|
PR DRAINAGE DEEP PERIURETHRAL ABSCESS
|
Professional
|
Both
|
$839.00
|
|
|
Service Code
|
HCPCS 53040
|
| Min. Negotiated Rate |
$231.11 |
| Max. Negotiated Rate |
$689.67 |
| Rate for Payer: Aetna Commercial |
$476.18
|
| Rate for Payer: Aetna Medicare |
$369.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.72
|
| Rate for Payer: BCBS Complete |
$242.67
|
| Rate for Payer: BCBS MAPPO |
$355.36
|
| Rate for Payer: BCN Commercial |
$592.10
|
| Rate for Payer: BCN Medicare Advantage |
$355.36
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cash Price |
$671.20
|
| Rate for Payer: Cofinity Commercial |
$511.72
|
| Rate for Payer: Cofinity Commercial |
$476.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.36
|
| Rate for Payer: Healthscope Commercial |
$657.42
|
| Rate for Payer: Healthscope Commercial |
$568.58
|
| Rate for Payer: Mclaren Medicaid |
$231.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.13
|
| Rate for Payer: Meridian Medicaid |
$242.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$390.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.67
|
| Rate for Payer: Nomi Health Commercial |
$426.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$629.25
|
| Rate for Payer: PACE SWMI |
$355.36
|
| Rate for Payer: PHP Medicare Advantage |
$355.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$644.99
|
| Rate for Payer: Priority Health Medicare |
$355.36
|
| Rate for Payer: Priority Health SBD |
$644.99
|
| Rate for Payer: Priority Health Tiered Network |
$644.99
|
| Rate for Payer: Railroad Medicare Medicare |
$355.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$689.41
|
| Rate for Payer: UHC Core |
$689.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$355.36
|
| Rate for Payer: UHC Exchange |
$689.41
|
| Rate for Payer: UHC Medicaid |
$231.11
|
| Rate for Payer: UHCCP Medicaid |
$231.11
|
|
|
PR DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
HCPCS 69020
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna Medicare |
$132.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.20
|
| Rate for Payer: BCBS Complete |
$89.01
|
| Rate for Payer: BCBS MAPPO |
$127.22
|
| Rate for Payer: BCN Commercial |
$216.62
|
| Rate for Payer: BCN Medicare Advantage |
$127.22
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cash Price |
$312.80
|
| Rate for Payer: Cofinity Commercial |
$183.20
|
| Rate for Payer: Cofinity Commercial |
$170.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.22
|
| Rate for Payer: Healthscope Commercial |
$235.36
|
| Rate for Payer: Healthscope Commercial |
$203.55
|
| Rate for Payer: Mclaren Medicaid |
$84.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.58
|
| Rate for Payer: Meridian Medicaid |
$89.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$252.23
|
| Rate for Payer: Nomi Health Commercial |
$152.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.25
|
| Rate for Payer: PACE SWMI |
$127.22
|
| Rate for Payer: PHP Medicare Advantage |
$127.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$214.05
|
| Rate for Payer: Priority Health Medicare |
$127.22
|
| Rate for Payer: Priority Health SBD |
$214.05
|
| Rate for Payer: Priority Health Tiered Network |
$214.05
|
| Rate for Payer: Railroad Medicare Medicare |
$127.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.74
|
| Rate for Payer: UHC Core |
$239.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.22
|
| Rate for Payer: UHC Exchange |
$239.74
|
| Rate for Payer: UHC Medicaid |
$84.77
|
| Rate for Payer: UHCCP Medicaid |
$84.77
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA COMP
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 69005
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$297.75 |
| Rate for Payer: Aetna Commercial |
$190.39
|
| Rate for Payer: Aetna Medicare |
$147.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.60
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCBS MAPPO |
$142.08
|
| Rate for Payer: BCN Commercial |
$244.01
|
| Rate for Payer: BCN Medicare Advantage |
$142.08
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cofinity Commercial |
$204.60
|
| Rate for Payer: Cofinity Commercial |
$190.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.08
|
| Rate for Payer: Healthscope Commercial |
$262.85
|
| Rate for Payer: Healthscope Commercial |
$227.33
|
| Rate for Payer: Mclaren Medicaid |
$93.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.18
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$282.02
|
| Rate for Payer: Nomi Health Commercial |
$170.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.75
|
| Rate for Payer: PACE SWMI |
$142.08
|
| Rate for Payer: PHP Medicare Advantage |
$142.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$241.11
|
| Rate for Payer: Priority Health Medicare |
$142.08
|
| Rate for Payer: Priority Health SBD |
$241.11
|
| Rate for Payer: Priority Health Tiered Network |
$241.11
|
| Rate for Payer: Railroad Medicare Medicare |
$142.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.72
|
| Rate for Payer: UHC Core |
$271.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.08
|
| Rate for Payer: UHC Exchange |
$271.72
|
| Rate for Payer: UHC Medicaid |
$93.29
|
| Rate for Payer: UHCCP Medicaid |
$93.29
|
|
|
PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 69000
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$245.25 |
| Rate for Payer: Aetna Commercial |
$151.74
|
| Rate for Payer: Aetna Medicare |
$117.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.07
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$113.24
|
| Rate for Payer: BCN Commercial |
$189.23
|
| Rate for Payer: BCN Medicare Advantage |
$113.24
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$163.07
|
| Rate for Payer: Cofinity Commercial |
$151.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.24
|
| Rate for Payer: Healthscope Commercial |
$209.49
|
| Rate for Payer: Healthscope Commercial |
$181.18
|
| Rate for Payer: Mclaren Medicaid |
$74.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.90
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.74
|
| Rate for Payer: Nomi Health Commercial |
$135.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.25
|
| Rate for Payer: PACE SWMI |
$113.24
|
| Rate for Payer: PHP Medicare Advantage |
$113.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$186.99
|
| Rate for Payer: Priority Health Medicare |
$113.24
|
| Rate for Payer: Priority Health SBD |
$186.99
|
| Rate for Payer: Priority Health Tiered Network |
$186.99
|
| Rate for Payer: Railroad Medicare Medicare |
$113.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.59
|
| Rate for Payer: UHC Core |
$208.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$113.24
|
| Rate for Payer: UHC Exchange |
$208.59
|
| Rate for Payer: UHC Medicaid |
$74.98
|
| Rate for Payer: UHCCP Medicaid |
$74.98
|
|
|
PR DRAINAGE FINGER ABSCESS COMPLICATED
|
Professional
|
Both
|
$835.00
|
|
|
Service Code
|
HCPCS 26011
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$626.25 |
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Medicare |
$182.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.35
|
| Rate for Payer: BCBS Complete |
$122.11
|
| Rate for Payer: BCBS MAPPO |
$175.94
|
| Rate for Payer: BCN Commercial |
$282.86
|
| Rate for Payer: BCN Medicare Advantage |
$175.94
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cash Price |
$668.00
|
| Rate for Payer: Cofinity Commercial |
$253.35
|
| Rate for Payer: Cofinity Commercial |
$235.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.94
|
| Rate for Payer: Healthscope Commercial |
$325.49
|
| Rate for Payer: Healthscope Commercial |
$281.50
|
| Rate for Payer: Mclaren Medicaid |
$116.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.74
|
| Rate for Payer: Meridian Medicaid |
$122.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$193.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.47
|
| Rate for Payer: Nomi Health Commercial |
$211.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$626.25
|
| Rate for Payer: PACE SWMI |
$175.94
|
| Rate for Payer: PHP Medicare Advantage |
$175.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$302.37
|
| Rate for Payer: Priority Health Medicare |
$175.94
|
| Rate for Payer: Priority Health SBD |
$302.37
|
| Rate for Payer: Priority Health Tiered Network |
$302.37
|
| Rate for Payer: Railroad Medicare Medicare |
$175.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.79
|
| Rate for Payer: UHC Core |
$319.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.94
|
| Rate for Payer: UHC Exchange |
$319.79
|
| Rate for Payer: UHC Medicaid |
$116.30
|
| Rate for Payer: UHCCP Medicaid |
$116.30
|
|
|
PR DRAINAGE FINGER ABSCESS SIMPLE
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 26010
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Aetna Commercial |
$186.09
|
| Rate for Payer: Aetna Medicare |
$144.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.97
|
| Rate for Payer: BCBS Complete |
$97.06
|
| Rate for Payer: BCBS MAPPO |
$138.87
|
| Rate for Payer: BCN Commercial |
$214.63
|
| Rate for Payer: BCN Medicare Advantage |
$138.87
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$199.97
|
| Rate for Payer: Cofinity Commercial |
$186.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.87
|
| Rate for Payer: Healthscope Commercial |
$256.91
|
| Rate for Payer: Healthscope Commercial |
$222.19
|
| Rate for Payer: Mclaren Medicaid |
$92.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.81
|
| Rate for Payer: Meridian Medicaid |
$97.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.52
|
| Rate for Payer: Nomi Health Commercial |
$166.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$444.75
|
| Rate for Payer: PACE SWMI |
$138.87
|
| Rate for Payer: PHP Medicare Advantage |
$138.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$229.43
|
| Rate for Payer: Priority Health Medicare |
$138.87
|
| Rate for Payer: Priority Health SBD |
$229.43
|
| Rate for Payer: Priority Health Tiered Network |
$229.43
|
| Rate for Payer: Railroad Medicare Medicare |
$138.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.01
|
| Rate for Payer: UHC Core |
$238.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.87
|
| Rate for Payer: UHC Exchange |
$238.01
|
| Rate for Payer: UHC Medicaid |
$92.44
|
| Rate for Payer: UHCCP Medicaid |
$92.44
|
|
|
PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA
|
Professional
|
Both
|
$3,273.00
|
|
|
Service Code
|
HCPCS 26030
|
| Min. Negotiated Rate |
$297.14 |
| Max. Negotiated Rate |
$2,454.75 |
| Rate for Payer: Aetna Commercial |
$605.26
|
| Rate for Payer: Aetna Medicare |
$469.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$650.43
|
| Rate for Payer: BCBS Complete |
$312.00
|
| Rate for Payer: BCBS MAPPO |
$451.69
|
| Rate for Payer: BCN Commercial |
$756.93
|
| Rate for Payer: BCN Medicare Advantage |
$451.69
|
| Rate for Payer: Cash Price |
$2,618.40
|
| Rate for Payer: Cash Price |
$2,618.40
|
| Rate for Payer: Cofinity Commercial |
$650.43
|
| Rate for Payer: Cofinity Commercial |
$605.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$451.69
|
| Rate for Payer: Healthscope Commercial |
$835.63
|
| Rate for Payer: Healthscope Commercial |
$722.70
|
| Rate for Payer: Mclaren Medicaid |
$297.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$474.27
|
| Rate for Payer: Meridian Medicaid |
$312.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$496.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.57
|
| Rate for Payer: Nomi Health Commercial |
$542.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,454.75
|
| Rate for Payer: PACE SWMI |
$451.69
|
| Rate for Payer: PHP Medicare Advantage |
$451.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$809.14
|
| Rate for Payer: Priority Health Medicare |
$451.69
|
| Rate for Payer: Priority Health SBD |
$809.14
|
| Rate for Payer: Priority Health Tiered Network |
$809.14
|
| Rate for Payer: Railroad Medicare Medicare |
$451.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$852.57
|
| Rate for Payer: UHC Core |
$852.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$451.69
|
| Rate for Payer: UHC Exchange |
$852.57
|
| Rate for Payer: UHC Medicaid |
$297.14
|
| Rate for Payer: UHCCP Medicaid |
$297.14
|
|
|
PR DRAINAGE OF PALMAR BURSA SINGLE BURSA
|
Professional
|
Both
|
$1,404.00
|
|
|
Service Code
|
HCPCS 26025
|
| Min. Negotiated Rate |
$257.94 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$523.70
|
| Rate for Payer: Aetna Medicare |
$406.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.78
|
| Rate for Payer: BCBS Complete |
$270.84
|
| Rate for Payer: BCBS MAPPO |
$390.82
|
| Rate for Payer: BCN Commercial |
$643.89
|
| Rate for Payer: BCN Medicare Advantage |
$390.82
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cofinity Commercial |
$562.78
|
| Rate for Payer: Cofinity Commercial |
$523.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.82
|
| Rate for Payer: Healthscope Commercial |
$723.02
|
| Rate for Payer: Healthscope Commercial |
$625.31
|
| Rate for Payer: Mclaren Medicaid |
$257.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.36
|
| Rate for Payer: Meridian Medicaid |
$270.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$744.07
|
| Rate for Payer: Nomi Health Commercial |
$468.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,053.00
|
| Rate for Payer: PACE SWMI |
$390.82
|
| Rate for Payer: PHP Medicare Advantage |
$390.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$688.30
|
| Rate for Payer: Priority Health Medicare |
$390.82
|
| Rate for Payer: Priority Health SBD |
$688.30
|
| Rate for Payer: Priority Health Tiered Network |
$688.30
|
| Rate for Payer: Railroad Medicare Medicare |
$390.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.52
|
| Rate for Payer: UHC Core |
$728.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$390.82
|
| Rate for Payer: UHC Exchange |
$728.52
|
| Rate for Payer: UHC Medicaid |
$257.94
|
| Rate for Payer: UHCCP Medicaid |
$257.94
|
|
|
PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
HCPCS 49060
|
| Min. Negotiated Rate |
$654.34 |
| Max. Negotiated Rate |
$2,020.51 |
| Rate for Payer: Aetna Commercial |
$1,366.68
|
| Rate for Payer: Aetna Medicare |
$1,060.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,468.67
|
| Rate for Payer: BCBS Complete |
$687.06
|
| Rate for Payer: BCBS MAPPO |
$1,019.91
|
| Rate for Payer: BCN Commercial |
$1,658.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,019.91
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cash Price |
$1,852.80
|
| Rate for Payer: Cofinity Commercial |
$1,468.67
|
| Rate for Payer: Cofinity Commercial |
$1,366.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,019.91
|
| Rate for Payer: Healthscope Commercial |
$1,886.83
|
| Rate for Payer: Healthscope Commercial |
$1,631.86
|
| Rate for Payer: Mclaren Medicaid |
$654.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,070.91
|
| Rate for Payer: Meridian Medicaid |
$687.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,121.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,955.30
|
| Rate for Payer: Nomi Health Commercial |
$1,223.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,737.00
|
| Rate for Payer: PACE SWMI |
$1,019.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,019.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,020.51
|
| Rate for Payer: Priority Health Medicare |
$1,019.91
|
| Rate for Payer: Priority Health SBD |
$2,020.51
|
| Rate for Payer: Priority Health Tiered Network |
$2,020.51
|
| Rate for Payer: Railroad Medicare Medicare |
$1,019.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,959.97
|
| Rate for Payer: UHC Core |
$1,959.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,019.91
|
| Rate for Payer: UHC Exchange |
$1,959.97
|
| Rate for Payer: UHC Medicaid |
$654.34
|
| Rate for Payer: UHCCP Medicaid |
$654.34
|
|
|
PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
HCPCS 58822
|
| Min. Negotiated Rate |
$403.42 |
| Max. Negotiated Rate |
$1,332.75 |
| Rate for Payer: Aetna Commercial |
$838.30
|
| Rate for Payer: Aetna Medicare |
$650.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$838.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.86
|
| Rate for Payer: BCBS Complete |
$423.59
|
| Rate for Payer: BCBS MAPPO |
$625.60
|
| Rate for Payer: BCN Commercial |
$1,071.66
|
| Rate for Payer: BCN Medicare Advantage |
$625.60
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cash Price |
$1,421.60
|
| Rate for Payer: Cofinity Commercial |
$900.86
|
| Rate for Payer: Cofinity Commercial |
$838.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.60
|
| Rate for Payer: Healthscope Commercial |
$1,157.36
|
| Rate for Payer: Healthscope Commercial |
$1,000.96
|
| Rate for Payer: Mclaren Medicaid |
$403.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.88
|
| Rate for Payer: Meridian Medicaid |
$423.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$688.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,277.80
|
| Rate for Payer: Nomi Health Commercial |
$750.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,332.75
|
| Rate for Payer: PACE SWMI |
$625.60
|
| Rate for Payer: PHP Medicare Advantage |
$625.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,085.36
|
| Rate for Payer: Priority Health Medicare |
$625.60
|
| Rate for Payer: Priority Health SBD |
$1,085.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,085.36
|
| Rate for Payer: Railroad Medicare Medicare |
$625.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,255.34
|
| Rate for Payer: UHC Core |
$1,255.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.60
|
| Rate for Payer: UHC Exchange |
$1,255.34
|
| Rate for Payer: UHC Medicaid |
$403.42
|
| Rate for Payer: UHCCP Medicaid |
$403.42
|
|
|
PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 58820
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Aetna Commercial |
$397.11
|
| Rate for Payer: Aetna Medicare |
$308.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.74
|
| Rate for Payer: BCBS Complete |
$203.30
|
| Rate for Payer: BCBS MAPPO |
$296.35
|
| Rate for Payer: BCN Commercial |
$510.44
|
| Rate for Payer: BCN Medicare Advantage |
$296.35
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$426.74
|
| Rate for Payer: Cofinity Commercial |
$397.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.35
|
| Rate for Payer: Healthscope Commercial |
$548.25
|
| Rate for Payer: Healthscope Commercial |
$474.16
|
| Rate for Payer: Mclaren Medicaid |
$193.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.17
|
| Rate for Payer: Meridian Medicaid |
$203.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$325.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$602.39
|
| Rate for Payer: Nomi Health Commercial |
$355.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$693.00
|
| Rate for Payer: PACE SWMI |
$296.35
|
| Rate for Payer: PHP Medicare Advantage |
$296.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$516.95
|
| Rate for Payer: Priority Health Medicare |
$296.35
|
| Rate for Payer: Priority Health SBD |
$516.95
|
| Rate for Payer: Priority Health Tiered Network |
$516.95
|
| Rate for Payer: Railroad Medicare Medicare |
$296.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.12
|
| Rate for Payer: UHC Core |
$573.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$296.35
|
| Rate for Payer: UHC Exchange |
$573.12
|
| Rate for Payer: UHC Medicaid |
$193.62
|
| Rate for Payer: UHCCP Medicaid |
$193.62
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL
|
Professional
|
Both
|
$1,660.00
|
|
|
Service Code
|
HCPCS 58805
|
| Min. Negotiated Rate |
$243.03 |
| Max. Negotiated Rate |
$1,245.00 |
| Rate for Payer: Aetna Commercial |
$501.27
|
| Rate for Payer: Aetna Medicare |
$389.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.68
|
| Rate for Payer: BCBS Complete |
$255.18
|
| Rate for Payer: BCBS MAPPO |
$374.08
|
| Rate for Payer: BCN Commercial |
$642.39
|
| Rate for Payer: BCN Medicare Advantage |
$374.08
|
| Rate for Payer: Cash Price |
$1,328.00
|
| Rate for Payer: Cash Price |
$1,328.00
|
| Rate for Payer: Cofinity Commercial |
$538.68
|
| Rate for Payer: Cofinity Commercial |
$501.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.08
|
| Rate for Payer: Healthscope Commercial |
$692.05
|
| Rate for Payer: Healthscope Commercial |
$598.53
|
| Rate for Payer: Mclaren Medicaid |
$243.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.78
|
| Rate for Payer: Meridian Medicaid |
$255.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$411.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$762.91
|
| Rate for Payer: Nomi Health Commercial |
$448.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,245.00
|
| Rate for Payer: PACE SWMI |
$374.08
|
| Rate for Payer: PHP Medicare Advantage |
$374.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$243.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$650.61
|
| Rate for Payer: Priority Health Medicare |
$374.08
|
| Rate for Payer: Priority Health SBD |
$650.61
|
| Rate for Payer: Priority Health Tiered Network |
$650.61
|
| Rate for Payer: Railroad Medicare Medicare |
$374.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.41
|
| Rate for Payer: UHC Core |
$735.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$374.08
|
| Rate for Payer: UHC Exchange |
$735.41
|
| Rate for Payer: UHC Medicaid |
$243.03
|
| Rate for Payer: UHCCP Medicaid |
$243.03
|
|
|
PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
HCPCS 58800
|
| Min. Negotiated Rate |
$179.56 |
| Max. Negotiated Rate |
$767.25 |
| Rate for Payer: Aetna Commercial |
$369.64
|
| Rate for Payer: Aetna Medicare |
$286.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.22
|
| Rate for Payer: BCBS Complete |
$188.54
|
| Rate for Payer: BCBS MAPPO |
$275.85
|
| Rate for Payer: BCN Commercial |
$476.07
|
| Rate for Payer: BCN Medicare Advantage |
$275.85
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cash Price |
$818.40
|
| Rate for Payer: Cofinity Commercial |
$397.22
|
| Rate for Payer: Cofinity Commercial |
$369.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.85
|
| Rate for Payer: Healthscope Commercial |
$510.32
|
| Rate for Payer: Healthscope Commercial |
$441.36
|
| Rate for Payer: Mclaren Medicaid |
$179.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.64
|
| Rate for Payer: Meridian Medicaid |
$188.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$303.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$561.08
|
| Rate for Payer: Nomi Health Commercial |
$331.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$767.25
|
| Rate for Payer: PACE SWMI |
$275.85
|
| Rate for Payer: PHP Medicare Advantage |
$275.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$482.15
|
| Rate for Payer: Priority Health Medicare |
$275.85
|
| Rate for Payer: Priority Health SBD |
$482.15
|
| Rate for Payer: Priority Health Tiered Network |
$482.15
|
| Rate for Payer: Railroad Medicare Medicare |
$275.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.04
|
| Rate for Payer: UHC Core |
$541.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$275.85
|
| Rate for Payer: UHC Exchange |
$541.04
|
| Rate for Payer: UHC Medicaid |
$179.56
|
| Rate for Payer: UHCCP Medicaid |
$179.56
|
|
|
PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN
|
Professional
|
Both
|
$2,913.00
|
|
|
Service Code
|
HCPCS 49020
|
| Min. Negotiated Rate |
$948.92 |
| Max. Negotiated Rate |
$2,913.05 |
| Rate for Payer: Aetna Commercial |
$1,983.00
|
| Rate for Payer: Aetna Medicare |
$1,539.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,983.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.98
|
| Rate for Payer: BCBS Complete |
$996.37
|
| Rate for Payer: BCBS MAPPO |
$1,479.85
|
| Rate for Payer: BCN Commercial |
$2,390.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,479.85
|
| Rate for Payer: Cash Price |
$2,330.40
|
| Rate for Payer: Cash Price |
$2,330.40
|
| Rate for Payer: Cofinity Commercial |
$2,130.98
|
| Rate for Payer: Cofinity Commercial |
$1,983.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,479.85
|
| Rate for Payer: Healthscope Commercial |
$2,737.72
|
| Rate for Payer: Healthscope Commercial |
$2,367.76
|
| Rate for Payer: Mclaren Medicaid |
$948.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,553.84
|
| Rate for Payer: Meridian Medicaid |
$996.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,627.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,844.56
|
| Rate for Payer: Nomi Health Commercial |
$1,775.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,184.75
|
| Rate for Payer: PACE SWMI |
$1,479.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,479.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$948.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,913.05
|
| Rate for Payer: Priority Health Medicare |
$1,479.85
|
| Rate for Payer: Priority Health SBD |
$2,913.05
|
| Rate for Payer: Priority Health Tiered Network |
$2,913.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1,479.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,837.51
|
| Rate for Payer: UHC Core |
$2,837.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,479.85
|
| Rate for Payer: UHC Exchange |
$2,837.51
|
| Rate for Payer: UHC Medicaid |
$948.92
|
| Rate for Payer: UHCCP Medicaid |
$948.92
|
|
|
PR DRAINAGE SCROTAL WALL ABSCESS
|
Professional
|
Both
|
$411.00
|
|
|
Service Code
|
HCPCS 55100
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$308.25 |
| Rate for Payer: Aetna Commercial |
$213.62
|
| Rate for Payer: Aetna Medicare |
$165.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.56
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$159.42
|
| Rate for Payer: BCN Commercial |
$254.47
|
| Rate for Payer: BCN Medicare Advantage |
$159.42
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cofinity Commercial |
$229.56
|
| Rate for Payer: Cofinity Commercial |
$213.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.42
|
| Rate for Payer: Healthscope Commercial |
$294.93
|
| Rate for Payer: Healthscope Commercial |
$255.07
|
| Rate for Payer: Mclaren Medicaid |
$104.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.39
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.54
|
| Rate for Payer: Nomi Health Commercial |
$191.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$308.25
|
| Rate for Payer: PACE SWMI |
$159.42
|
| Rate for Payer: PHP Medicare Advantage |
$159.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$277.20
|
| Rate for Payer: Priority Health Medicare |
$159.42
|
| Rate for Payer: Priority Health SBD |
$277.20
|
| Rate for Payer: Priority Health Tiered Network |
$277.20
|
| Rate for Payer: Railroad Medicare Medicare |
$159.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$290.72
|
| Rate for Payer: UHC Core |
$290.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.42
|
| Rate for Payer: UHC Exchange |
$290.72
|
| Rate for Payer: UHC Medicaid |
$104.58
|
| Rate for Payer: UHCCP Medicaid |
$104.58
|
|
|
PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
|
Professional
|
Both
|
$2,291.00
|
|
|
Service Code
|
HCPCS 49040
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$1,842.72 |
| Rate for Payer: Priority Health SBD |
$1,842.72
|
| Rate for Payer: Aetna Commercial |
$1,276.04
|
| Rate for Payer: Aetna Medicare |
$990.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.27
|
| Rate for Payer: BCBS Complete |
$642.10
|
| Rate for Payer: BCBS MAPPO |
$952.27
|
| Rate for Payer: BCN Commercial |
$1,512.37
|
| Rate for Payer: BCN Medicare Advantage |
$952.27
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Cash Price |
$1,832.80
|
| Rate for Payer: Cofinity Commercial |
$1,371.27
|
| Rate for Payer: Cofinity Commercial |
$1,276.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$952.27
|
| Rate for Payer: Healthscope Commercial |
$1,761.70
|
| Rate for Payer: Healthscope Commercial |
$1,523.63
|
| Rate for Payer: Mclaren Medicaid |
$611.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$999.88
|
| Rate for Payer: Meridian Medicaid |
$642.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,047.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,794.31
|
| Rate for Payer: Nomi Health Commercial |
$1,142.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,718.25
|
| Rate for Payer: PACE SWMI |
$952.27
|
| Rate for Payer: PHP Medicare Advantage |
$952.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$611.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,842.72
|
| Rate for Payer: Priority Health Medicare |
$952.27
|
| Rate for Payer: Priority Health Tiered Network |
$1,842.72
|
| Rate for Payer: Railroad Medicare Medicare |
$952.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,783.34
|
| Rate for Payer: UHC Core |
$1,783.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$952.27
|
| Rate for Payer: UHC Exchange |
$1,783.34
|
| Rate for Payer: UHC Medicaid |
$611.52
|
| Rate for Payer: UHCCP Medicaid |
$611.52
|
|
|
PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 26020
|
| Min. Negotiated Rate |
$339.31 |
| Max. Negotiated Rate |
$986.35 |
| Rate for Payer: Aetna Commercial |
$689.59
|
| Rate for Payer: Aetna Medicare |
$535.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$741.05
|
| Rate for Payer: BCBS Complete |
$356.28
|
| Rate for Payer: BCBS MAPPO |
$514.62
|
| Rate for Payer: BCN Commercial |
$856.03
|
| Rate for Payer: BCN Medicare Advantage |
$514.62
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$741.05
|
| Rate for Payer: Cofinity Commercial |
$689.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$514.62
|
| Rate for Payer: Healthscope Commercial |
$952.05
|
| Rate for Payer: Healthscope Commercial |
$823.39
|
| Rate for Payer: Mclaren Medicaid |
$339.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$540.35
|
| Rate for Payer: Meridian Medicaid |
$356.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$566.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.35
|
| Rate for Payer: Nomi Health Commercial |
$617.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$591.00
|
| Rate for Payer: PACE SWMI |
$514.62
|
| Rate for Payer: PHP Medicare Advantage |
$514.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$339.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$915.08
|
| Rate for Payer: Priority Health Medicare |
$514.62
|
| Rate for Payer: Priority Health SBD |
$915.08
|
| Rate for Payer: Priority Health Tiered Network |
$915.08
|
| Rate for Payer: Railroad Medicare Medicare |
$514.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$960.13
|
| Rate for Payer: UHC Core |
$960.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$514.62
|
| Rate for Payer: UHC Exchange |
$960.13
|
| Rate for Payer: UHC Medicaid |
$339.31
|
| Rate for Payer: UHCCP Medicaid |
$339.31
|
|
|
PR DRESSING CHANGE UNDER ANESTHESIA
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 15852
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Aetna Commercial |
$51.83
|
| Rate for Payer: Aetna Medicare |
$40.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.70
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.68
|
| Rate for Payer: BCN Commercial |
$66.24
|
| Rate for Payer: BCN Medicare Advantage |
$38.68
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$55.70
|
| Rate for Payer: Cofinity Commercial |
$51.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.68
|
| Rate for Payer: Healthscope Commercial |
$71.56
|
| Rate for Payer: Healthscope Commercial |
$61.89
|
| Rate for Payer: Mclaren Medicaid |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.61
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.51
|
| Rate for Payer: Nomi Health Commercial |
$46.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PACE SWMI |
$38.68
|
| Rate for Payer: PHP Medicare Advantage |
$38.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$60.62
|
| Rate for Payer: Priority Health Medicare |
$38.68
|
| Rate for Payer: Priority Health SBD |
$60.62
|
| Rate for Payer: Priority Health Tiered Network |
$60.62
|
| Rate for Payer: Railroad Medicare Medicare |
$38.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.27
|
| Rate for Payer: UHC Core |
$82.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.68
|
| Rate for Payer: UHC Exchange |
$82.27
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 41800
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$431.25 |
| Rate for Payer: Aetna Commercial |
$238.63
|
| Rate for Payer: Aetna Medicare |
$185.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.44
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS MAPPO |
$178.08
|
| Rate for Payer: BCN Commercial |
$239.53
|
| Rate for Payer: BCN Medicare Advantage |
$178.08
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$256.44
|
| Rate for Payer: Cofinity Commercial |
$238.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.08
|
| Rate for Payer: Healthscope Commercial |
$329.45
|
| Rate for Payer: Healthscope Commercial |
$284.93
|
| Rate for Payer: Mclaren Medicaid |
$120.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.98
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.84
|
| Rate for Payer: Nomi Health Commercial |
$213.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$431.25
|
| Rate for Payer: PACE SWMI |
$178.08
|
| Rate for Payer: PHP Medicare Advantage |
$178.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$291.86
|
| Rate for Payer: Priority Health Medicare |
$178.08
|
| Rate for Payer: Priority Health SBD |
$291.86
|
| Rate for Payer: Priority Health Tiered Network |
$291.86
|
| Rate for Payer: Railroad Medicare Medicare |
$178.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$259.03
|
| Rate for Payer: UHC Core |
$259.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.08
|
| Rate for Payer: UHC Exchange |
$259.03
|
| Rate for Payer: UHC Medicaid |
$120.56
|
| Rate for Payer: UHCCP Medicaid |
$120.56
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 40801
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$488.25 |
| Rate for Payer: Aetna Commercial |
$244.95
|
| Rate for Payer: Aetna Medicare |
$190.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.23
|
| Rate for Payer: BCBS Complete |
$126.81
|
| Rate for Payer: BCBS MAPPO |
$182.80
|
| Rate for Payer: BCN Commercial |
$304.76
|
| Rate for Payer: BCN Medicare Advantage |
$182.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cofinity Commercial |
$263.23
|
| Rate for Payer: Cofinity Commercial |
$244.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.80
|
| Rate for Payer: Healthscope Commercial |
$338.18
|
| Rate for Payer: Healthscope Commercial |
$292.48
|
| Rate for Payer: Mclaren Medicaid |
$120.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.94
|
| Rate for Payer: Meridian Medicaid |
$126.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.20
|
| Rate for Payer: Nomi Health Commercial |
$219.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$488.25
|
| Rate for Payer: PACE SWMI |
$182.80
|
| Rate for Payer: PHP Medicare Advantage |
$182.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$371.33
|
| Rate for Payer: Priority Health Medicare |
$182.80
|
| Rate for Payer: Priority Health SBD |
$371.33
|
| Rate for Payer: Priority Health Tiered Network |
$371.33
|
| Rate for Payer: Railroad Medicare Medicare |
$182.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.87
|
| Rate for Payer: UHC Core |
$357.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.80
|
| Rate for Payer: UHC Exchange |
$357.87
|
| Rate for Payer: UHC Medicaid |
$120.77
|
| Rate for Payer: UHCCP Medicaid |
$120.77
|
|
|
PR DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 40800
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$367.50 |
| Rate for Payer: Aetna Commercial |
$148.02
|
| Rate for Payer: Aetna Medicare |
$114.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.06
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCBS MAPPO |
$110.46
|
| Rate for Payer: BCN Commercial |
$181.76
|
| Rate for Payer: BCN Medicare Advantage |
$110.46
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$159.06
|
| Rate for Payer: Cofinity Commercial |
$148.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.46
|
| Rate for Payer: Healthscope Commercial |
$204.35
|
| Rate for Payer: Healthscope Commercial |
$176.74
|
| Rate for Payer: Mclaren Medicaid |
$73.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.98
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.59
|
| Rate for Payer: Nomi Health Commercial |
$132.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$367.50
|
| Rate for Payer: PACE SWMI |
$110.46
|
| Rate for Payer: PHP Medicare Advantage |
$110.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$221.46
|
| Rate for Payer: Priority Health Medicare |
$110.46
|
| Rate for Payer: Priority Health SBD |
$221.46
|
| Rate for Payer: Priority Health Tiered Network |
$221.46
|
| Rate for Payer: Railroad Medicare Medicare |
$110.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.76
|
| Rate for Payer: UHC Core |
$211.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.46
|
| Rate for Payer: UHC Exchange |
$211.76
|
| Rate for Payer: UHC Medicaid |
$73.91
|
| Rate for Payer: UHCCP Medicaid |
$73.91
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 38305
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,001.86 |
| Rate for Payer: Aetna Commercial |
$643.27
|
| Rate for Payer: Aetna Medicare |
$499.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.27
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$480.05
|
| Rate for Payer: BCN Commercial |
$752.95
|
| Rate for Payer: BCN Medicare Advantage |
$480.05
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cofinity Commercial |
$691.27
|
| Rate for Payer: Cofinity Commercial |
$643.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.05
|
| Rate for Payer: Healthscope Commercial |
$888.09
|
| Rate for Payer: Healthscope Commercial |
$768.08
|
| Rate for Payer: Mclaren Medicaid |
$313.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.05
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$877.70
|
| Rate for Payer: Nomi Health Commercial |
$576.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$817.50
|
| Rate for Payer: PACE SWMI |
$480.05
|
| Rate for Payer: PHP Medicare Advantage |
$480.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,001.86
|
| Rate for Payer: Priority Health Medicare |
$480.05
|
| Rate for Payer: Priority Health SBD |
$1,001.86
|
| Rate for Payer: Priority Health Tiered Network |
$1,001.86
|
| Rate for Payer: Railroad Medicare Medicare |
$480.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.13
|
| Rate for Payer: UHC Core |
$856.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.05
|
| Rate for Payer: UHC Exchange |
$856.13
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
|
|
PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL
|
Professional
|
Both
|
$469.00
|
|
|
Service Code
|
HCPCS 38300
|
| Min. Negotiated Rate |
$137.81 |
| Max. Negotiated Rate |
$425.38 |
| Rate for Payer: Priority Health SBD |
$425.38
|
| Rate for Payer: Aetna Commercial |
$279.24
|
| Rate for Payer: Aetna Medicare |
$216.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.08
|
| Rate for Payer: BCBS Complete |
$144.70
|
| Rate for Payer: BCBS MAPPO |
$208.39
|
| Rate for Payer: BCN Commercial |
$319.70
|
| Rate for Payer: BCN Medicare Advantage |
$208.39
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cash Price |
$375.20
|
| Rate for Payer: Cofinity Commercial |
$300.08
|
| Rate for Payer: Cofinity Commercial |
$279.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.39
|
| Rate for Payer: Healthscope Commercial |
$385.52
|
| Rate for Payer: Healthscope Commercial |
$333.42
|
| Rate for Payer: Mclaren Medicaid |
$137.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$218.81
|
| Rate for Payer: Meridian Medicaid |
$144.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$229.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.72
|
| Rate for Payer: Nomi Health Commercial |
$250.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.75
|
| Rate for Payer: PACE SWMI |
$208.39
|
| Rate for Payer: PHP Medicare Advantage |
$208.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$425.38
|
| Rate for Payer: Priority Health Medicare |
$208.39
|
| Rate for Payer: Priority Health Tiered Network |
$425.38
|
| Rate for Payer: Railroad Medicare Medicare |
$208.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.19
|
| Rate for Payer: UHC Core |
$355.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$208.39
|
| Rate for Payer: UHC Exchange |
$355.19
|
| Rate for Payer: UHC Medicaid |
$137.81
|
| Rate for Payer: UHCCP Medicaid |
$137.81
|
|
|
PR DRG OF SKENE'S GLAND ABSCESS OR CYST
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 53060
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Aetna Commercial |
$196.77
|
| Rate for Payer: Aetna Medicare |
$152.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.45
|
| Rate for Payer: BCBS Complete |
$99.75
|
| Rate for Payer: BCBS MAPPO |
$146.84
|
| Rate for Payer: BCN Commercial |
$250.98
|
| Rate for Payer: BCN Medicare Advantage |
$146.84
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$211.45
|
| Rate for Payer: Cofinity Commercial |
$196.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.84
|
| Rate for Payer: Healthscope Commercial |
$271.65
|
| Rate for Payer: Healthscope Commercial |
$234.94
|
| Rate for Payer: Mclaren Medicaid |
$95.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.18
|
| Rate for Payer: Meridian Medicaid |
$99.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.15
|
| Rate for Payer: Nomi Health Commercial |
$176.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.75
|
| Rate for Payer: PACE SWMI |
$146.84
|
| Rate for Payer: PHP Medicare Advantage |
$146.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$273.41
|
| Rate for Payer: Priority Health Medicare |
$146.84
|
| Rate for Payer: Priority Health SBD |
$273.41
|
| Rate for Payer: Priority Health Tiered Network |
$273.41
|
| Rate for Payer: Railroad Medicare Medicare |
$146.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.37
|
| Rate for Payer: UHC Core |
$292.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.84
|
| Rate for Payer: UHC Exchange |
$292.37
|
| Rate for Payer: UHC Medicaid |
$95.00
|
| Rate for Payer: UHCCP Medicaid |
$95.00
|
|
|
PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 16030
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Aetna Commercial |
$162.43
|
| Rate for Payer: Aetna Medicare |
$126.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.56
|
| Rate for Payer: BCBS Complete |
$82.30
|
| Rate for Payer: BCBS MAPPO |
$121.22
|
| Rate for Payer: BCN Commercial |
$199.19
|
| Rate for Payer: BCN Medicare Advantage |
$121.22
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$174.56
|
| Rate for Payer: Cofinity Commercial |
$162.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.22
|
| Rate for Payer: Healthscope Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$193.95
|
| Rate for Payer: Mclaren Medicaid |
$78.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.28
|
| Rate for Payer: Meridian Medicaid |
$82.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.60
|
| Rate for Payer: Nomi Health Commercial |
$145.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.50
|
| Rate for Payer: PACE SWMI |
$121.22
|
| Rate for Payer: PHP Medicare Advantage |
$121.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$182.32
|
| Rate for Payer: Priority Health Medicare |
$121.22
|
| Rate for Payer: Priority Health SBD |
$182.32
|
| Rate for Payer: Priority Health Tiered Network |
$182.32
|
| Rate for Payer: Railroad Medicare Medicare |
$121.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.70
|
| Rate for Payer: UHC Core |
$233.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$121.22
|
| Rate for Payer: UHC Exchange |
$233.70
|
| Rate for Payer: UHC Medicaid |
$78.38
|
| Rate for Payer: UHCCP Medicaid |
$78.38
|
|
