|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Facility
|
OP
|
$1,270.00
|
|
|
Service Code
|
CPT 55520
|
| Hospital Charge Code |
55520
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$492.08 |
| Max. Negotiated Rate |
$10,620.87 |
| Rate for Payer: Aetna Commercial |
$1,079.50
|
| Rate for Payer: Aetna Medicare |
$3,514.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,224.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,224.04
|
| Rate for Payer: BCBS Complete |
$1,901.83
|
| Rate for Payer: BCBS MAPPO |
$3,379.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,055.55
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: BCN Medicare Advantage |
$3,379.23
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$889.00
|
| Rate for Payer: Cofinity Commercial |
$1,092.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$889.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,016.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,379.23
|
| Rate for Payer: Healthscope Commercial |
$1,143.00
|
| Rate for Payer: Mclaren Medicaid |
$1,811.27
|
| Rate for Payer: Mclaren Medicare |
$3,379.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,548.19
|
| Rate for Payer: Meridian Medicaid |
$1,901.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,886.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,079.50
|
| Rate for Payer: Nomi Health Commercial |
$7,096.38
|
| Rate for Payer: PACE Medicare |
$3,210.27
|
| Rate for Payer: PACE SWMI |
$3,379.23
|
| Rate for Payer: PHP Commercial |
$1,079.50
|
| Rate for Payer: PHP Medicare Advantage |
$3,379.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,811.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,620.87
|
| Rate for Payer: Priority Health Medicare |
$3,379.23
|
| Rate for Payer: Priority Health Narrow Network |
$8,496.70
|
| Rate for Payer: Priority Health SBD |
$800.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,379.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.08
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,379.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,379.23
|
| Rate for Payer: UHCCP Medicaid |
$1,902.51
|
| Rate for Payer: VA VA |
$3,379.23
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$950.40 |
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health SBD |
$665.28
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$56,003.00 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Healthscope Commercial |
$565.79
|
| Rate for Payer: Healthscope Commercial |
$489.33
|
| Rate for Payer: Mclaren Medicaid |
$209.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,003.00
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Exchange |
$839.09
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$337.46 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Commercial |
$897.60
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$686.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$997.30
|
| Rate for Payer: BCN Commercial |
$997.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$908.16
|
| Rate for Payer: Cofinity Commercial |
$739.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$739.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$844.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$950.40
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$897.60
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$897.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$665.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.46
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$56,003.00 |
| Rate for Payer: Aetna Commercial |
$409.81
|
| Rate for Payer: Aetna Medicare |
$318.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.40
|
| Rate for Payer: BCBS Complete |
$220.07
|
| Rate for Payer: BCBS MAPPO |
$305.83
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$305.83
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$440.40
|
| Rate for Payer: Cofinity Commercial |
$409.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.83
|
| Rate for Payer: Healthscope Commercial |
$565.79
|
| Rate for Payer: Healthscope Commercial |
$489.33
|
| Rate for Payer: Mclaren Medicaid |
$209.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.12
|
| Rate for Payer: Meridian Medicaid |
$220.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56,003.00
|
| Rate for Payer: Nomi Health Commercial |
$367.00
|
| Rate for Payer: PACE SWMI |
$305.83
|
| Rate for Payer: PHP Medicare Advantage |
$305.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$495.63
|
| Rate for Payer: Priority Health Medicare |
$305.83
|
| Rate for Payer: Priority Health Narrow Network |
$495.63
|
| Rate for Payer: Priority Health SBD |
$495.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.83
|
| Rate for Payer: UHC Exchange |
$839.09
|
| Rate for Payer: UHC Medicare Advantage |
$305.83
|
| Rate for Payer: UHCCP Medicaid |
$209.59
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$558.18 |
| Max. Negotiated Rate |
$797.40 |
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health SBD |
$558.18
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$326.15 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$575.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.51
|
| Rate for Payer: BCN Commercial |
$1,089.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$761.96
|
| Rate for Payer: Cofinity Commercial |
$620.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$620.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$708.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$797.40
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753.10
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$753.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$558.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.15
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$54,056.00 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Healthscope Commercial |
$547.08
|
| Rate for Payer: Healthscope Commercial |
$473.15
|
| Rate for Payer: Mclaren Medicaid |
$201.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,056.00
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: Priority Health SBD |
$476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Exchange |
$500.79
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$54,056.00 |
| Rate for Payer: Aetna Commercial |
$396.26
|
| Rate for Payer: Aetna Medicare |
$307.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.84
|
| Rate for Payer: BCBS Complete |
$211.35
|
| Rate for Payer: BCBS MAPPO |
$295.72
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$295.72
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$425.84
|
| Rate for Payer: Cofinity Commercial |
$396.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.72
|
| Rate for Payer: Healthscope Commercial |
$547.08
|
| Rate for Payer: Healthscope Commercial |
$473.15
|
| Rate for Payer: Mclaren Medicaid |
$201.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.51
|
| Rate for Payer: Meridian Medicaid |
$211.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,056.00
|
| Rate for Payer: Nomi Health Commercial |
$354.86
|
| Rate for Payer: PACE SWMI |
$295.72
|
| Rate for Payer: PHP Medicare Advantage |
$295.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$476.29
|
| Rate for Payer: Priority Health Medicare |
$295.72
|
| Rate for Payer: Priority Health Narrow Network |
$476.29
|
| Rate for Payer: Priority Health SBD |
$476.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.72
|
| Rate for Payer: UHC Exchange |
$500.79
|
| Rate for Payer: UHC Medicare Advantage |
$295.72
|
| Rate for Payer: UHCCP Medicaid |
$201.29
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$829.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$177.86 |
| Max. Negotiated Rate |
$47,380.00 |
| Rate for Payer: Aetna Commercial |
$348.72
|
| Rate for Payer: Aetna Medicare |
$270.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.75
|
| Rate for Payer: BCBS Complete |
$186.75
|
| Rate for Payer: BCBS MAPPO |
$260.24
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$612.80
|
| Rate for Payer: BCN Medicare Advantage |
$260.24
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cash Price |
$663.20
|
| Rate for Payer: Cofinity Commercial |
$374.75
|
| Rate for Payer: Cofinity Commercial |
$348.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.24
|
| Rate for Payer: Healthscope Commercial |
$481.44
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Mclaren Medicaid |
$177.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.25
|
| Rate for Payer: Meridian Medicaid |
$186.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,380.00
|
| Rate for Payer: Nomi Health Commercial |
$312.29
|
| Rate for Payer: PACE SWMI |
$260.24
|
| Rate for Payer: PHP Medicare Advantage |
$260.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.34
|
| Rate for Payer: Priority Health Medicare |
$260.24
|
| Rate for Payer: Priority Health Narrow Network |
$421.34
|
| Rate for Payer: Priority Health SBD |
$421.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.24
|
| Rate for Payer: UHC Exchange |
$479.84
|
| Rate for Payer: UHC Medicare Advantage |
$260.24
|
| Rate for Payer: UHCCP Medicaid |
$177.86
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$42,453.00 |
| Rate for Payer: Aetna Commercial |
$306.30
|
| Rate for Payer: Aetna Medicare |
$237.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.16
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$228.58
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: BCN Commercial |
$499.92
|
| Rate for Payer: BCN Medicare Advantage |
$228.58
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$329.16
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.58
|
| Rate for Payer: Healthscope Commercial |
$422.87
|
| Rate for Payer: Healthscope Commercial |
$365.73
|
| Rate for Payer: Mclaren Medicaid |
$157.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.01
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,453.00
|
| Rate for Payer: Nomi Health Commercial |
$274.30
|
| Rate for Payer: PACE SWMI |
$228.58
|
| Rate for Payer: PHP Medicare Advantage |
$228.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$437.31
|
| Rate for Payer: Priority Health Medicare |
$228.58
|
| Rate for Payer: Priority Health Narrow Network |
$437.31
|
| Rate for Payer: Priority Health SBD |
$437.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.58
|
| Rate for Payer: UHC Exchange |
$285.75
|
| Rate for Payer: UHC Medicare Advantage |
$228.58
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$757.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$46,345.00 |
| Rate for Payer: Aetna Commercial |
$333.41
|
| Rate for Payer: Aetna Medicare |
$258.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.29
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: BCBS MAPPO |
$248.81
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$248.81
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cash Price |
$605.60
|
| Rate for Payer: Cofinity Commercial |
$358.29
|
| Rate for Payer: Cofinity Commercial |
$333.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.81
|
| Rate for Payer: Healthscope Commercial |
$460.30
|
| Rate for Payer: Healthscope Commercial |
$398.10
|
| Rate for Payer: Mclaren Medicaid |
$170.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.25
|
| Rate for Payer: Meridian Medicaid |
$179.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,345.00
|
| Rate for Payer: Nomi Health Commercial |
$298.57
|
| Rate for Payer: PACE SWMI |
$248.81
|
| Rate for Payer: PHP Medicare Advantage |
$248.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$474.30
|
| Rate for Payer: Priority Health Medicare |
$248.81
|
| Rate for Payer: Priority Health Narrow Network |
$474.30
|
| Rate for Payer: Priority Health SBD |
$474.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.81
|
| Rate for Payer: UHC Exchange |
$319.39
|
| Rate for Payer: UHC Medicare Advantage |
$248.81
|
| Rate for Payer: UHCCP Medicaid |
$170.61
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$399.38 |
| Max. Negotiated Rate |
$109,746.00 |
| Rate for Payer: Aetna Commercial |
$788.94
|
| Rate for Payer: Aetna Medicare |
$612.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$847.81
|
| Rate for Payer: BCBS Complete |
$419.35
|
| Rate for Payer: BCBS MAPPO |
$588.76
|
| Rate for Payer: BCBS Trust/PPO |
$515.09
|
| Rate for Payer: BCN Commercial |
$911.87
|
| Rate for Payer: BCN Medicare Advantage |
$588.76
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$847.81
|
| Rate for Payer: Cofinity Commercial |
$788.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.76
|
| Rate for Payer: Healthscope Commercial |
$942.02
|
| Rate for Payer: Healthscope Commercial |
$1,089.21
|
| Rate for Payer: Mclaren Medicaid |
$399.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.20
|
| Rate for Payer: Meridian Medicaid |
$419.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109,746.00
|
| Rate for Payer: Nomi Health Commercial |
$706.51
|
| Rate for Payer: PACE SWMI |
$588.76
|
| Rate for Payer: PHP Medicare Advantage |
$588.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$399.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,117.41
|
| Rate for Payer: Priority Health Medicare |
$588.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,117.41
|
| Rate for Payer: Priority Health SBD |
$1,117.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$711.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.76
|
| Rate for Payer: UHC Exchange |
$711.61
|
| Rate for Payer: UHC Medicare Advantage |
$588.76
|
| Rate for Payer: UHCCP Medicaid |
$399.38
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$50,234.00 |
| Rate for Payer: Aetna Commercial |
$369.12
|
| Rate for Payer: Aetna Medicare |
$286.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.66
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS MAPPO |
$275.46
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: BCN Commercial |
$633.33
|
| Rate for Payer: BCN Medicare Advantage |
$275.46
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cofinity Commercial |
$396.66
|
| Rate for Payer: Cofinity Commercial |
$369.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.46
|
| Rate for Payer: Healthscope Commercial |
$509.60
|
| Rate for Payer: Healthscope Commercial |
$440.74
|
| Rate for Payer: Mclaren Medicaid |
$188.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.23
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50,234.00
|
| Rate for Payer: Nomi Health Commercial |
$330.55
|
| Rate for Payer: PACE SWMI |
$275.46
|
| Rate for Payer: PHP Medicare Advantage |
$275.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$517.85
|
| Rate for Payer: Priority Health Medicare |
$275.46
|
| Rate for Payer: Priority Health Narrow Network |
$517.85
|
| Rate for Payer: Priority Health SBD |
$517.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$368.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.46
|
| Rate for Payer: UHC Exchange |
$368.86
|
| Rate for Payer: UHC Medicare Advantage |
$275.46
|
| Rate for Payer: UHCCP Medicaid |
$188.51
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$21,109.00 |
| Rate for Payer: Aetna Commercial |
$153.36
|
| Rate for Payer: Aetna Medicare |
$119.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.81
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$114.45
|
| Rate for Payer: BCBS Trust/PPO |
$339.70
|
| Rate for Payer: BCN Commercial |
$324.97
|
| Rate for Payer: BCN Medicare Advantage |
$114.45
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Cofinity Commercial |
$153.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.45
|
| Rate for Payer: Healthscope Commercial |
$211.73
|
| Rate for Payer: Healthscope Commercial |
$183.12
|
| Rate for Payer: Mclaren Medicaid |
$78.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.17
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,109.00
|
| Rate for Payer: Nomi Health Commercial |
$137.34
|
| Rate for Payer: PACE SWMI |
$114.45
|
| Rate for Payer: PHP Medicare Advantage |
$114.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.96
|
| Rate for Payer: Priority Health Medicare |
$114.45
|
| Rate for Payer: Priority Health Narrow Network |
$218.96
|
| Rate for Payer: Priority Health SBD |
$218.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.45
|
| Rate for Payer: UHC Exchange |
$186.02
|
| Rate for Payer: UHC Medicare Advantage |
$114.45
|
| Rate for Payer: UHCCP Medicaid |
$78.81
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$79.02 |
| Max. Negotiated Rate |
$21,424.00 |
| Rate for Payer: Aetna Commercial |
$153.56
|
| Rate for Payer: Aetna Medicare |
$119.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.02
|
| Rate for Payer: BCBS Complete |
$82.97
|
| Rate for Payer: BCBS MAPPO |
$114.60
|
| Rate for Payer: BCBS Trust/PPO |
$667.79
|
| Rate for Payer: BCN Commercial |
$320.09
|
| Rate for Payer: BCN Medicare Advantage |
$114.60
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cofinity Commercial |
$165.02
|
| Rate for Payer: Cofinity Commercial |
$153.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.60
|
| Rate for Payer: Healthscope Commercial |
$212.01
|
| Rate for Payer: Healthscope Commercial |
$183.36
|
| Rate for Payer: Mclaren Medicaid |
$79.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.33
|
| Rate for Payer: Meridian Medicaid |
$82.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,424.00
|
| Rate for Payer: Nomi Health Commercial |
$137.52
|
| Rate for Payer: PACE SWMI |
$114.60
|
| Rate for Payer: PHP Medicare Advantage |
$114.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.73
|
| Rate for Payer: Priority Health Medicare |
$114.60
|
| Rate for Payer: Priority Health Narrow Network |
$220.73
|
| Rate for Payer: Priority Health SBD |
$220.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.60
|
| Rate for Payer: UHC Exchange |
$150.39
|
| Rate for Payer: UHC Medicare Advantage |
$114.60
|
| Rate for Payer: UHCCP Medicaid |
$79.02
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$355.71 |
| Max. Negotiated Rate |
$97,364.00 |
| Rate for Payer: Aetna Commercial |
$702.60
|
| Rate for Payer: Aetna Medicare |
$545.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$755.04
|
| Rate for Payer: BCBS Complete |
$373.50
|
| Rate for Payer: BCBS MAPPO |
$524.33
|
| Rate for Payer: BCBS Trust/PPO |
$774.49
|
| Rate for Payer: BCN Commercial |
$808.76
|
| Rate for Payer: BCN Medicare Advantage |
$524.33
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$755.04
|
| Rate for Payer: Cofinity Commercial |
$702.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$524.33
|
| Rate for Payer: Healthscope Commercial |
$970.01
|
| Rate for Payer: Healthscope Commercial |
$838.93
|
| Rate for Payer: Mclaren Medicaid |
$355.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$550.55
|
| Rate for Payer: Meridian Medicaid |
$373.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97,364.00
|
| Rate for Payer: Nomi Health Commercial |
$629.20
|
| Rate for Payer: PACE SWMI |
$524.33
|
| Rate for Payer: PHP Medicare Advantage |
$524.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$995.13
|
| Rate for Payer: Priority Health Medicare |
$524.33
|
| Rate for Payer: Priority Health Narrow Network |
$995.13
|
| Rate for Payer: Priority Health SBD |
$995.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$524.33
|
| Rate for Payer: UHC Exchange |
$786.06
|
| Rate for Payer: UHC Medicare Advantage |
$524.33
|
| Rate for Payer: UHCCP Medicaid |
$355.71
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$61,394.00 |
| Rate for Payer: Aetna Commercial |
$445.83
|
| Rate for Payer: Aetna Medicare |
$346.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.10
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$332.71
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCN Commercial |
$719.83
|
| Rate for Payer: BCN Medicare Advantage |
$332.71
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Cofinity Commercial |
$445.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$332.71
|
| Rate for Payer: Healthscope Commercial |
$615.51
|
| Rate for Payer: Healthscope Commercial |
$532.34
|
| Rate for Payer: Mclaren Medicaid |
$226.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.35
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,394.00
|
| Rate for Payer: Nomi Health Commercial |
$399.25
|
| Rate for Payer: PACE SWMI |
$332.71
|
| Rate for Payer: PHP Medicare Advantage |
$332.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$630.60
|
| Rate for Payer: Priority Health Medicare |
$332.71
|
| Rate for Payer: Priority Health Narrow Network |
$630.60
|
| Rate for Payer: Priority Health SBD |
$630.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$332.71
|
| Rate for Payer: UHC Exchange |
$555.87
|
| Rate for Payer: UHC Medicare Advantage |
$332.71
|
| Rate for Payer: UHCCP Medicaid |
$226.42
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,184.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$232.60 |
| Max. Negotiated Rate |
$63,061.00 |
| Rate for Payer: Aetna Commercial |
$457.73
|
| Rate for Payer: Aetna Medicare |
$355.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.89
|
| Rate for Payer: BCBS Complete |
$244.23
|
| Rate for Payer: BCBS MAPPO |
$341.59
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$341.59
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cash Price |
$947.20
|
| Rate for Payer: Cofinity Commercial |
$491.89
|
| Rate for Payer: Cofinity Commercial |
$457.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.59
|
| Rate for Payer: Healthscope Commercial |
$631.94
|
| Rate for Payer: Healthscope Commercial |
$546.54
|
| Rate for Payer: Mclaren Medicaid |
$232.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.67
|
| Rate for Payer: Meridian Medicaid |
$244.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63,061.00
|
| Rate for Payer: Nomi Health Commercial |
$409.91
|
| Rate for Payer: PACE SWMI |
$341.59
|
| Rate for Payer: PHP Medicare Advantage |
$341.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$769.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.33
|
| Rate for Payer: Priority Health Medicare |
$341.59
|
| Rate for Payer: Priority Health Narrow Network |
$644.33
|
| Rate for Payer: Priority Health SBD |
$644.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.59
|
| Rate for Payer: UHC Exchange |
$598.11
|
| Rate for Payer: UHC Medicare Advantage |
$341.59
|
| Rate for Payer: UHCCP Medicaid |
$232.60
|
|
|
PR EXC LOCAL MALIGNANT TUMOR STOMACH
|
Professional
|
Both
|
$1,843.00
|
|
|
Service Code
|
HCPCS 43611
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$219,501.00 |
| Rate for Payer: Aetna Commercial |
$1,598.33
|
| Rate for Payer: Aetna Medicare |
$1,240.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,598.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.60
|
| Rate for Payer: BCBS Complete |
$828.85
|
| Rate for Payer: BCBS MAPPO |
$1,192.78
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$1,790.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.78
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cash Price |
$1,474.40
|
| Rate for Payer: Cofinity Commercial |
$1,717.60
|
| Rate for Payer: Cofinity Commercial |
$1,598.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.78
|
| Rate for Payer: Healthscope Commercial |
$2,206.64
|
| Rate for Payer: Healthscope Commercial |
$1,908.45
|
| Rate for Payer: Mclaren Medicaid |
$789.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.42
|
| Rate for Payer: Meridian Medicaid |
$828.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219,501.00
|
| Rate for Payer: Nomi Health Commercial |
$1,431.34
|
| Rate for Payer: PACE SWMI |
$1,192.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,197.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,200.84
|
| Rate for Payer: Priority Health Medicare |
$1,192.78
|
| Rate for Payer: Priority Health Narrow Network |
$2,200.84
|
| Rate for Payer: Priority Health SBD |
$2,200.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,158.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.78
|
| Rate for Payer: UHC Exchange |
$1,158.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.78
|
| Rate for Payer: UHCCP Medicaid |
$789.38
|
|
|
PR EXC LOCAL ULCER/BENIGN TUMOR STOMACH
|
Professional
|
Both
|
$3,159.00
|
|
|
Service Code
|
HCPCS 43610
|
| Min. Negotiated Rate |
$627.29 |
| Max. Negotiated Rate |
$175,428.00 |
| Rate for Payer: Aetna Commercial |
$1,271.00
|
| Rate for Payer: Aetna Medicare |
$986.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,271.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,365.85
|
| Rate for Payer: BCBS Complete |
$658.65
|
| Rate for Payer: BCBS MAPPO |
$948.51
|
| Rate for Payer: BCBS Trust/PPO |
$686.26
|
| Rate for Payer: BCN Commercial |
$1,429.87
|
| Rate for Payer: BCN Medicare Advantage |
$948.51
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cash Price |
$2,527.20
|
| Rate for Payer: Cofinity Commercial |
$1,365.85
|
| Rate for Payer: Cofinity Commercial |
$1,271.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$948.51
|
| Rate for Payer: Healthscope Commercial |
$1,754.74
|
| Rate for Payer: Healthscope Commercial |
$1,517.62
|
| Rate for Payer: Mclaren Medicaid |
$627.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$995.94
|
| Rate for Payer: Meridian Medicaid |
$658.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175,428.00
|
| Rate for Payer: Nomi Health Commercial |
$1,138.21
|
| Rate for Payer: PACE SWMI |
$948.51
|
| Rate for Payer: PHP Medicare Advantage |
$948.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,053.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,751.60
|
| Rate for Payer: Priority Health Medicare |
$948.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,751.60
|
| Rate for Payer: Priority Health SBD |
$1,751.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$972.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$948.51
|
| Rate for Payer: UHC Exchange |
$972.08
|
| Rate for Payer: UHC Medicare Advantage |
$948.51
|
| Rate for Payer: UHCCP Medicaid |
$627.29
|
|
|
PR EXCLUSION LAA OPEN TM STRNT/THRCM ANY METHOD
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 33268
|
| Min. Negotiated Rate |
$81.15 |
| Max. Negotiated Rate |
$23,148.00 |
| Rate for Payer: Aetna Commercial |
$166.90
|
| Rate for Payer: Aetna Medicare |
$129.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.35
|
| Rate for Payer: BCBS Complete |
$85.21
|
| Rate for Payer: BCBS MAPPO |
$124.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,025.43
|
| Rate for Payer: BCN Commercial |
$186.67
|
| Rate for Payer: BCN Medicare Advantage |
$124.55
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$179.35
|
| Rate for Payer: Cofinity Commercial |
$166.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.55
|
| Rate for Payer: Healthscope Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$230.42
|
| Rate for Payer: Mclaren Medicaid |
$81.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.78
|
| Rate for Payer: Meridian Medicaid |
$85.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,148.00
|
| Rate for Payer: Nomi Health Commercial |
$149.46
|
| Rate for Payer: PACE SWMI |
$124.55
|
| Rate for Payer: PHP Medicare Advantage |
$124.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$81.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.56
|
| Rate for Payer: Priority Health Medicare |
$124.55
|
| Rate for Payer: Priority Health Narrow Network |
$201.56
|
| Rate for Payer: Priority Health SBD |
$201.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.55
|
| Rate for Payer: UHC Medicare Advantage |
$124.55
|
| Rate for Payer: UHCCP Medicaid |
$81.15
|
|
|
PR EXCLUSION LEFT ATRIAL APPENDAGE OPEN ANY METHOD
|
Professional
|
Both
|
$2,124.00
|
|
|
Service Code
|
HCPCS 33267
|
| Min. Negotiated Rate |
$659.66 |
| Max. Negotiated Rate |
$184,522.00 |
| Rate for Payer: Aetna Commercial |
$1,344.13
|
| Rate for Payer: Aetna Medicare |
$1,043.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.44
|
| Rate for Payer: BCBS Complete |
$692.64
|
| Rate for Payer: BCBS MAPPO |
$1,003.08
|
| Rate for Payer: BCBS Trust/PPO |
$5,381.79
|
| Rate for Payer: BCN Commercial |
$1,497.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.08
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cash Price |
$1,699.20
|
| Rate for Payer: Cofinity Commercial |
$1,444.44
|
| Rate for Payer: Cofinity Commercial |
$1,344.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.08
|
| Rate for Payer: Healthscope Commercial |
$1,604.93
|
| Rate for Payer: Healthscope Commercial |
$1,855.70
|
| Rate for Payer: Mclaren Medicaid |
$659.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.23
|
| Rate for Payer: Meridian Medicaid |
$692.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184,522.00
|
| Rate for Payer: Nomi Health Commercial |
$1,203.70
|
| Rate for Payer: PACE SWMI |
$1,003.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,380.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,638.03
|
| Rate for Payer: Priority Health Medicare |
$1,003.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,638.03
|
| Rate for Payer: Priority Health SBD |
$1,638.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.08
|
| Rate for Payer: UHCCP Medicaid |
$659.66
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Facility
|
OP
|
$2,114.00
|
|
|
Service Code
|
CPT 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$834.47 |
| Max. Negotiated Rate |
$3,362.00 |
| Rate for Payer: Aetna Commercial |
$1,796.90
|
| Rate for Payer: Aetna Medicare |
$1,057.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.10
|
| Rate for Payer: BCBS Complete |
$845.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,606.16
|
| Rate for Payer: BCN Commercial |
$1,606.16
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,479.80
|
| Rate for Payer: Cofinity Commercial |
$1,818.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,479.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,691.20
|
| Rate for Payer: Healthscope Commercial |
$1,902.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,796.90
|
| Rate for Payer: PHP Commercial |
$1,796.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health SBD |
$1,331.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.47
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
|
|
PR EXC MECKEL'S DIVERTICULUM/OMPHALOMESENTERIC DUCT
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 44800
|
| Hospital Charge Code |
44800
|
| Min. Negotiated Rate |
$332.30 |
| Max. Negotiated Rate |
$138,233.00 |
| Rate for Payer: Aetna Commercial |
$1,006.11
|
| Rate for Payer: Aetna Medicare |
$780.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,006.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,081.20
|
| Rate for Payer: BCBS Complete |
$525.13
|
| Rate for Payer: BCBS MAPPO |
$750.83
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$750.83
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,081.20
|
| Rate for Payer: Cofinity Commercial |
$1,006.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.83
|
| Rate for Payer: Healthscope Commercial |
$1,389.04
|
| Rate for Payer: Healthscope Commercial |
$1,201.33
|
| Rate for Payer: Mclaren Medicaid |
$500.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$788.37
|
| Rate for Payer: Meridian Medicaid |
$525.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138,233.00
|
| Rate for Payer: Nomi Health Commercial |
$901.00
|
| Rate for Payer: PACE SWMI |
$750.83
|
| Rate for Payer: PHP Medicare Advantage |
$750.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,374.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,397.22
|
| Rate for Payer: Priority Health Medicare |
$750.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,397.22
|
| Rate for Payer: Priority Health SBD |
$1,397.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.83
|
| Rate for Payer: UHC Exchange |
$795.05
|
| Rate for Payer: UHC Medicare Advantage |
$750.83
|
| Rate for Payer: UHCCP Medicaid |
$500.12
|
|
