|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$227.84
|
| Rate for Payer: Aetna Medicare |
$176.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.84
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$170.03
|
| Rate for Payer: BCN Commercial |
$270.40
|
| Rate for Payer: BCN Medicare Advantage |
$170.03
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$244.84
|
| Rate for Payer: Cofinity Commercial |
$227.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.03
|
| Rate for Payer: Healthscope Commercial |
$314.56
|
| Rate for Payer: Healthscope Commercial |
$272.05
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.53
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.42
|
| Rate for Payer: Nomi Health Commercial |
$204.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.00
|
| Rate for Payer: PACE SWMI |
$170.03
|
| Rate for Payer: PHP Medicare Advantage |
$170.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.00
|
| Rate for Payer: Priority Health Medicare |
$170.03
|
| Rate for Payer: Priority Health SBD |
$257.00
|
| Rate for Payer: Priority Health Tiered Network |
$257.00
|
| Rate for Payer: Railroad Medicare Medicare |
$170.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.62
|
| Rate for Payer: UHC Core |
$306.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.03
|
| Rate for Payer: UHC Exchange |
$306.62
|
| Rate for Payer: UHC Medicaid |
$108.63
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP
|
Professional
|
Both
|
$7,051.00
|
|
|
Service Code
|
HCPCS 33315
|
| Min. Negotiated Rate |
$1,137.42 |
| Max. Negotiated Rate |
$5,288.25 |
| Rate for Payer: Aetna Commercial |
$2,395.72
|
| Rate for Payer: Aetna Medicare |
$1,859.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,395.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,574.50
|
| Rate for Payer: BCBS Complete |
$1,194.29
|
| Rate for Payer: BCBS MAPPO |
$1,787.85
|
| Rate for Payer: BCN Commercial |
$2,807.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,787.85
|
| Rate for Payer: Cash Price |
$5,640.80
|
| Rate for Payer: Cash Price |
$5,640.80
|
| Rate for Payer: Cofinity Commercial |
$2,574.50
|
| Rate for Payer: Cofinity Commercial |
$2,395.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,787.85
|
| Rate for Payer: Healthscope Commercial |
$3,307.52
|
| Rate for Payer: Healthscope Commercial |
$2,860.56
|
| Rate for Payer: Mclaren Medicaid |
$1,137.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,877.24
|
| Rate for Payer: Meridian Medicaid |
$1,194.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,966.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,394.35
|
| Rate for Payer: Nomi Health Commercial |
$2,145.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,288.25
|
| Rate for Payer: PACE SWMI |
$1,787.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,787.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,137.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,019.24
|
| Rate for Payer: Priority Health Medicare |
$1,787.85
|
| Rate for Payer: Priority Health SBD |
$3,019.24
|
| Rate for Payer: Priority Health Tiered Network |
$3,019.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,787.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,412.24
|
| Rate for Payer: UHC Core |
$3,412.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,787.85
|
| Rate for Payer: UHC Exchange |
$3,412.24
|
| Rate for Payer: UHC Medicaid |
$1,137.42
|
| Rate for Payer: UHCCP Medicaid |
$1,137.42
|
|
|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$4,758.00
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$720.58 |
| Max. Negotiated Rate |
$3,568.50 |
| Rate for Payer: Aetna Commercial |
$1,505.54
|
| Rate for Payer: Aetna Medicare |
$1,168.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,505.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,617.90
|
| Rate for Payer: BCBS Complete |
$756.61
|
| Rate for Payer: BCBS MAPPO |
$1,123.54
|
| Rate for Payer: BCN Commercial |
$1,725.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,123.54
|
| Rate for Payer: Cash Price |
$3,806.40
|
| Rate for Payer: Cash Price |
$3,806.40
|
| Rate for Payer: Cofinity Commercial |
$1,617.90
|
| Rate for Payer: Cofinity Commercial |
$1,505.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,123.54
|
| Rate for Payer: Healthscope Commercial |
$2,078.55
|
| Rate for Payer: Healthscope Commercial |
$1,797.66
|
| Rate for Payer: Mclaren Medicaid |
$720.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,179.72
|
| Rate for Payer: Meridian Medicaid |
$756.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,235.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,065.39
|
| Rate for Payer: Nomi Health Commercial |
$1,348.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,568.50
|
| Rate for Payer: PACE SWMI |
$1,123.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,123.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,855.57
|
| Rate for Payer: Priority Health Medicare |
$1,123.54
|
| Rate for Payer: Priority Health SBD |
$1,855.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,855.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,123.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,074.13
|
| Rate for Payer: UHC Core |
$2,074.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,123.54
|
| Rate for Payer: UHC Exchange |
$2,074.13
|
| Rate for Payer: UHC Medicaid |
$720.58
|
| Rate for Payer: UHCCP Medicaid |
$720.58
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$213.98
|
| Rate for Payer: Aetna Medicare |
$166.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.98
|
| Rate for Payer: BCBS MAPPO |
$159.69
|
| Rate for Payer: BCN Commercial |
$245.01
|
| Rate for Payer: BCN Medicare Advantage |
$159.69
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$229.95
|
| Rate for Payer: Cofinity Commercial |
$213.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.69
|
| Rate for Payer: Healthscope Commercial |
$255.50
|
| Rate for Payer: Healthscope Commercial |
$295.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.73
|
| Rate for Payer: Nomi Health Commercial |
$191.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.50
|
| Rate for Payer: PACE SWMI |
$159.69
|
| Rate for Payer: PHP Medicare Advantage |
$159.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$232.86
|
| Rate for Payer: Priority Health Medicare |
$159.69
|
| Rate for Payer: Priority Health SBD |
$232.86
|
| Rate for Payer: Priority Health Tiered Network |
$232.86
|
| Rate for Payer: Railroad Medicare Medicare |
$159.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.02
|
| Rate for Payer: UHC Core |
$249.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.69
|
| Rate for Payer: UHC Exchange |
$249.02
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$464.40 |
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.40
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Advantage |
$361.20
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PHP Commercial |
$438.60
|
| Rate for Payer: Priority Health SBD |
$325.08
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$2,129.73 |
| Rate for Payer: Aetna Commercial |
$438.60
|
| Rate for Payer: Aetna Medicare |
$684.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$823.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$823.21
|
| Rate for Payer: BCBS Complete |
$361.69
|
| Rate for Payer: BCBS MAPPO |
$658.57
|
| Rate for Payer: BCBS Trust/PPO |
$460.81
|
| Rate for Payer: BCN Commercial |
$460.81
|
| Rate for Payer: BCN Medicare Advantage |
$658.57
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Advantage |
$361.20
|
| Rate for Payer: Cofinity Commercial |
$443.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$412.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.57
|
| Rate for Payer: Healthscope Commercial |
$464.40
|
| Rate for Payer: Mclaren Medicaid |
$344.43
|
| Rate for Payer: Mclaren Medicare |
$658.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.50
|
| Rate for Payer: Meridian Medicaid |
$691.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$757.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$724.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.60
|
| Rate for Payer: Nomi Health Commercial |
$1,975.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE Medicare |
$625.64
|
| Rate for Payer: PACE SWMI |
$658.57
|
| Rate for Payer: PHP Commercial |
$438.60
|
| Rate for Payer: PHP Medicare Advantage |
$658.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,129.73
|
| Rate for Payer: Priority Health Medicare |
$658.57
|
| Rate for Payer: Priority Health SBD |
$325.08
|
| Rate for Payer: Priority Health Tiered Network |
$1,703.78
|
| Rate for Payer: Railroad Medicare Medicare |
$658.57
|
| Rate for Payer: UHC Medicaid |
$344.43
|
| Rate for Payer: UHCCP Medicaid |
$344.43
|
| Rate for Payer: VA VA |
$658.57
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: Aetna Medicare |
$97.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$93.35
|
| Rate for Payer: BCN Commercial |
$175.61
|
| Rate for Payer: BCN Medicare Advantage |
$93.35
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$134.42
|
| Rate for Payer: Cofinity Commercial |
$125.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$172.70
|
| Rate for Payer: Healthscope Commercial |
$149.36
|
| Rate for Payer: Mclaren Medicaid |
$60.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.02
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.19
|
| Rate for Payer: Nomi Health Commercial |
$112.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE SWMI |
$93.35
|
| Rate for Payer: PHP Medicare Advantage |
$93.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$151.93
|
| Rate for Payer: Priority Health Medicare |
$93.35
|
| Rate for Payer: Priority Health SBD |
$151.93
|
| Rate for Payer: Priority Health Tiered Network |
$151.93
|
| Rate for Payer: Railroad Medicare Medicare |
$93.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.39
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.35
|
| Rate for Payer: UHC Exchange |
$176.39
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Aetna Commercial |
$125.09
|
| Rate for Payer: Aetna Medicare |
$97.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$93.35
|
| Rate for Payer: BCN Commercial |
$175.61
|
| Rate for Payer: BCN Medicare Advantage |
$93.35
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$134.42
|
| Rate for Payer: Cofinity Commercial |
$125.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.35
|
| Rate for Payer: Healthscope Commercial |
$172.70
|
| Rate for Payer: Healthscope Commercial |
$149.36
|
| Rate for Payer: Mclaren Medicaid |
$60.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.02
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$102.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.19
|
| Rate for Payer: Nomi Health Commercial |
$112.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.00
|
| Rate for Payer: PACE SWMI |
$93.35
|
| Rate for Payer: PHP Medicare Advantage |
$93.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$151.93
|
| Rate for Payer: Priority Health Medicare |
$93.35
|
| Rate for Payer: Priority Health SBD |
$151.93
|
| Rate for Payer: Priority Health Tiered Network |
$151.93
|
| Rate for Payer: Railroad Medicare Medicare |
$93.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.39
|
| Rate for Payer: UHC Core |
$176.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.35
|
| Rate for Payer: UHC Exchange |
$176.39
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$407.17 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$224.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.13
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$216.06
|
| Rate for Payer: BCN Commercial |
$356.55
|
| Rate for Payer: BCN Medicare Advantage |
$216.06
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$311.13
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.06
|
| Rate for Payer: Healthscope Commercial |
$399.71
|
| Rate for Payer: Healthscope Commercial |
$345.70
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.86
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.83
|
| Rate for Payer: Nomi Health Commercial |
$259.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: PACE SWMI |
$216.06
|
| Rate for Payer: PHP Medicare Advantage |
$216.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$338.89
|
| Rate for Payer: Priority Health Medicare |
$216.06
|
| Rate for Payer: Priority Health SBD |
$338.89
|
| Rate for Payer: Priority Health Tiered Network |
$338.89
|
| Rate for Payer: Railroad Medicare Medicare |
$216.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.17
|
| Rate for Payer: UHC Core |
$407.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.06
|
| Rate for Payer: UHC Exchange |
$407.17
|
| Rate for Payer: UHC Medicaid |
$137.39
|
| Rate for Payer: UHCCP Medicaid |
$137.39
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$5.64 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.09
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$4.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$5.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: Priority Health SBD |
$5.43
|
| Rate for Payer: Priority Health Tiered Network |
$5.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.72
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$71.24 |
| Rate for Payer: Aetna Commercial |
$51.60
|
| Rate for Payer: Aetna Medicare |
$40.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.45
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.51
|
| Rate for Payer: BCN Commercial |
$39.56
|
| Rate for Payer: BCN Medicare Advantage |
$38.51
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$55.45
|
| Rate for Payer: Cofinity Commercial |
$51.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.51
|
| Rate for Payer: Healthscope Commercial |
$71.24
|
| Rate for Payer: Healthscope Commercial |
$61.62
|
| Rate for Payer: Mclaren Medicaid |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.44
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.38
|
| Rate for Payer: Nomi Health Commercial |
$46.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PACE SWMI |
$38.51
|
| Rate for Payer: PHP Medicare Advantage |
$38.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.33
|
| Rate for Payer: Priority Health Medicare |
$38.51
|
| Rate for Payer: Priority Health SBD |
$57.33
|
| Rate for Payer: Priority Health Tiered Network |
$57.33
|
| Rate for Payer: Railroad Medicare Medicare |
$38.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.54
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.51
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$606.04
|
| Rate for Payer: Aetna Medicare |
$470.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.27
|
| Rate for Payer: BCBS Complete |
$312.89
|
| Rate for Payer: BCBS MAPPO |
$452.27
|
| Rate for Payer: BCN Commercial |
$761.42
|
| Rate for Payer: BCN Medicare Advantage |
$452.27
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$651.27
|
| Rate for Payer: Cofinity Commercial |
$606.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.27
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Healthscope Commercial |
$723.63
|
| Rate for Payer: Mclaren Medicaid |
$297.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.88
|
| Rate for Payer: Meridian Medicaid |
$312.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.46
|
| Rate for Payer: Nomi Health Commercial |
$542.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$452.27
|
| Rate for Payer: PHP Medicare Advantage |
$452.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$813.93
|
| Rate for Payer: Priority Health Medicare |
$452.27
|
| Rate for Payer: Priority Health SBD |
$813.93
|
| Rate for Payer: Priority Health Tiered Network |
$813.93
|
| Rate for Payer: Railroad Medicare Medicare |
$452.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.68
|
| Rate for Payer: UHC Core |
$849.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$452.27
|
| Rate for Payer: UHC Exchange |
$849.68
|
| Rate for Payer: UHC Medicaid |
$297.99
|
| Rate for Payer: UHCCP Medicaid |
$297.99
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,752.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,103.76 |
| Max. Negotiated Rate |
$1,576.80 |
| Rate for Payer: Aetna Commercial |
$1,489.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.80
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Advantage |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,506.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.60
|
| Rate for Payer: Healthscope Commercial |
$1,576.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PHP Commercial |
$1,489.20
|
| Rate for Payer: Priority Health SBD |
$1,103.76
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$297.99 |
| Max. Negotiated Rate |
$1,314.00 |
| Rate for Payer: Aetna Commercial |
$606.04
|
| Rate for Payer: Aetna Medicare |
$470.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.27
|
| Rate for Payer: BCBS Complete |
$312.89
|
| Rate for Payer: BCBS MAPPO |
$452.27
|
| Rate for Payer: BCN Commercial |
$761.42
|
| Rate for Payer: BCN Medicare Advantage |
$452.27
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Commercial |
$651.27
|
| Rate for Payer: Cofinity Commercial |
$606.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.27
|
| Rate for Payer: Healthscope Commercial |
$836.70
|
| Rate for Payer: Healthscope Commercial |
$723.63
|
| Rate for Payer: Mclaren Medicaid |
$297.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.88
|
| Rate for Payer: Meridian Medicaid |
$312.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$497.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$876.46
|
| Rate for Payer: Nomi Health Commercial |
$542.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE SWMI |
$452.27
|
| Rate for Payer: PHP Medicare Advantage |
$452.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$813.93
|
| Rate for Payer: Priority Health Medicare |
$452.27
|
| Rate for Payer: Priority Health SBD |
$813.93
|
| Rate for Payer: Priority Health Tiered Network |
$813.93
|
| Rate for Payer: Railroad Medicare Medicare |
$452.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.68
|
| Rate for Payer: UHC Core |
$849.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$452.27
|
| Rate for Payer: UHC Exchange |
$849.68
|
| Rate for Payer: UHC Medicaid |
$297.99
|
| Rate for Payer: UHCCP Medicaid |
$297.99
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,752.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,103.76 |
| Max. Negotiated Rate |
$10,543.31 |
| Rate for Payer: Aetna Commercial |
$1,489.20
|
| Rate for Payer: Aetna Medicare |
$3,390.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,075.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,075.29
|
| Rate for Payer: BCBS Complete |
$1,790.52
|
| Rate for Payer: BCBS MAPPO |
$3,260.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,628.11
|
| Rate for Payer: BCN Commercial |
$1,628.11
|
| Rate for Payer: BCN Medicare Advantage |
$3,260.23
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cofinity Advantage |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,506.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,401.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,260.23
|
| Rate for Payer: Healthscope Commercial |
$1,576.80
|
| Rate for Payer: Mclaren Medicaid |
$1,705.10
|
| Rate for Payer: Mclaren Medicare |
$3,260.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,423.24
|
| Rate for Payer: Meridian Medicaid |
$3,423.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,749.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,586.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,489.20
|
| Rate for Payer: Nomi Health Commercial |
$9,780.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,314.00
|
| Rate for Payer: PACE Medicare |
$3,097.22
|
| Rate for Payer: PACE SWMI |
$3,260.23
|
| Rate for Payer: PHP Commercial |
$1,489.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,260.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,705.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,543.31
|
| Rate for Payer: Priority Health Medicare |
$3,260.23
|
| Rate for Payer: Priority Health SBD |
$1,103.76
|
| Rate for Payer: Priority Health Tiered Network |
$8,434.65
|
| Rate for Payer: Railroad Medicare Medicare |
$3,260.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,260.23
|
| Rate for Payer: UHC Medicaid |
$1,705.10
|
| Rate for Payer: UHCCP Medicaid |
$1,705.10
|
| Rate for Payer: VA VA |
$3,260.23
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,358.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$368.49 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Aetna Commercial |
$752.45
|
| Rate for Payer: Aetna Medicare |
$583.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.60
|
| Rate for Payer: BCBS Complete |
$386.91
|
| Rate for Payer: BCBS MAPPO |
$561.53
|
| Rate for Payer: BCN Commercial |
$952.63
|
| Rate for Payer: BCN Medicare Advantage |
$561.53
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cofinity Commercial |
$808.60
|
| Rate for Payer: Cofinity Commercial |
$752.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.53
|
| Rate for Payer: Healthscope Commercial |
$898.45
|
| Rate for Payer: Healthscope Commercial |
$1,038.83
|
| Rate for Payer: Mclaren Medicaid |
$368.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.61
|
| Rate for Payer: Meridian Medicaid |
$386.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$617.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,101.29
|
| Rate for Payer: Nomi Health Commercial |
$673.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,768.50
|
| Rate for Payer: PACE SWMI |
$561.53
|
| Rate for Payer: PHP Medicare Advantage |
$561.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,018.35
|
| Rate for Payer: Priority Health Medicare |
$561.53
|
| Rate for Payer: Priority Health SBD |
$1,018.35
|
| Rate for Payer: Priority Health Tiered Network |
$1,018.35
|
| Rate for Payer: Railroad Medicare Medicare |
$561.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,074.43
|
| Rate for Payer: UHC Core |
$1,074.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$561.53
|
| Rate for Payer: UHC Exchange |
$1,074.43
|
| Rate for Payer: UHC Medicaid |
$368.49
|
| Rate for Payer: UHCCP Medicaid |
$368.49
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$838.69 |
| Rate for Payer: Aetna Commercial |
$599.70
|
| Rate for Payer: Aetna Medicare |
$465.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.46
|
| Rate for Payer: BCBS Complete |
$310.65
|
| Rate for Payer: BCBS MAPPO |
$447.54
|
| Rate for Payer: BCN Commercial |
$731.53
|
| Rate for Payer: BCN Medicare Advantage |
$447.54
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cofinity Commercial |
$644.46
|
| Rate for Payer: Cofinity Commercial |
$599.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.54
|
| Rate for Payer: Healthscope Commercial |
$827.95
|
| Rate for Payer: Healthscope Commercial |
$716.06
|
| Rate for Payer: Mclaren Medicaid |
$295.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.92
|
| Rate for Payer: Meridian Medicaid |
$310.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$838.69
|
| Rate for Payer: Nomi Health Commercial |
$537.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$725.25
|
| Rate for Payer: PACE SWMI |
$447.54
|
| Rate for Payer: PHP Medicare Advantage |
$447.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$781.99
|
| Rate for Payer: Priority Health Medicare |
$447.54
|
| Rate for Payer: Priority Health SBD |
$781.99
|
| Rate for Payer: Priority Health Tiered Network |
$781.99
|
| Rate for Payer: Railroad Medicare Medicare |
$447.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.96
|
| Rate for Payer: UHC Core |
$810.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.54
|
| Rate for Payer: UHC Exchange |
$810.96
|
| Rate for Payer: UHC Medicaid |
$295.86
|
| Rate for Payer: UHCCP Medicaid |
$295.86
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$277.54 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Aetna Commercial |
$566.95
|
| Rate for Payer: Aetna Medicare |
$440.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.26
|
| Rate for Payer: BCBS Complete |
$291.42
|
| Rate for Payer: BCBS MAPPO |
$423.10
|
| Rate for Payer: BCN Commercial |
$730.04
|
| Rate for Payer: BCN Medicare Advantage |
$423.10
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cofinity Commercial |
$609.26
|
| Rate for Payer: Cofinity Commercial |
$566.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.10
|
| Rate for Payer: Healthscope Commercial |
$782.74
|
| Rate for Payer: Healthscope Commercial |
$676.96
|
| Rate for Payer: Mclaren Medicaid |
$277.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.25
|
| Rate for Payer: Meridian Medicaid |
$291.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$465.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.00
|
| Rate for Payer: Nomi Health Commercial |
$507.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.00
|
| Rate for Payer: PACE SWMI |
$423.10
|
| Rate for Payer: PHP Medicare Advantage |
$423.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$780.39
|
| Rate for Payer: Priority Health Medicare |
$423.10
|
| Rate for Payer: Priority Health SBD |
$780.39
|
| Rate for Payer: Priority Health Tiered Network |
$780.39
|
| Rate for Payer: Railroad Medicare Medicare |
$423.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.12
|
| Rate for Payer: UHC Core |
$823.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$423.10
|
| Rate for Payer: UHC Exchange |
$823.12
|
| Rate for Payer: UHC Medicaid |
$277.54
|
| Rate for Payer: UHCCP Medicaid |
$277.54
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$165.85 |
| Max. Negotiated Rate |
$2,996.60 |
| Rate for Payer: Aetna Commercial |
$358.70
|
| Rate for Payer: Aetna Medicare |
$963.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,158.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,158.26
|
| Rate for Payer: BCBS Complete |
$508.89
|
| Rate for Payer: BCBS MAPPO |
$926.61
|
| Rate for Payer: BCBS Trust/PPO |
$577.15
|
| Rate for Payer: BCN Commercial |
$577.15
|
| Rate for Payer: BCN Medicare Advantage |
$926.61
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Advantage |
$295.40
|
| Rate for Payer: Cofinity Commercial |
$362.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.61
|
| Rate for Payer: Healthscope Commercial |
$379.80
|
| Rate for Payer: Mclaren Medicaid |
$484.62
|
| Rate for Payer: Mclaren Medicare |
$926.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.94
|
| Rate for Payer: Meridian Medicaid |
$972.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,065.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,019.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.70
|
| Rate for Payer: Nomi Health Commercial |
$2,779.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE Medicare |
$880.28
|
| Rate for Payer: PACE SWMI |
$926.61
|
| Rate for Payer: PHP Commercial |
$358.70
|
| Rate for Payer: PHP Medicare Advantage |
$926.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,996.60
|
| Rate for Payer: Priority Health Medicare |
$926.61
|
| Rate for Payer: Priority Health SBD |
$265.86
|
| Rate for Payer: Priority Health Tiered Network |
$2,397.28
|
| Rate for Payer: Railroad Medicare Medicare |
$926.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$274.30
|
| Rate for Payer: UHC Core |
$219.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$926.61
|
| Rate for Payer: UHC Exchange |
$165.85
|
| Rate for Payer: UHC Medicaid |
$484.62
|
| Rate for Payer: UHCCP Medicaid |
$484.62
|
| Rate for Payer: VA VA |
$926.61
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.84
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.97
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$74.84
|
| Rate for Payer: Cofinity Commercial |
$69.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.97
|
| Rate for Payer: Healthscope Commercial |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$83.15
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.14
|
| Rate for Payer: Nomi Health Commercial |
$62.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$51.97
|
| Rate for Payer: PHP Medicare Advantage |
$51.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$51.97
|
| Rate for Payer: Priority Health SBD |
$103.15
|
| Rate for Payer: Priority Health Tiered Network |
$103.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.58
|
| Rate for Payer: UHC Core |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.97
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$265.86 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna Commercial |
$358.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.30
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Advantage |
$295.40
|
| Rate for Payer: Cofinity Commercial |
$362.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.60
|
| Rate for Payer: Healthscope Commercial |
$379.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$358.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PHP Commercial |
$358.70
|
| Rate for Payer: Priority Health SBD |
$265.86
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$69.64
|
| Rate for Payer: Aetna Medicare |
$54.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.84
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$51.97
|
| Rate for Payer: BCN Commercial |
$84.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.97
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$74.84
|
| Rate for Payer: Cofinity Commercial |
$69.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.97
|
| Rate for Payer: Healthscope Commercial |
$96.14
|
| Rate for Payer: Healthscope Commercial |
$83.15
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.57
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.14
|
| Rate for Payer: Nomi Health Commercial |
$62.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$51.97
|
| Rate for Payer: PHP Medicare Advantage |
$51.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.15
|
| Rate for Payer: Priority Health Medicare |
$51.97
|
| Rate for Payer: Priority Health SBD |
$103.15
|
| Rate for Payer: Priority Health Tiered Network |
$103.15
|
| Rate for Payer: Railroad Medicare Medicare |
$51.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.58
|
| Rate for Payer: UHC Core |
$97.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.97
|
| Rate for Payer: UHC Exchange |
$97.58
|
| Rate for Payer: UHC Medicaid |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$32.63
|
| Rate for Payer: Aetna Medicare |
$25.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.06
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.35
|
| Rate for Payer: BCN Commercial |
$40.34
|
| Rate for Payer: BCN Medicare Advantage |
$24.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$32.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$45.05
|
| Rate for Payer: Healthscope Commercial |
$38.96
|
| Rate for Payer: Mclaren Medicaid |
$15.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.57
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.59
|
| Rate for Payer: Nomi Health Commercial |
$29.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PACE SWMI |
$24.35
|
| Rate for Payer: PHP Medicare Advantage |
$24.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.28
|
| Rate for Payer: Priority Health Medicare |
$24.35
|
| Rate for Payer: Priority Health SBD |
$36.28
|
| Rate for Payer: Priority Health Tiered Network |
$36.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.68
|
| Rate for Payer: UHC Core |
$45.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.35
|
| Rate for Payer: UHC Exchange |
$45.68
|
| Rate for Payer: UHC Medicaid |
$15.76
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$62.60 |
| Rate for Payer: Aetna Commercial |
$45.35
|
| Rate for Payer: Aetna Medicare |
$35.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.35
|
| Rate for Payer: BCBS MAPPO |
$33.84
|
| Rate for Payer: BCN Commercial |
$32.40
|
| Rate for Payer: BCN Medicare Advantage |
$33.84
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$48.73
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$54.14
|
| Rate for Payer: Healthscope Commercial |
$62.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.58
|
| Rate for Payer: Nomi Health Commercial |
$40.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: PACE SWMI |
$33.84
|
| Rate for Payer: PHP Medicare Advantage |
$33.84
|
| Rate for Payer: Priority Health Medicare |
$33.84
|
| Rate for Payer: Railroad Medicare Medicare |
$33.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.03
|
| Rate for Payer: UHC Core |
$11.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.84
|
| Rate for Payer: UHC Exchange |
$11.03
|
|
|
PR CAST SUP GAUNTLET PLASTER
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS Q4013
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$37.13 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$20.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.90
|
| Rate for Payer: BCBS MAPPO |
$20.07
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: BCN Medicare Advantage |
$20.07
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$28.90
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$32.11
|
| Rate for Payer: Healthscope Commercial |
$37.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: Nomi Health Commercial |
$24.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: PACE SWMI |
$20.07
|
| Rate for Payer: PHP Medicare Advantage |
$20.07
|
| Rate for Payer: Priority Health Medicare |
$20.07
|
| Rate for Payer: Railroad Medicare Medicare |
$20.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.54
|
| Rate for Payer: UHC Core |
$6.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.07
|
| Rate for Payer: UHC Exchange |
$6.54
|
|
