|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$789.39 |
| Max. Negotiated Rate |
$1,127.70 |
| Rate for Payer: Aetna Commercial |
$1,065.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.45
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.58
|
| Rate for Payer: Cofinity Commercial |
$877.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$877.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,002.40
|
| Rate for Payer: Healthscope Commercial |
$1,127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,065.05
|
| Rate for Payer: PHP Commercial |
$1,065.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health SBD |
$789.39
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 24120
|
| Hospital Charge Code |
24120
|
| Min. Negotiated Rate |
$501.20 |
| Max. Negotiated Rate |
$957.54 |
| Rate for Payer: Aetna Commercial |
$693.57
|
| Rate for Payer: Aetna Medicare |
$538.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.33
|
| Rate for Payer: BCBS Complete |
$501.20
|
| Rate for Payer: BCBS MAPPO |
$517.59
|
| Rate for Payer: BCN Medicare Advantage |
$517.59
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$745.33
|
| Rate for Payer: Cofinity Commercial |
$693.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$517.59
|
| Rate for Payer: Healthscope Commercial |
$828.14
|
| Rate for Payer: Healthscope Commercial |
$957.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$543.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$814.45
|
| Rate for Payer: Nomi Health Commercial |
$621.11
|
| Rate for Payer: PACE SWMI |
$517.59
|
| Rate for Payer: PHP Medicare Advantage |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health Medicare |
$517.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$517.59
|
| Rate for Payer: UHC Medicare Advantage |
$517.59
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 23155
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,427.33 |
| Rate for Payer: Aetna Commercial |
$1,033.85
|
| Rate for Payer: Aetna Medicare |
$802.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.85
|
| Rate for Payer: BCBS Complete |
$564.40
|
| Rate for Payer: BCBS MAPPO |
$771.53
|
| Rate for Payer: BCN Medicare Advantage |
$771.53
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$1,111.00
|
| Rate for Payer: Cofinity Commercial |
$1,033.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.53
|
| Rate for Payer: Healthscope Commercial |
$1,234.45
|
| Rate for Payer: Healthscope Commercial |
$1,427.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$917.15
|
| Rate for Payer: Nomi Health Commercial |
$925.84
|
| Rate for Payer: PACE SWMI |
$771.53
|
| Rate for Payer: PHP Medicare Advantage |
$771.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health Medicare |
$771.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.53
|
| Rate for Payer: UHC Medicare Advantage |
$771.53
|
|
|
PR EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 23156
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$1,218.45 |
| Rate for Payer: Aetna Commercial |
$882.55
|
| Rate for Payer: Aetna Medicare |
$684.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.55
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$658.62
|
| Rate for Payer: BCN Medicare Advantage |
$658.62
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$948.41
|
| Rate for Payer: Cofinity Commercial |
$882.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.62
|
| Rate for Payer: Healthscope Commercial |
$1,218.45
|
| Rate for Payer: Healthscope Commercial |
$1,053.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.35
|
| Rate for Payer: Nomi Health Commercial |
$790.34
|
| Rate for Payer: PACE SWMI |
$658.62
|
| Rate for Payer: PHP Medicare Advantage |
$658.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$658.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.62
|
| Rate for Payer: UHC Medicare Advantage |
$658.62
|
|
|
PR EXC/CURTG CST/B9 TUM PHALANGES FOOT
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 28108
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$511.64 |
| Rate for Payer: Aetna Commercial |
$370.59
|
| Rate for Payer: Aetna Medicare |
$287.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.59
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$276.56
|
| Rate for Payer: BCN Medicare Advantage |
$276.56
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$398.25
|
| Rate for Payer: Cofinity Commercial |
$370.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$276.56
|
| Rate for Payer: Healthscope Commercial |
$442.50
|
| Rate for Payer: Healthscope Commercial |
$511.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.80
|
| Rate for Payer: Nomi Health Commercial |
$331.87
|
| Rate for Payer: PACE SWMI |
$276.56
|
| Rate for Payer: PHP Medicare Advantage |
$276.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$276.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$276.56
|
| Rate for Payer: UHC Medicare Advantage |
$276.56
|
|
|
PR EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 28106
|
| Min. Negotiated Rate |
$384.40 |
| Max. Negotiated Rate |
$754.91 |
| Rate for Payer: Aetna Commercial |
$546.80
|
| Rate for Payer: Aetna Medicare |
$424.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.80
|
| Rate for Payer: BCBS Complete |
$384.40
|
| Rate for Payer: BCBS MAPPO |
$408.06
|
| Rate for Payer: BCN Medicare Advantage |
$408.06
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cofinity Commercial |
$587.61
|
| Rate for Payer: Cofinity Commercial |
$546.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.06
|
| Rate for Payer: Healthscope Commercial |
$754.91
|
| Rate for Payer: Healthscope Commercial |
$652.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.65
|
| Rate for Payer: Nomi Health Commercial |
$489.67
|
| Rate for Payer: PACE SWMI |
$408.06
|
| Rate for Payer: PHP Medicare Advantage |
$408.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$624.65
|
| Rate for Payer: Priority Health Medicare |
$408.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$408.06
|
| Rate for Payer: UHC Medicare Advantage |
$408.06
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 25136
|
| Min. Negotiated Rate |
$401.20 |
| Max. Negotiated Rate |
$893.62 |
| Rate for Payer: Aetna Commercial |
$647.27
|
| Rate for Payer: Aetna Medicare |
$502.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$695.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.27
|
| Rate for Payer: BCBS Complete |
$401.20
|
| Rate for Payer: BCBS MAPPO |
$483.04
|
| Rate for Payer: BCN Medicare Advantage |
$483.04
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cofinity Commercial |
$695.58
|
| Rate for Payer: Cofinity Commercial |
$647.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.04
|
| Rate for Payer: Healthscope Commercial |
$772.86
|
| Rate for Payer: Healthscope Commercial |
$893.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$507.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.95
|
| Rate for Payer: Nomi Health Commercial |
$579.65
|
| Rate for Payer: PACE SWMI |
$483.04
|
| Rate for Payer: PHP Medicare Advantage |
$483.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$651.95
|
| Rate for Payer: Priority Health Medicare |
$483.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.04
|
| Rate for Payer: UHC Medicare Advantage |
$483.04
|
|
|
PR EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
HCPCS 25135
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,008.07 |
| Rate for Payer: Aetna Commercial |
$730.17
|
| Rate for Payer: Aetna Medicare |
$566.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$784.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$730.17
|
| Rate for Payer: BCBS Complete |
$404.40
|
| Rate for Payer: BCBS MAPPO |
$544.90
|
| Rate for Payer: BCN Medicare Advantage |
$544.90
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cash Price |
$808.80
|
| Rate for Payer: Cofinity Commercial |
$784.66
|
| Rate for Payer: Cofinity Commercial |
$730.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.90
|
| Rate for Payer: Healthscope Commercial |
$871.84
|
| Rate for Payer: Healthscope Commercial |
$1,008.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$572.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$657.15
|
| Rate for Payer: Nomi Health Commercial |
$653.88
|
| Rate for Payer: PACE SWMI |
$544.90
|
| Rate for Payer: PHP Medicare Advantage |
$544.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.15
|
| Rate for Payer: Priority Health Medicare |
$544.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.90
|
| Rate for Payer: UHC Medicare Advantage |
$544.90
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
HCPCS 25126
|
| Min. Negotiated Rate |
$486.40 |
| Max. Negotiated Rate |
$1,075.61 |
| Rate for Payer: Aetna Commercial |
$779.09
|
| Rate for Payer: Aetna Medicare |
$604.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.09
|
| Rate for Payer: BCBS Complete |
$486.40
|
| Rate for Payer: BCBS MAPPO |
$581.41
|
| Rate for Payer: BCN Medicare Advantage |
$581.41
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cash Price |
$972.80
|
| Rate for Payer: Cofinity Commercial |
$837.23
|
| Rate for Payer: Cofinity Commercial |
$779.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$581.41
|
| Rate for Payer: Healthscope Commercial |
$1,075.61
|
| Rate for Payer: Healthscope Commercial |
$930.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$610.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$790.40
|
| Rate for Payer: Nomi Health Commercial |
$697.69
|
| Rate for Payer: PACE SWMI |
$581.41
|
| Rate for Payer: PHP Medicare Advantage |
$581.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$790.40
|
| Rate for Payer: Priority Health Medicare |
$581.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$581.41
|
| Rate for Payer: UHC Medicare Advantage |
$581.41
|
|
|
PR EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 25125
|
| Min. Negotiated Rate |
$577.59 |
| Max. Negotiated Rate |
$1,507.35 |
| Rate for Payer: Aetna Commercial |
$773.97
|
| Rate for Payer: Aetna Medicare |
$600.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.97
|
| Rate for Payer: BCBS Complete |
$927.60
|
| Rate for Payer: BCBS MAPPO |
$577.59
|
| Rate for Payer: BCN Medicare Advantage |
$577.59
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cofinity Commercial |
$831.73
|
| Rate for Payer: Cofinity Commercial |
$773.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.59
|
| Rate for Payer: Healthscope Commercial |
$924.14
|
| Rate for Payer: Healthscope Commercial |
$1,068.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,507.35
|
| Rate for Payer: Nomi Health Commercial |
$693.11
|
| Rate for Payer: PACE SWMI |
$577.59
|
| Rate for Payer: PHP Medicare Advantage |
$577.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,507.35
|
| Rate for Payer: Priority Health Medicare |
$577.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.59
|
| Rate for Payer: UHC Medicare Advantage |
$577.59
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$662.76 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Aetna Commercial |
$894.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.80
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$736.40
|
| Rate for Payer: Cofinity Commercial |
$904.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Healthscope Commercial |
$946.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.20
|
| Rate for Payer: PHP Commercial |
$894.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health SBD |
$662.76
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
19120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$662.76 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna Commercial |
$894.20
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$904.72
|
| Rate for Payer: Cofinity Commercial |
$736.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$736.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$841.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$946.80
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$894.20
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$894.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$662.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,102.59
|
| Rate for Payer: VA VA |
$3,734.62
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Min. Negotiated Rate |
$405.42 |
| Max. Negotiated Rate |
$750.03 |
| Rate for Payer: Aetna Commercial |
$543.26
|
| Rate for Payer: Aetna Medicare |
$421.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.26
|
| Rate for Payer: BCBS Complete |
$420.80
|
| Rate for Payer: BCBS MAPPO |
$405.42
|
| Rate for Payer: BCN Medicare Advantage |
$405.42
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$543.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.42
|
| Rate for Payer: Healthscope Commercial |
$648.67
|
| Rate for Payer: Healthscope Commercial |
$750.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.80
|
| Rate for Payer: Nomi Health Commercial |
$486.50
|
| Rate for Payer: PACE SWMI |
$405.42
|
| Rate for Payer: PHP Medicare Advantage |
$405.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health Medicare |
$405.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.42
|
| Rate for Payer: UHC Medicare Advantage |
$405.42
|
|
|
PR EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
HCPCS 19120
|
| Hospital Charge Code |
19120
|
| Min. Negotiated Rate |
$405.42 |
| Max. Negotiated Rate |
$750.03 |
| Rate for Payer: Aetna Commercial |
$543.26
|
| Rate for Payer: Aetna Medicare |
$421.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$543.26
|
| Rate for Payer: BCBS Complete |
$420.80
|
| Rate for Payer: BCBS MAPPO |
$405.42
|
| Rate for Payer: BCN Medicare Advantage |
$405.42
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Cofinity Commercial |
$543.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.42
|
| Rate for Payer: Healthscope Commercial |
$648.67
|
| Rate for Payer: Healthscope Commercial |
$750.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.80
|
| Rate for Payer: Nomi Health Commercial |
$486.50
|
| Rate for Payer: PACE SWMI |
$405.42
|
| Rate for Payer: PHP Medicare Advantage |
$405.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.80
|
| Rate for Payer: Priority Health Medicare |
$405.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$405.42
|
| Rate for Payer: UHC Medicare Advantage |
$405.42
|
|
|
PR EXC CYST/ADENOMA THYROID/TRANSECTION ISTHMUS
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 60200
|
| Min. Negotiated Rate |
$564.40 |
| Max. Negotiated Rate |
$1,190.60 |
| Rate for Payer: Aetna Commercial |
$862.38
|
| Rate for Payer: Aetna Medicare |
$669.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.38
|
| Rate for Payer: BCBS Complete |
$564.40
|
| Rate for Payer: BCBS MAPPO |
$643.57
|
| Rate for Payer: BCN Medicare Advantage |
$643.57
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$926.74
|
| Rate for Payer: Cofinity Commercial |
$862.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.57
|
| Rate for Payer: Healthscope Commercial |
$1,029.71
|
| Rate for Payer: Healthscope Commercial |
$1,190.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$917.15
|
| Rate for Payer: Nomi Health Commercial |
$772.28
|
| Rate for Payer: PACE SWMI |
$643.57
|
| Rate for Payer: PHP Medicare Advantage |
$643.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$917.15
|
| Rate for Payer: Priority Health Medicare |
$643.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.57
|
| Rate for Payer: UHC Medicare Advantage |
$643.57
|
|
|
PR EXC/DESTRUCTION OPEN ABDMNL TUMORS 5.1-10.0 CM
|
Professional
|
Both
|
$3,970.00
|
|
|
Service Code
|
HCPCS 49204
|
| Min. Negotiated Rate |
$1,588.00 |
| Max. Negotiated Rate |
$2,580.50 |
| Rate for Payer: Aetna Medicare |
$1,985.00
|
| Rate for Payer: BCBS Complete |
$1,588.00
|
| Rate for Payer: Cash Price |
$3,176.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,580.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,580.50
|
|
|
PR EXC/DESTRUCTION OPEN ABDOMINAL TUMORS >10.0 CM
|
Professional
|
Both
|
$3,208.00
|
|
|
Service Code
|
HCPCS 49205
|
| Min. Negotiated Rate |
$1,283.20 |
| Max. Negotiated Rate |
$2,085.20 |
| Rate for Payer: Aetna Medicare |
$1,604.00
|
| Rate for Payer: BCBS Complete |
$1,283.20
|
| Rate for Payer: Cash Price |
$2,566.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,085.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,085.20
|
|
|
PR EXC/DSTRJ LINGUAL TONSIL ANY METHOD SPX
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 42870
|
| Min. Negotiated Rate |
$420.40 |
| Max. Negotiated Rate |
$1,006.86 |
| Rate for Payer: Aetna Commercial |
$729.29
|
| Rate for Payer: Aetna Medicare |
$566.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$783.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$729.29
|
| Rate for Payer: BCBS Complete |
$420.40
|
| Rate for Payer: BCBS MAPPO |
$544.25
|
| Rate for Payer: BCN Medicare Advantage |
$544.25
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cofinity Commercial |
$783.72
|
| Rate for Payer: Cofinity Commercial |
$729.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.25
|
| Rate for Payer: Healthscope Commercial |
$870.80
|
| Rate for Payer: Healthscope Commercial |
$1,006.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$571.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$683.15
|
| Rate for Payer: Nomi Health Commercial |
$653.10
|
| Rate for Payer: PACE SWMI |
$544.25
|
| Rate for Payer: PHP Medicare Advantage |
$544.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health Medicare |
$544.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.25
|
| Rate for Payer: UHC Medicare Advantage |
$544.25
|
|
|
PR EXC EXCSV SKN ABD INFRAUMBILICAL PANNICULECTOMY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 15830
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$2,083.84 |
| Rate for Payer: Aetna Commercial |
$1,509.38
|
| Rate for Payer: Aetna Medicare |
$1,171.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,622.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.38
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,126.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,126.40
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,622.02
|
| Rate for Payer: Cofinity Commercial |
$1,509.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,126.40
|
| Rate for Payer: Healthscope Commercial |
$1,802.24
|
| Rate for Payer: Healthscope Commercial |
$2,083.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,182.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Nomi Health Commercial |
$1,351.68
|
| Rate for Payer: PACE SWMI |
$1,126.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,126.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,126.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,126.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,126.40
|
|
|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$826.08 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,106.95
|
| Rate for Payer: Aetna Medicare |
$859.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,189.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,106.95
|
| Rate for Payer: BCBS Complete |
$1,060.40
|
| Rate for Payer: BCBS MAPPO |
$826.08
|
| Rate for Payer: BCN Medicare Advantage |
$826.08
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,189.56
|
| Rate for Payer: Cofinity Commercial |
$1,106.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.08
|
| Rate for Payer: Healthscope Commercial |
$1,528.25
|
| Rate for Payer: Healthscope Commercial |
$1,321.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.15
|
| Rate for Payer: Nomi Health Commercial |
$991.30
|
| Rate for Payer: PACE SWMI |
$826.08
|
| Rate for Payer: PHP Medicare Advantage |
$826.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.15
|
| Rate for Payer: Priority Health Medicare |
$826.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.08
|
| Rate for Payer: UHC Medicare Advantage |
$826.08
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$189.81 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$254.35
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.35
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: BCBS MAPPO |
$189.81
|
| Rate for Payer: BCN Medicare Advantage |
$189.81
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$273.33
|
| Rate for Payer: Cofinity Commercial |
$254.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.81
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: Healthscope Commercial |
$351.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.50
|
| Rate for Payer: Nomi Health Commercial |
$227.77
|
| Rate for Payer: PACE SWMI |
$189.81
|
| Rate for Payer: PHP Medicare Advantage |
$189.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$189.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.81
|
| Rate for Payer: UHC Medicare Advantage |
$189.81
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$164.80 |
| Max. Negotiated Rate |
$336.77 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.93
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Healthscope Commercial |
$336.77
|
| Rate for Payer: Healthscope Commercial |
$291.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.80
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$322.01 |
| Rate for Payer: Aetna Commercial |
$233.24
|
| Rate for Payer: Aetna Medicare |
$181.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.24
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$174.06
|
| Rate for Payer: BCN Medicare Advantage |
$174.06
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$250.65
|
| Rate for Payer: Cofinity Commercial |
$233.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.06
|
| Rate for Payer: Healthscope Commercial |
$278.50
|
| Rate for Payer: Healthscope Commercial |
$322.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.75
|
| Rate for Payer: Nomi Health Commercial |
$208.87
|
| Rate for Payer: PACE SWMI |
$174.06
|
| Rate for Payer: PHP Medicare Advantage |
$174.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health Medicare |
$174.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.06
|
| Rate for Payer: UHC Medicare Advantage |
$174.06
|
|
|
PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 50435
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$828.10 |
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Medicare |
$97.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.16
|
| Rate for Payer: BCBS Complete |
$509.60
|
| Rate for Payer: BCBS MAPPO |
$93.40
|
| Rate for Payer: BCN Medicare Advantage |
$93.40
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Commercial |
$125.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.40
|
| Rate for Payer: Healthscope Commercial |
$172.79
|
| Rate for Payer: Healthscope Commercial |
$149.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.10
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: PACE SWMI |
$93.40
|
| Rate for Payer: PHP Medicare Advantage |
$93.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health Medicare |
$93.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.40
|
| Rate for Payer: UHC Medicare Advantage |
$93.40
|
|
|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$66.56 |
| Max. Negotiated Rate |
$828.10 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.19
|
| Rate for Payer: BCBS Complete |
$509.60
|
| Rate for Payer: BCBS MAPPO |
$66.56
|
| Rate for Payer: BCN Medicare Advantage |
$66.56
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$95.85
|
| Rate for Payer: Cofinity Commercial |
$89.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.56
|
| Rate for Payer: Healthscope Commercial |
$106.50
|
| Rate for Payer: Healthscope Commercial |
$123.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.10
|
| Rate for Payer: Nomi Health Commercial |
$79.87
|
| Rate for Payer: PACE SWMI |
$66.56
|
| Rate for Payer: PHP Medicare Advantage |
$66.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health Medicare |
$66.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.56
|
| Rate for Payer: UHC Medicare Advantage |
$66.56
|
|
