|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$5,240.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$356,477.00 |
| Rate for Payer: Aetna Commercial |
$2,578.79
|
| Rate for Payer: Aetna Medicare |
$2,001.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,578.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,771.24
|
| Rate for Payer: BCBS Complete |
$1,349.06
|
| Rate for Payer: BCBS MAPPO |
$1,924.47
|
| Rate for Payer: BCBS Trust/PPO |
$131.55
|
| Rate for Payer: BCN Commercial |
$2,921.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,924.47
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cash Price |
$4,192.00
|
| Rate for Payer: Cofinity Commercial |
$2,771.24
|
| Rate for Payer: Cofinity Commercial |
$2,578.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,924.47
|
| Rate for Payer: Healthscope Commercial |
$3,560.27
|
| Rate for Payer: Healthscope Commercial |
$3,079.15
|
| Rate for Payer: Mclaren Medicaid |
$1,284.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,020.69
|
| Rate for Payer: Meridian Medicaid |
$1,349.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356,477.00
|
| Rate for Payer: Nomi Health Commercial |
$2,309.36
|
| Rate for Payer: PACE SWMI |
$1,924.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,924.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,284.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,406.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,990.17
|
| Rate for Payer: Priority Health Medicare |
$1,924.47
|
| Rate for Payer: Priority Health Narrow Network |
$2,990.17
|
| Rate for Payer: Priority Health SBD |
$2,990.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,167.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,924.47
|
| Rate for Payer: UHC Exchange |
$2,167.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,924.47
|
| Rate for Payer: UHCCP Medicaid |
$1,284.82
|
|
|
PR BSO W/TOT OMENTECTOMY & HYSTERECTOMY MALIGNANC
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 58956
|
| Min. Negotiated Rate |
$502.94 |
| Max. Negotiated Rate |
$242,068.00 |
| Rate for Payer: Aetna Commercial |
$1,753.00
|
| Rate for Payer: Aetna Medicare |
$1,360.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,753.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.82
|
| Rate for Payer: BCBS Complete |
$918.31
|
| Rate for Payer: BCBS MAPPO |
$1,308.21
|
| Rate for Payer: BCBS Trust/PPO |
$502.94
|
| Rate for Payer: BCN Commercial |
$1,986.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.21
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$1,883.82
|
| Rate for Payer: Cofinity Commercial |
$1,753.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.21
|
| Rate for Payer: Healthscope Commercial |
$2,420.19
|
| Rate for Payer: Healthscope Commercial |
$2,093.14
|
| Rate for Payer: Mclaren Medicaid |
$874.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.62
|
| Rate for Payer: Meridian Medicaid |
$918.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242,068.00
|
| Rate for Payer: Nomi Health Commercial |
$1,569.85
|
| Rate for Payer: PACE SWMI |
$1,308.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,579.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,035.29
|
| Rate for Payer: Priority Health Medicare |
$1,308.21
|
| Rate for Payer: Priority Health Narrow Network |
$2,035.29
|
| Rate for Payer: Priority Health SBD |
$2,035.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,586.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.21
|
| Rate for Payer: UHC Exchange |
$1,586.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.21
|
| Rate for Payer: UHCCP Medicaid |
$874.58
|
|
|
PR BUDESONIDE NON-COMP UNIT
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J7626
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.84
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS MAPPO |
$1.28
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Medicare Advantage |
$1.28
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cofinity Commercial |
$1.84
|
| Rate for Payer: Cofinity Commercial |
$1.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.28
|
| Rate for Payer: Healthscope Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.00
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: PACE SWMI |
$1.28
|
| Rate for Payer: PHP Medicare Advantage |
$1.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.85
|
| Rate for Payer: Priority Health Medicare |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.28
|
| Rate for Payer: UHC Exchange |
$1.49
|
| Rate for Payer: UHC Medicare Advantage |
$1.28
|
|
|
PR BURR HOLE FOR VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$1,871.00
|
|
|
Service Code
|
HCPCS 61120
|
| Min. Negotiated Rate |
$493.73 |
| Max. Negotiated Rate |
$135,590.00 |
| Rate for Payer: Aetna Commercial |
$997.19
|
| Rate for Payer: Aetna Medicare |
$773.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,071.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.19
|
| Rate for Payer: BCBS Complete |
$518.42
|
| Rate for Payer: BCBS MAPPO |
$744.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,670.48
|
| Rate for Payer: BCN Commercial |
$1,112.23
|
| Rate for Payer: BCN Medicare Advantage |
$744.17
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cash Price |
$1,496.80
|
| Rate for Payer: Cofinity Commercial |
$997.19
|
| Rate for Payer: Cofinity Commercial |
$1,071.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.17
|
| Rate for Payer: Healthscope Commercial |
$1,376.71
|
| Rate for Payer: Healthscope Commercial |
$1,190.67
|
| Rate for Payer: Mclaren Medicaid |
$493.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.38
|
| Rate for Payer: Meridian Medicaid |
$518.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135,590.00
|
| Rate for Payer: Nomi Health Commercial |
$893.00
|
| Rate for Payer: PACE SWMI |
$744.17
|
| Rate for Payer: PHP Medicare Advantage |
$744.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$493.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,216.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,309.75
|
| Rate for Payer: Priority Health Medicare |
$744.17
|
| Rate for Payer: Priority Health Narrow Network |
$1,309.75
|
| Rate for Payer: Priority Health SBD |
$1,309.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.17
|
| Rate for Payer: UHC Exchange |
$750.00
|
| Rate for Payer: UHC Medicare Advantage |
$744.17
|
| Rate for Payer: UHCCP Medicaid |
$493.73
|
|
|
PR BURR HOLE IMPLANT VENTRICULAR CATH/OTHER DEVICE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 61210
|
| Min. Negotiated Rate |
$235.79 |
| Max. Negotiated Rate |
$66,600.00 |
| Rate for Payer: Aetna Commercial |
$486.63
|
| Rate for Payer: Aetna Medicare |
$377.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.95
|
| Rate for Payer: BCBS Complete |
$247.58
|
| Rate for Payer: BCBS MAPPO |
$363.16
|
| Rate for Payer: BCBS Trust/PPO |
$324.90
|
| Rate for Payer: BCN Commercial |
$745.05
|
| Rate for Payer: BCN Medicare Advantage |
$363.16
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$522.95
|
| Rate for Payer: Cofinity Commercial |
$486.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.16
|
| Rate for Payer: Healthscope Commercial |
$671.85
|
| Rate for Payer: Healthscope Commercial |
$581.06
|
| Rate for Payer: Mclaren Medicaid |
$235.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.32
|
| Rate for Payer: Meridian Medicaid |
$247.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66,600.00
|
| Rate for Payer: Nomi Health Commercial |
$435.79
|
| Rate for Payer: PACE SWMI |
$363.16
|
| Rate for Payer: PHP Medicare Advantage |
$363.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.29
|
| Rate for Payer: Priority Health Medicare |
$363.16
|
| Rate for Payer: Priority Health Narrow Network |
$627.29
|
| Rate for Payer: Priority Health SBD |
$627.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$535.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.16
|
| Rate for Payer: UHC Exchange |
$535.15
|
| Rate for Payer: UHC Medicare Advantage |
$363.16
|
| Rate for Payer: UHCCP Medicaid |
$235.79
|
|
|
PR BURR HOLE/TREPHINE STTL EXPL N/FLWD OTH SURG
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 61250
|
| Min. Negotiated Rate |
$570.41 |
| Max. Negotiated Rate |
$157,415.00 |
| Rate for Payer: Aetna Commercial |
$1,155.60
|
| Rate for Payer: Aetna Medicare |
$896.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.84
|
| Rate for Payer: BCBS Complete |
$598.93
|
| Rate for Payer: BCBS MAPPO |
$862.39
|
| Rate for Payer: BCBS Trust/PPO |
$918.19
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: BCN Medicare Advantage |
$862.39
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,241.84
|
| Rate for Payer: Cofinity Commercial |
$1,155.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.39
|
| Rate for Payer: Healthscope Commercial |
$1,595.42
|
| Rate for Payer: Healthscope Commercial |
$1,379.82
|
| Rate for Payer: Mclaren Medicaid |
$570.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.51
|
| Rate for Payer: Meridian Medicaid |
$598.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,415.00
|
| Rate for Payer: Nomi Health Commercial |
$1,034.87
|
| Rate for Payer: PACE SWMI |
$862.39
|
| Rate for Payer: PHP Medicare Advantage |
$862.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,512.79
|
| Rate for Payer: Priority Health Medicare |
$862.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,512.79
|
| Rate for Payer: Priority Health SBD |
$1,512.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.39
|
| Rate for Payer: UHC Exchange |
$963.00
|
| Rate for Payer: UHC Medicare Advantage |
$862.39
|
| Rate for Payer: UHCCP Medicaid |
$570.41
|
|
|
PR BURR HOLE/TREPHINE W/BX BRAIN/INTRACRNIAL LESION
|
Professional
|
Both
|
$4,613.00
|
|
|
Service Code
|
HCPCS 61140
|
| Min. Negotiated Rate |
$832.83 |
| Max. Negotiated Rate |
$229,811.00 |
| Rate for Payer: Aetna Commercial |
$1,690.46
|
| Rate for Payer: Aetna Medicare |
$1,312.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,690.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,816.62
|
| Rate for Payer: BCBS Complete |
$874.47
|
| Rate for Payer: BCBS MAPPO |
$1,261.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.79
|
| Rate for Payer: BCN Commercial |
$2,604.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,261.54
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cash Price |
$3,690.40
|
| Rate for Payer: Cofinity Commercial |
$1,816.62
|
| Rate for Payer: Cofinity Commercial |
$1,690.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,261.54
|
| Rate for Payer: Healthscope Commercial |
$2,333.85
|
| Rate for Payer: Healthscope Commercial |
$2,018.46
|
| Rate for Payer: Mclaren Medicaid |
$832.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,324.62
|
| Rate for Payer: Meridian Medicaid |
$874.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229,811.00
|
| Rate for Payer: Nomi Health Commercial |
$1,513.85
|
| Rate for Payer: PACE SWMI |
$1,261.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,261.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$832.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,998.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,213.44
|
| Rate for Payer: Priority Health Medicare |
$1,261.54
|
| Rate for Payer: Priority Health Narrow Network |
$2,213.44
|
| Rate for Payer: Priority Health SBD |
$2,213.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,526.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,261.54
|
| Rate for Payer: UHC Exchange |
$1,526.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,261.54
|
| Rate for Payer: UHCCP Medicaid |
$832.83
|
|
|
PR BURR HOLE/TREPHINE W/DRG BRAIN ABSCESS/CYST
|
Professional
|
Both
|
$4,121.00
|
|
|
Service Code
|
HCPCS 61150
|
| Min. Negotiated Rate |
$614.94 |
| Max. Negotiated Rate |
$244,901.00 |
| Rate for Payer: Aetna Commercial |
$1,798.49
|
| Rate for Payer: Aetna Medicare |
$1,395.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,798.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,932.71
|
| Rate for Payer: BCBS Complete |
$927.26
|
| Rate for Payer: BCBS MAPPO |
$1,342.16
|
| Rate for Payer: BCBS Trust/PPO |
$614.94
|
| Rate for Payer: BCN Commercial |
$2,768.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,342.16
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cash Price |
$3,296.80
|
| Rate for Payer: Cofinity Commercial |
$1,932.71
|
| Rate for Payer: Cofinity Commercial |
$1,798.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,342.16
|
| Rate for Payer: Healthscope Commercial |
$2,483.00
|
| Rate for Payer: Healthscope Commercial |
$2,147.46
|
| Rate for Payer: Mclaren Medicaid |
$883.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,409.27
|
| Rate for Payer: Meridian Medicaid |
$927.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244,901.00
|
| Rate for Payer: Nomi Health Commercial |
$1,610.59
|
| Rate for Payer: PACE SWMI |
$1,342.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,342.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$883.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,678.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,344.81
|
| Rate for Payer: Priority Health Medicare |
$1,342.16
|
| Rate for Payer: Priority Health Narrow Network |
$2,344.81
|
| Rate for Payer: Priority Health SBD |
$2,344.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,628.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,342.16
|
| Rate for Payer: UHC Exchange |
$1,628.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,342.16
|
| Rate for Payer: UHCCP Medicaid |
$883.10
|
|
|
PR BURR HOLE W/ASPIR HEMATOMA/CYST INTRACEREBRAL
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
HCPCS 61156
|
| Min. Negotiated Rate |
$284.75 |
| Max. Negotiated Rate |
$223,389.00 |
| Rate for Payer: Aetna Commercial |
$1,652.78
|
| Rate for Payer: Aetna Medicare |
$1,282.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,652.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,776.12
|
| Rate for Payer: BCBS Complete |
$851.89
|
| Rate for Payer: BCBS MAPPO |
$1,233.42
|
| Rate for Payer: BCBS Trust/PPO |
$284.75
|
| Rate for Payer: BCN Commercial |
$2,525.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,233.42
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cash Price |
$2,948.00
|
| Rate for Payer: Cofinity Commercial |
$1,776.12
|
| Rate for Payer: Cofinity Commercial |
$1,652.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,233.42
|
| Rate for Payer: Healthscope Commercial |
$2,281.83
|
| Rate for Payer: Healthscope Commercial |
$1,973.47
|
| Rate for Payer: Mclaren Medicaid |
$811.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,295.09
|
| Rate for Payer: Meridian Medicaid |
$851.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223,389.00
|
| Rate for Payer: Nomi Health Commercial |
$1,480.10
|
| Rate for Payer: PACE SWMI |
$1,233.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,233.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,395.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,152.58
|
| Rate for Payer: Priority Health Medicare |
$1,233.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,152.58
|
| Rate for Payer: Priority Health SBD |
$2,152.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,486.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,233.42
|
| Rate for Payer: UHC Exchange |
$1,486.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,233.42
|
| Rate for Payer: UHCCP Medicaid |
$811.32
|
|
|
PR BURR HOLE W/EVAC&/DRG HEMATOMA EXTRADURAL/SDRL
|
Professional
|
Both
|
$4,188.00
|
|
|
Service Code
|
HCPCS 61154
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$231,064.00 |
| Rate for Payer: Aetna Commercial |
$1,697.34
|
| Rate for Payer: Aetna Medicare |
$1,317.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,697.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,824.00
|
| Rate for Payer: BCBS Complete |
$879.16
|
| Rate for Payer: BCBS MAPPO |
$1,266.67
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$2,621.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.67
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cash Price |
$3,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$1,697.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.67
|
| Rate for Payer: Healthscope Commercial |
$2,343.34
|
| Rate for Payer: Healthscope Commercial |
$2,026.67
|
| Rate for Payer: Mclaren Medicaid |
$837.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,330.00
|
| Rate for Payer: Meridian Medicaid |
$879.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231,064.00
|
| Rate for Payer: Nomi Health Commercial |
$1,520.00
|
| Rate for Payer: PACE SWMI |
$1,266.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,722.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,224.24
|
| Rate for Payer: Priority Health Medicare |
$1,266.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,224.24
|
| Rate for Payer: Priority Health SBD |
$2,224.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,378.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,266.67
|
| Rate for Payer: UHC Exchange |
$1,378.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.67
|
| Rate for Payer: UHCCP Medicaid |
$837.30
|
|
|
PR BUTORPHANOL TARTRATE 1 MG
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0595
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: Aetna Commercial |
$6.77
|
| Rate for Payer: Aetna Medicare |
$5.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.28
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$5.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.72
|
| Rate for Payer: BCN Commercial |
$0.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$6.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.05
|
| Rate for Payer: Healthscope Commercial |
$8.08
|
| Rate for Payer: Healthscope Commercial |
$9.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.00
|
| Rate for Payer: Nomi Health Commercial |
$6.06
|
| Rate for Payer: PACE SWMI |
$5.05
|
| Rate for Payer: PHP Medicare Advantage |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$5.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.05
|
| Rate for Payer: UHC Exchange |
$6.02
|
| Rate for Payer: UHC Medicare Advantage |
$5.05
|
|
|
PR BX ABDL/RETROPERITONEAL MASS PRQ NEEDLE
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 49180
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$14,735.00 |
| Rate for Payer: Aetna Commercial |
$104.95
|
| Rate for Payer: Aetna Medicare |
$81.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.95
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$78.32
|
| Rate for Payer: BCBS Trust/PPO |
$553.66
|
| Rate for Payer: BCN Commercial |
$256.56
|
| Rate for Payer: BCN Medicare Advantage |
$78.32
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$112.78
|
| Rate for Payer: Cofinity Commercial |
$104.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.32
|
| Rate for Payer: Healthscope Commercial |
$144.89
|
| Rate for Payer: Healthscope Commercial |
$125.31
|
| Rate for Payer: Mclaren Medicaid |
$51.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.24
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,735.00
|
| Rate for Payer: Nomi Health Commercial |
$93.98
|
| Rate for Payer: PACE SWMI |
$78.32
|
| Rate for Payer: PHP Medicare Advantage |
$78.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.38
|
| Rate for Payer: Priority Health Medicare |
$78.32
|
| Rate for Payer: Priority Health Narrow Network |
$144.38
|
| Rate for Payer: Priority Health SBD |
$144.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.32
|
| Rate for Payer: UHC Exchange |
$404.46
|
| Rate for Payer: UHC Medicare Advantage |
$78.32
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
PR BX ANORECTAL WALL ANAL APPROACH
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 45100
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$53,393.00 |
| Rate for Payer: Aetna Commercial |
$388.84
|
| Rate for Payer: Aetna Medicare |
$301.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.86
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS MAPPO |
$290.18
|
| Rate for Payer: BCBS Trust/PPO |
$534.64
|
| Rate for Payer: BCN Commercial |
$443.72
|
| Rate for Payer: BCN Medicare Advantage |
$290.18
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$417.86
|
| Rate for Payer: Cofinity Commercial |
$388.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.18
|
| Rate for Payer: Healthscope Commercial |
$536.83
|
| Rate for Payer: Healthscope Commercial |
$464.29
|
| Rate for Payer: Mclaren Medicaid |
$196.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.69
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53,393.00
|
| Rate for Payer: Nomi Health Commercial |
$348.22
|
| Rate for Payer: PACE SWMI |
$290.18
|
| Rate for Payer: PHP Medicare Advantage |
$290.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.67
|
| Rate for Payer: Priority Health Medicare |
$290.18
|
| Rate for Payer: Priority Health Narrow Network |
$547.67
|
| Rate for Payer: Priority Health SBD |
$547.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.18
|
| Rate for Payer: UHC Exchange |
$270.63
|
| Rate for Payer: UHC Medicare Advantage |
$290.18
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$74.59 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$392.15
|
| Rate for Payer: BCCCP Commercial |
$140.71
|
| Rate for Payer: BCN Commercial |
$392.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$188.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.59
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$893.75
|
| Rate for Payer: VA VA |
$1,587.48
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$269.10 |
| Rate for Payer: Aetna Commercial |
$254.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.35
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$209.30
|
| Rate for Payer: Cofinity Commercial |
$257.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.20
|
| Rate for Payer: Healthscope Commercial |
$269.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.15
|
| Rate for Payer: PHP Commercial |
$254.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health SBD |
$188.37
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Hospital Charge Code |
19100
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$12,382.00 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: Aetna Medicare |
$69.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.79
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS MAPPO |
$66.52
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: BCN Medicare Advantage |
$66.52
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$95.79
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.52
|
| Rate for Payer: Healthscope Commercial |
$123.06
|
| Rate for Payer: Healthscope Commercial |
$106.43
|
| Rate for Payer: Mclaren Medicaid |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.85
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,382.00
|
| Rate for Payer: Nomi Health Commercial |
$79.82
|
| Rate for Payer: PACE SWMI |
$66.52
|
| Rate for Payer: PHP Medicare Advantage |
$66.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.01
|
| Rate for Payer: Priority Health Medicare |
$66.52
|
| Rate for Payer: Priority Health Narrow Network |
$93.01
|
| Rate for Payer: Priority Health SBD |
$93.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.52
|
| Rate for Payer: UHC Exchange |
$140.10
|
| Rate for Payer: UHC Medicare Advantage |
$66.52
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
|
|
PR BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 19100
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$12,382.00 |
| Rate for Payer: Aetna Commercial |
$89.14
|
| Rate for Payer: Aetna Medicare |
$69.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.79
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCBS MAPPO |
$66.52
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$221.86
|
| Rate for Payer: BCN Medicare Advantage |
$66.52
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$95.79
|
| Rate for Payer: Cofinity Commercial |
$89.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.52
|
| Rate for Payer: Healthscope Commercial |
$123.06
|
| Rate for Payer: Healthscope Commercial |
$106.43
|
| Rate for Payer: Mclaren Medicaid |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.85
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,382.00
|
| Rate for Payer: Nomi Health Commercial |
$79.82
|
| Rate for Payer: PACE SWMI |
$66.52
|
| Rate for Payer: PHP Medicare Advantage |
$66.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.01
|
| Rate for Payer: Priority Health Medicare |
$66.52
|
| Rate for Payer: Priority Health Narrow Network |
$93.01
|
| Rate for Payer: Priority Health SBD |
$93.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.52
|
| Rate for Payer: UHC Exchange |
$140.10
|
| Rate for Payer: UHC Medicare Advantage |
$66.52
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
|
|
PR BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 19081
|
| Min. Negotiated Rate |
$102.67 |
| Max. Negotiated Rate |
$28,912.00 |
| Rate for Payer: Aetna Commercial |
$206.76
|
| Rate for Payer: Aetna Medicare |
$160.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.19
|
| Rate for Payer: BCBS Complete |
$107.80
|
| Rate for Payer: BCBS MAPPO |
$154.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,836.42
|
| Rate for Payer: BCN Commercial |
$741.81
|
| Rate for Payer: BCN Medicare Advantage |
$154.30
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$222.19
|
| Rate for Payer: Cofinity Commercial |
$206.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.30
|
| Rate for Payer: Healthscope Commercial |
$246.88
|
| Rate for Payer: Healthscope Commercial |
$285.46
|
| Rate for Payer: Mclaren Medicaid |
$102.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.02
|
| Rate for Payer: Meridian Medicaid |
$107.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,912.00
|
| Rate for Payer: Nomi Health Commercial |
$185.16
|
| Rate for Payer: PACE SWMI |
$154.30
|
| Rate for Payer: PHP Medicare Advantage |
$154.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.28
|
| Rate for Payer: Priority Health Medicare |
$154.30
|
| Rate for Payer: Priority Health Narrow Network |
$216.28
|
| Rate for Payer: Priority Health SBD |
$216.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.30
|
| Rate for Payer: UHC Medicare Advantage |
$154.30
|
| Rate for Payer: UHCCP Medicaid |
$102.67
|
|
|
PR BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 19083
|
| Min. Negotiated Rate |
$96.49 |
| Max. Negotiated Rate |
$27,167.00 |
| Rate for Payer: Aetna Commercial |
$194.25
|
| Rate for Payer: Aetna Medicare |
$150.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.74
|
| Rate for Payer: BCBS Complete |
$101.31
|
| Rate for Payer: BCBS MAPPO |
$144.96
|
| Rate for Payer: BCBS Trust/PPO |
$456.13
|
| Rate for Payer: BCN Commercial |
$741.81
|
| Rate for Payer: BCN Medicare Advantage |
$144.96
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$208.74
|
| Rate for Payer: Cofinity Commercial |
$194.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.96
|
| Rate for Payer: Healthscope Commercial |
$231.94
|
| Rate for Payer: Healthscope Commercial |
$268.18
|
| Rate for Payer: Mclaren Medicaid |
$96.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.21
|
| Rate for Payer: Meridian Medicaid |
$101.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,167.00
|
| Rate for Payer: Nomi Health Commercial |
$173.95
|
| Rate for Payer: PACE SWMI |
$144.96
|
| Rate for Payer: PHP Medicare Advantage |
$144.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.53
|
| Rate for Payer: Priority Health Medicare |
$144.96
|
| Rate for Payer: Priority Health Narrow Network |
$204.53
|
| Rate for Payer: Priority Health SBD |
$204.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.96
|
| Rate for Payer: UHC Medicare Advantage |
$144.96
|
| Rate for Payer: UHCCP Medicaid |
$96.49
|
|
|
PR BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 19084
|
| Min. Negotiated Rate |
$48.56 |
| Max. Negotiated Rate |
$13,738.00 |
| Rate for Payer: Aetna Commercial |
$97.82
|
| Rate for Payer: Aetna Medicare |
$75.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.82
|
| Rate for Payer: BCBS Complete |
$50.99
|
| Rate for Payer: BCBS MAPPO |
$73.00
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$566.87
|
| Rate for Payer: BCN Medicare Advantage |
$73.00
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Commercial |
$105.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.00
|
| Rate for Payer: Healthscope Commercial |
$116.80
|
| Rate for Payer: Healthscope Commercial |
$135.05
|
| Rate for Payer: Mclaren Medicaid |
$48.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.65
|
| Rate for Payer: Meridian Medicaid |
$50.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,738.00
|
| Rate for Payer: Nomi Health Commercial |
$87.60
|
| Rate for Payer: PACE SWMI |
$73.00
|
| Rate for Payer: PHP Medicare Advantage |
$73.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.04
|
| Rate for Payer: Priority Health Medicare |
$73.00
|
| Rate for Payer: Priority Health Narrow Network |
$102.04
|
| Rate for Payer: Priority Health SBD |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.00
|
| Rate for Payer: UHC Medicare Advantage |
$73.00
|
| Rate for Payer: UHCCP Medicaid |
$48.56
|
|
|
PR BX/EXC LYMPH NODE NEEDLE SUPERFICIAL
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 38505
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$15,149.00 |
| Rate for Payer: Aetna Commercial |
$108.65
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.76
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCBS Trust/PPO |
$656.16
|
| Rate for Payer: BCN Commercial |
$259.00
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$116.76
|
| Rate for Payer: Cofinity Commercial |
$108.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Healthscope Commercial |
$150.00
|
| Rate for Payer: Healthscope Commercial |
$129.73
|
| Rate for Payer: Mclaren Medicaid |
$54.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,149.00
|
| Rate for Payer: Nomi Health Commercial |
$97.30
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.44
|
| Rate for Payer: Priority Health Medicare |
$81.08
|
| Rate for Payer: Priority Health Narrow Network |
$168.44
|
| Rate for Payer: Priority Health SBD |
$168.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.08
|
| Rate for Payer: UHC Exchange |
$178.26
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$78,532.00 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.95
|
| Rate for Payer: BCBS Complete |
$300.36
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Healthscope Commercial |
$791.32
|
| Rate for Payer: Healthscope Commercial |
$684.38
|
| Rate for Payer: Mclaren Medicaid |
$286.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Meridian Medicaid |
$300.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,532.00
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.12
|
| Rate for Payer: Priority Health Medicare |
$427.74
|
| Rate for Payer: Priority Health Narrow Network |
$888.12
|
| Rate for Payer: Priority Health SBD |
$888.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Exchange |
$462.51
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
| Rate for Payer: UHCCP Medicaid |
$286.06
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
HCPCS 38525
|
| Hospital Charge Code |
38525
|
| Min. Negotiated Rate |
$286.06 |
| Max. Negotiated Rate |
$78,532.00 |
| Rate for Payer: Aetna Commercial |
$573.17
|
| Rate for Payer: Aetna Medicare |
$444.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.95
|
| Rate for Payer: BCBS Complete |
$300.36
|
| Rate for Payer: BCBS MAPPO |
$427.74
|
| Rate for Payer: BCBS Trust/PPO |
$486.04
|
| Rate for Payer: BCN Commercial |
$646.03
|
| Rate for Payer: BCN Medicare Advantage |
$427.74
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$615.95
|
| Rate for Payer: Cofinity Commercial |
$573.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$427.74
|
| Rate for Payer: Healthscope Commercial |
$791.32
|
| Rate for Payer: Healthscope Commercial |
$684.38
|
| Rate for Payer: Mclaren Medicaid |
$286.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.13
|
| Rate for Payer: Meridian Medicaid |
$300.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78,532.00
|
| Rate for Payer: Nomi Health Commercial |
$513.29
|
| Rate for Payer: PACE SWMI |
$427.74
|
| Rate for Payer: PHP Medicare Advantage |
$427.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.12
|
| Rate for Payer: Priority Health Medicare |
$427.74
|
| Rate for Payer: Priority Health Narrow Network |
$888.12
|
| Rate for Payer: Priority Health SBD |
$888.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$427.74
|
| Rate for Payer: UHC Exchange |
$462.51
|
| Rate for Payer: UHC Medicare Advantage |
$427.74
|
| Rate for Payer: UHCCP Medicaid |
$286.06
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
OP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$473.53 |
| Max. Negotiated Rate |
$11,792.02 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna Medicare |
$3,901.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,689.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,689.81
|
| Rate for Payer: BCBS Complete |
$2,111.54
|
| Rate for Payer: BCBS MAPPO |
$3,751.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.23
|
| Rate for Payer: BCN Commercial |
$1,872.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,751.85
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,751.85
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Mclaren Medicaid |
$2,010.99
|
| Rate for Payer: Mclaren Medicare |
$3,751.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,939.44
|
| Rate for Payer: Meridian Medicaid |
$2,111.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,314.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: Nomi Health Commercial |
$7,878.88
|
| Rate for Payer: PACE Medicare |
$3,564.26
|
| Rate for Payer: PACE SWMI |
$3,751.85
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: PHP Medicare Advantage |
$3,751.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,010.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,792.02
|
| Rate for Payer: Priority Health Medicare |
$3,751.85
|
| Rate for Payer: Priority Health Narrow Network |
$9,433.62
|
| Rate for Payer: Priority Health SBD |
$993.51
|
| Rate for Payer: Railroad Medicare Medicare |
$3,751.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$473.53
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,751.85
|
| Rate for Payer: UHC Medicare Advantage |
$3,751.85
|
| Rate for Payer: UHCCP Medicaid |
$2,112.29
|
| Rate for Payer: VA VA |
$3,751.85
|
|
|
PR BX/EXC LYMPH NODE OPEN DEEP AXILLARY NODE
|
Facility
|
IP
|
$1,577.00
|
|
|
Service Code
|
CPT 38525
|
| Hospital Charge Code |
38525
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$993.51 |
| Max. Negotiated Rate |
$1,419.30 |
| Rate for Payer: Aetna Commercial |
$1,340.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.05
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,356.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,103.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,261.60
|
| Rate for Payer: Healthscope Commercial |
$1,419.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.45
|
| Rate for Payer: PHP Commercial |
$1,340.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,025.05
|
| Rate for Payer: Priority Health SBD |
$993.51
|
|
