridian Medicaid |
$1,075.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,792.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,140.82
|
| Rate for Payer: Nomi Health Commercial |
$1,955.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,496.75
|
| Rate for Payer: PACE SWMI |
$1,629.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,629.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,024.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,776.65
|
| Rate for Payer: Priority Health Medicare |
$1,629.87
|
| Rate for Payer: Priority Health SBD |
$2,776.65
|
| Rate for Payer: Priority Health Tiered Network |
$2,776.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,629.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,186.78
|
| Rate for Payer: UHC Core |
$3,186.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,629.87
|
| Rate for Payer: UHC Exchange |
$3,186.78
|
| Rate for Payer: UHC Medicaid |
$1,024.10
|
| Rate for Payer: UHCCP Medicaid |
$1,024.10
|
|
