|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna Commercial |
$139.94
|
| Rate for Payer: Aetna Medicare |
$108.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.38
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$104.43
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.43
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cofinity Commercial |
$150.38
|
| Rate for Payer: Cofinity Commercial |
$139.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.43
|
| Rate for Payer: Healthscope Commercial |
$193.20
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Mclaren Medicaid |
$69.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.65
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.30
|
| Rate for Payer: Nomi Health Commercial |
$125.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.00
|
| Rate for Payer: PACE SWMI |
$104.43
|
| Rate for Payer: PHP Medicare Advantage |
$104.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$104.43
|
| Rate for Payer: Priority Health SBD |
$168.35
|
| Rate for Payer: Priority Health Tiered Network |
$168.35
|
| Rate for Payer: Railroad Medicare Medicare |
$104.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.58
|
| Rate for Payer: UHC Core |
$201.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.43
|
| Rate for Payer: UHC Exchange |
$201.58
|
| Rate for Payer: UHC Medicaid |
$69.44
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$463.57 |
| Rate for Payer: Aetna Commercial |
$296.57
|
| Rate for Payer: Aetna Medicare |
$230.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.70
|
| Rate for Payer: BCBS Complete |
$154.32
|
| Rate for Payer: BCBS MAPPO |
$221.32
|
| Rate for Payer: BCN Commercial |
$380.46
|
| Rate for Payer: BCN Medicare Advantage |
$221.32
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cash Price |
$468.80
|
| Rate for Payer: Cofinity Commercial |
$318.70
|
| Rate for Payer: Cofinity Commercial |
$296.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.32
|
| Rate for Payer: Healthscope Commercial |
$354.11
|
| Rate for Payer: Healthscope Commercial |
$409.44
|
| Rate for Payer: Mclaren Medicaid |
$146.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$232.39
|
| Rate for Payer: Meridian Medicaid |
$154.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$243.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.05
|
| Rate for Payer: Nomi Health Commercial |
$265.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$439.50
|
| Rate for Payer: PACE SWMI |
$221.32
|
| Rate for Payer: PHP Medicare Advantage |
$221.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$463.57
|
| Rate for Payer: Priority Health Medicare |
$221.32
|
| Rate for Payer: Priority Health SBD |
$463.57
|
| Rate for Payer: Priority Health Tiered Network |
$463.57
|
| Rate for Payer: Railroad Medicare Medicare |
$221.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.97
|
| Rate for Payer: UHC Core |
$423.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$221.32
|
| Rate for Payer: UHC Exchange |
$423.97
|
| Rate for Payer: UHC Medicaid |
$146.97
|
| Rate for Payer: UHCCP Medicaid |
$146.97
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Aetna Commercial |
$240.99
|
| Rate for Payer: Aetna Medicare |
$187.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.97
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS MAPPO |
$179.84
|
| Rate for Payer: BCN Commercial |
$295.30
|
| Rate for Payer: BCN Medicare Advantage |
$179.84
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Cofinity Commercial |
$240.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.84
|
| Rate for Payer: Healthscope Commercial |
$332.70
|
| Rate for Payer: Healthscope Commercial |
$287.74
|
| Rate for Payer: Mclaren Medicaid |
$118.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.83
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$197.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.26
|
| Rate for Payer: Nomi Health Commercial |
$215.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.50
|
| Rate for Payer: PACE SWMI |
$179.84
|
| Rate for Payer: PHP Medicare Advantage |
$179.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$321.67
|
| Rate for Payer: Priority Health Medicare |
$179.84
|
| Rate for Payer: Priority Health SBD |
$321.67
|
| Rate for Payer: Priority Health Tiered Network |
$321.67
|
| Rate for Payer: Railroad Medicare Medicare |
$179.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.05
|
| Rate for Payer: UHC Core |
$335.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$179.84
|
| Rate for Payer: UHC Exchange |
$335.05
|
| Rate for Payer: UHC Medicaid |
$118.22
|
| Rate for Payer: UHCCP Medicaid |
$118.22
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,548.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$428.98 |
| Max. Negotiated Rate |
$1,288.21 |
| Rate for Payer: Aetna Commercial |
$880.97
|
| Rate for Payer: Aetna Medicare |
$683.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$880.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.71
|
| Rate for Payer: BCBS Complete |
$450.43
|
| Rate for Payer: BCBS MAPPO |
$657.44
|
| Rate for Payer: BCN Commercial |
$1,098.05
|
| Rate for Payer: BCN Medicare Advantage |
$657.44
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cash Price |
$1,238.40
|
| Rate for Payer: Cofinity Commercial |
$946.71
|
| Rate for Payer: Cofinity Commercial |
$880.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.44
|
| Rate for Payer: Healthscope Commercial |
$1,216.26
|
| Rate for Payer: Healthscope Commercial |
$1,051.90
|
| Rate for Payer: Mclaren Medicaid |
$428.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.31
|
| Rate for Payer: Meridian Medicaid |
$450.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$723.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,288.21
|
| Rate for Payer: Nomi Health Commercial |
$788.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,161.00
|
| Rate for Payer: PACE SWMI |
$657.44
|
| Rate for Payer: PHP Medicare Advantage |
$657.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,005.00
|
| Rate for Payer: Priority Health Medicare |
$657.44
|
| Rate for Payer: Priority Health SBD |
$1,005.00
|
| Rate for Payer: Priority Health Tiered Network |
$1,005.00
|
| Rate for Payer: Railroad Medicare Medicare |
$657.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,280.69
|
| Rate for Payer: UHC Core |
$1,280.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$657.44
|
| Rate for Payer: UHC Exchange |
$1,280.69
|
| Rate for Payer: UHC Medicaid |
$428.98
|
| Rate for Payer: UHCCP Medicaid |
$428.98
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,672.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$359.33 |
| Max. Negotiated Rate |
$1,254.00 |
| Rate for Payer: Aetna Commercial |
$735.87
|
| Rate for Payer: Aetna Medicare |
$571.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.79
|
| Rate for Payer: BCBS Complete |
$377.30
|
| Rate for Payer: BCBS MAPPO |
$549.16
|
| Rate for Payer: BCN Commercial |
$977.53
|
| Rate for Payer: BCN Medicare Advantage |
$549.16
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cash Price |
$1,337.60
|
| Rate for Payer: Cofinity Commercial |
$790.79
|
| Rate for Payer: Cofinity Commercial |
$735.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.16
|
| Rate for Payer: Healthscope Commercial |
$878.66
|
| Rate for Payer: Healthscope Commercial |
$1,015.95
|
| Rate for Payer: Mclaren Medicaid |
$359.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.62
|
| Rate for Payer: Meridian Medicaid |
$377.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,134.61
|
| Rate for Payer: Nomi Health Commercial |
$658.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,254.00
|
| Rate for Payer: PACE SWMI |
$549.16
|
| Rate for Payer: PHP Medicare Advantage |
$549.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$359.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$894.70
|
| Rate for Payer: Priority Health Medicare |
$549.16
|
| Rate for Payer: Priority Health SBD |
$894.70
|
| Rate for Payer: Priority Health Tiered Network |
$894.70
|
| Rate for Payer: Railroad Medicare Medicare |
$549.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,143.77
|
| Rate for Payer: UHC Core |
$1,143.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.16
|
| Rate for Payer: UHC Exchange |
$1,143.77
|
| Rate for Payer: UHC Medicaid |
$359.33
|
| Rate for Payer: UHCCP Medicaid |
$359.33
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,613.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,294.40 |
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Aetna Commercial |
$875.17
|
| Rate for Payer: Aetna Medicare |
$679.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.48
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$653.11
|
| Rate for Payer: BCN Commercial |
$1,112.49
|
| Rate for Payer: BCN Medicare Advantage |
$653.11
|
| Rate for Payer: Cash Price |
$1,290.40
|
| Rate for Payer: Cofinity Commercial |
$940.48
|
| Rate for Payer: Cofinity Commercial |
$875.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.11
|
| Rate for Payer: Healthscope Commercial |
$1,208.25
|
| Rate for Payer: Healthscope Commercial |
$1,044.98
|
| Rate for Payer: Mclaren Medicaid |
$427.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.77
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$718.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.40
|
| Rate for Payer: Nomi Health Commercial |
$783.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.75
|
| Rate for Payer: PACE SWMI |
$653.11
|
| Rate for Payer: PHP Medicare Advantage |
$653.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,018.21
|
| Rate for Payer: Priority Health Medicare |
$653.11
|
| Rate for Payer: Priority Health SBD |
$1,018.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,018.21
|
| Rate for Payer: Railroad Medicare Medicare |
$653.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,285.08
|
| Rate for Payer: UHC Core |
$1,285.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.11
|
| Rate for Payer: UHC Exchange |
$1,285.08
|
| Rate for Payer: UHC Medicaid |
$427.28
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,976.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$407.90 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna Commercial |
$837.94
|
| Rate for Payer: Aetna Medicare |
$650.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$900.48
|
| Rate for Payer: BCBS Complete |
$428.30
|
| Rate for Payer: BCBS MAPPO |
$625.33
|
| Rate for Payer: BCN Commercial |
$1,089.09
|
| Rate for Payer: BCN Medicare Advantage |
$625.33
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cash Price |
$1,580.80
|
| Rate for Payer: Cofinity Commercial |
$900.48
|
| Rate for Payer: Cofinity Commercial |
$837.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.33
|
| Rate for Payer: Healthscope Commercial |
$1,156.86
|
| Rate for Payer: Healthscope Commercial |
$1,000.53
|
| Rate for Payer: Mclaren Medicaid |
$407.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.60
|
| Rate for Payer: Meridian Medicaid |
$428.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$687.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,292.24
|
| Rate for Payer: Nomi Health Commercial |
$750.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,482.00
|
| Rate for Payer: PACE SWMI |
$625.33
|
| Rate for Payer: PHP Medicare Advantage |
$625.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$996.80
|
| Rate for Payer: Priority Health Medicare |
$625.33
|
| Rate for Payer: Priority Health SBD |
$996.80
|
| Rate for Payer: Priority Health Tiered Network |
$996.80
|
| Rate for Payer: Railroad Medicare Medicare |
$625.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,307.75
|
| Rate for Payer: UHC Core |
$1,307.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.33
|
| Rate for Payer: UHC Exchange |
$1,307.75
|
| Rate for Payer: UHC Medicaid |
$407.90
|
| Rate for Payer: UHCCP Medicaid |
$407.90
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,441.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$907.83 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna Commercial |
$1,224.85
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,192.42
|
| Rate for Payer: BCN Commercial |
$2,192.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Advantage |
$1,008.70
|
| Rate for Payer: Cofinity Commercial |
$1,239.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,296.90
|
| Rate for Payer: Mclaren Medicaid |
$1,075.21
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.85
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,224.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$907.83
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: VA VA |
$2,055.86
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,384.60 |
| Rate for Payer: Aetna Commercial |
$906.43
|
| Rate for Payer: Aetna Medicare |
$703.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.07
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$676.44
|
| Rate for Payer: BCN Commercial |
$1,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.44
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$974.07
|
| Rate for Payer: Cofinity Commercial |
$906.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.44
|
| Rate for Payer: Healthscope Commercial |
$1,251.41
|
| Rate for Payer: Healthscope Commercial |
$1,082.30
|
| Rate for Payer: Mclaren Medicaid |
$445.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.26
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.60
|
| Rate for Payer: Nomi Health Commercial |
$811.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE SWMI |
$676.44
|
| Rate for Payer: PHP Medicare Advantage |
$676.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,097.98
|
| Rate for Payer: Priority Health Medicare |
$676.44
|
| Rate for Payer: Priority Health SBD |
$1,097.98
|
| Rate for Payer: Priority Health Tiered Network |
$1,097.98
|
| Rate for Payer: Railroad Medicare Medicare |
$676.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,369.24
|
| Rate for Payer: UHC Core |
$1,369.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.44
|
| Rate for Payer: UHC Exchange |
$1,369.24
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,441.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$907.83 |
| Max. Negotiated Rate |
$1,296.90 |
| Rate for Payer: Aetna Commercial |
$1,224.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.65
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Advantage |
$1,008.70
|
| Rate for Payer: Cofinity Commercial |
$1,239.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,152.80
|
| Rate for Payer: Healthscope Commercial |
$1,296.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,224.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PHP Commercial |
$1,224.85
|
| Rate for Payer: Priority Health SBD |
$907.83
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
15240
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,384.60 |
| Rate for Payer: Aetna Commercial |
$906.43
|
| Rate for Payer: Aetna Medicare |
$703.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$974.07
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$676.44
|
| Rate for Payer: BCN Commercial |
$1,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$676.44
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$974.07
|
| Rate for Payer: Cofinity Commercial |
$906.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.44
|
| Rate for Payer: Healthscope Commercial |
$1,251.41
|
| Rate for Payer: Healthscope Commercial |
$1,082.30
|
| Rate for Payer: Mclaren Medicaid |
$445.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.26
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$744.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,384.60
|
| Rate for Payer: Nomi Health Commercial |
$811.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.75
|
| Rate for Payer: PACE SWMI |
$676.44
|
| Rate for Payer: PHP Medicare Advantage |
$676.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,097.98
|
| Rate for Payer: Priority Health Medicare |
$676.44
|
| Rate for Payer: Priority Health SBD |
$1,097.98
|
| Rate for Payer: Priority Health Tiered Network |
$1,097.98
|
| Rate for Payer: Railroad Medicare Medicare |
$676.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,369.24
|
| Rate for Payer: UHC Core |
$1,369.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.44
|
| Rate for Payer: UHC Exchange |
$1,369.24
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$71.78 |
| Max. Negotiated Rate |
$329.25 |
| Rate for Payer: Aetna Commercial |
$149.06
|
| Rate for Payer: Aetna Medicare |
$115.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.19
|
| Rate for Payer: BCBS Complete |
$75.37
|
| Rate for Payer: BCBS MAPPO |
$111.24
|
| Rate for Payer: BCN Commercial |
$200.69
|
| Rate for Payer: BCN Medicare Advantage |
$111.24
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$160.19
|
| Rate for Payer: Cofinity Commercial |
$149.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.24
|
| Rate for Payer: Healthscope Commercial |
$205.79
|
| Rate for Payer: Healthscope Commercial |
$177.98
|
| Rate for Payer: Mclaren Medicaid |
$71.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.80
|
| Rate for Payer: Meridian Medicaid |
$75.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$122.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Nomi Health Commercial |
$133.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.25
|
| Rate for Payer: PACE SWMI |
$111.24
|
| Rate for Payer: PHP Medicare Advantage |
$111.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$183.69
|
| Rate for Payer: Priority Health Medicare |
$111.24
|
| Rate for Payer: Priority Health SBD |
$183.69
|
| Rate for Payer: Priority Health Tiered Network |
$183.69
|
| Rate for Payer: Railroad Medicare Medicare |
$111.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.02
|
| Rate for Payer: UHC Core |
$241.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.24
|
| Rate for Payer: UHC Exchange |
$241.02
|
| Rate for Payer: UHC Medicaid |
$71.78
|
| Rate for Payer: UHCCP Medicaid |
$71.78
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$463.91 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$946.86
|
| Rate for Payer: Aetna Medicare |
$734.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.86
|
| Rate for Payer: BCBS Complete |
$487.11
|
| Rate for Payer: BCBS MAPPO |
$706.61
|
| Rate for Payer: BCN Commercial |
$1,273.83
|
| Rate for Payer: BCN Medicare Advantage |
$706.61
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$946.86
|
| Rate for Payer: Cofinity Commercial |
$1,017.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.61
|
| Rate for Payer: Healthscope Commercial |
$1,307.23
|
| Rate for Payer: Healthscope Commercial |
$1,130.58
|
| Rate for Payer: Mclaren Medicaid |
$463.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.94
|
| Rate for Payer: Meridian Medicaid |
$487.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$777.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,472.00
|
| Rate for Payer: Nomi Health Commercial |
$847.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,313.25
|
| Rate for Payer: PACE SWMI |
$706.61
|
| Rate for Payer: PHP Medicare Advantage |
$706.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$463.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,165.88
|
| Rate for Payer: Priority Health Medicare |
$706.61
|
| Rate for Payer: Priority Health SBD |
$1,165.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,165.88
|
| Rate for Payer: Railroad Medicare Medicare |
$706.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.07
|
| Rate for Payer: UHC Core |
$1,458.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$706.61
|
| Rate for Payer: UHC Exchange |
$1,458.07
|
| Rate for Payer: UHC Medicaid |
$463.91
|
| Rate for Payer: UHCCP Medicaid |
$463.91
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$342.93 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$699.45
|
| Rate for Payer: Aetna Medicare |
$542.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.65
|
| Rate for Payer: BCBS Complete |
$360.08
|
| Rate for Payer: BCBS MAPPO |
$521.98
|
| Rate for Payer: BCN Commercial |
$918.78
|
| Rate for Payer: BCN Medicare Advantage |
$521.98
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cofinity Commercial |
$751.65
|
| Rate for Payer: Cofinity Commercial |
$699.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.98
|
| Rate for Payer: Healthscope Commercial |
$965.66
|
| Rate for Payer: Healthscope Commercial |
$835.17
|
| Rate for Payer: Mclaren Medicaid |
$342.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.08
|
| Rate for Payer: Meridian Medicaid |
$360.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$574.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,063.30
|
| Rate for Payer: Nomi Health Commercial |
$626.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,305.00
|
| Rate for Payer: PACE SWMI |
$521.98
|
| Rate for Payer: PHP Medicare Advantage |
$521.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$342.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$840.91
|
| Rate for Payer: Priority Health Medicare |
$521.98
|
| Rate for Payer: Priority Health SBD |
$840.91
|
| Rate for Payer: Priority Health Tiered Network |
$840.91
|
| Rate for Payer: Railroad Medicare Medicare |
$521.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,053.41
|
| Rate for Payer: UHC Core |
$1,053.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$521.98
|
| Rate for Payer: UHC Exchange |
$1,053.41
|
| Rate for Payer: UHC Medicaid |
$342.93
|
| Rate for Payer: UHCCP Medicaid |
$342.93
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,179.47 |
| Rate for Payer: Aetna Commercial |
$789.68
|
| Rate for Payer: Aetna Medicare |
$612.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.61
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS MAPPO |
$589.31
|
| Rate for Payer: BCN Commercial |
$1,014.89
|
| Rate for Payer: BCN Medicare Advantage |
$589.31
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$848.61
|
| Rate for Payer: Cofinity Commercial |
$789.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.31
|
| Rate for Payer: Healthscope Commercial |
$942.90
|
| Rate for Payer: Healthscope Commercial |
$1,090.22
|
| Rate for Payer: Mclaren Medicaid |
$385.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.78
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$648.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,179.47
|
| Rate for Payer: Nomi Health Commercial |
$707.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.25
|
| Rate for Payer: PACE SWMI |
$589.31
|
| Rate for Payer: PHP Medicare Advantage |
$589.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$928.88
|
| Rate for Payer: Priority Health Medicare |
$589.31
|
| Rate for Payer: Priority Health SBD |
$928.88
|
| Rate for Payer: Priority Health Tiered Network |
$928.88
|
| Rate for Payer: Railroad Medicare Medicare |
$589.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,165.02
|
| Rate for Payer: UHC Core |
$1,165.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$589.31
|
| Rate for Payer: UHC Exchange |
$1,165.02
|
| Rate for Payer: UHC Medicaid |
$385.96
|
| Rate for Payer: UHCCP Medicaid |
$385.96
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$119.37
|
| Rate for Payer: Aetna Medicare |
$92.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.28
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$89.08
|
| Rate for Payer: BCN Commercial |
$158.86
|
| Rate for Payer: BCN Medicare Advantage |
$89.08
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$128.28
|
| Rate for Payer: Cofinity Commercial |
$119.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.08
|
| Rate for Payer: Healthscope Commercial |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$142.53
|
| Rate for Payer: Mclaren Medicaid |
$57.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.53
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.39
|
| Rate for Payer: Nomi Health Commercial |
$106.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PACE SWMI |
$89.08
|
| Rate for Payer: PHP Medicare Advantage |
$89.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.40
|
| Rate for Payer: Priority Health Medicare |
$89.08
|
| Rate for Payer: Priority Health SBD |
$145.40
|
| Rate for Payer: Priority Health Tiered Network |
$145.40
|
| Rate for Payer: Railroad Medicare Medicare |
$89.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.39
|
| Rate for Payer: UHC Core |
$192.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$89.08
|
| Rate for Payer: UHC Exchange |
$192.39
|
| Rate for Payer: UHC Medicaid |
$57.08
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$219.75 |
| Rate for Payer: Aetna Commercial |
$77.14
|
| Rate for Payer: Aetna Medicare |
$59.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.90
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.57
|
| Rate for Payer: BCN Commercial |
$102.59
|
| Rate for Payer: BCN Medicare Advantage |
$57.57
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$82.90
|
| Rate for Payer: Cofinity Commercial |
$77.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.57
|
| Rate for Payer: Healthscope Commercial |
$92.11
|
| Rate for Payer: Healthscope Commercial |
$106.50
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.45
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.82
|
| Rate for Payer: Nomi Health Commercial |
$69.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.75
|
| Rate for Payer: PACE SWMI |
$57.57
|
| Rate for Payer: PHP Medicare Advantage |
$57.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$93.89
|
| Rate for Payer: Priority Health Medicare |
$57.57
|
| Rate for Payer: Priority Health SBD |
$93.89
|
| Rate for Payer: Priority Health Tiered Network |
$93.89
|
| Rate for Payer: Railroad Medicare Medicare |
$57.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.99
|
| Rate for Payer: UHC Core |
$123.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.57
|
| Rate for Payer: UHC Exchange |
$123.99
|
| Rate for Payer: UHC Medicaid |
$36.85
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$714.21 |
| Rate for Payer: Aetna Commercial |
$517.32
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.93
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$386.06
|
| Rate for Payer: BCN Commercial |
$369.62
|
| Rate for Payer: BCN Medicare Advantage |
$386.06
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$555.93
|
| Rate for Payer: Cofinity Commercial |
$517.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$386.06
|
| Rate for Payer: Healthscope Commercial |
$617.70
|
| Rate for Payer: Healthscope Commercial |
$714.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$405.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$424.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$360.25
|
| Rate for Payer: Nomi Health Commercial |
$463.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: PACE SWMI |
$386.06
|
| Rate for Payer: PHP Medicare Advantage |
$386.06
|
| Rate for Payer: Priority Health Medicare |
$386.06
|
| Rate for Payer: Railroad Medicare Medicare |
$386.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.88
|
| Rate for Payer: UHC Core |
$125.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$386.06
|
| Rate for Payer: UHC Exchange |
$125.88
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$344.61 |
| Max. Negotiated Rate |
$637.53 |
| Rate for Payer: Aetna Commercial |
$461.78
|
| Rate for Payer: Aetna Medicare |
$358.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.78
|
| Rate for Payer: BCBS MAPPO |
$344.61
|
| Rate for Payer: BCN Commercial |
$489.52
|
| Rate for Payer: BCN Medicare Advantage |
$344.61
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cash Price |
$423.20
|
| Rate for Payer: Cofinity Commercial |
$496.24
|
| Rate for Payer: Cofinity Commercial |
$461.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.61
|
| Rate for Payer: Healthscope Commercial |
$551.38
|
| Rate for Payer: Healthscope Commercial |
$637.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$447.62
|
| Rate for Payer: Nomi Health Commercial |
$413.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.75
|
| Rate for Payer: PACE SWMI |
$344.61
|
| Rate for Payer: PHP Medicare Advantage |
$344.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$451.44
|
| Rate for Payer: Priority Health Medicare |
$344.61
|
| Rate for Payer: Priority Health SBD |
$451.44
|
| Rate for Payer: Priority Health Tiered Network |
$451.44
|
| Rate for Payer: Railroad Medicare Medicare |
$344.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$483.31
|
| Rate for Payer: UHC Core |
$483.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$344.61
|
| Rate for Payer: UHC Exchange |
$483.31
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$47.07
|
| Rate for Payer: Aetna Medicare |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: BCBS MAPPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$54.78
|
| Rate for Payer: BCN Medicare Advantage |
$35.13
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Cofinity Commercial |
$47.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.13
|
| Rate for Payer: Healthscope Commercial |
$64.99
|
| Rate for Payer: Healthscope Commercial |
$56.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.39
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: PACE SWMI |
$35.13
|
| Rate for Payer: PHP Medicare Advantage |
$35.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$46.87
|
| Rate for Payer: Priority Health Medicare |
$35.13
|
| Rate for Payer: Priority Health SBD |
$46.87
|
| Rate for Payer: Priority Health Tiered Network |
$46.87
|
| Rate for Payer: Railroad Medicare Medicare |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.71
|
| Rate for Payer: UHC Core |
$54.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.13
|
| Rate for Payer: UHC Exchange |
$54.71
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$263.98 |
| Rate for Payer: Aetna Commercial |
$191.20
|
| Rate for Payer: Aetna Medicare |
$148.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.47
|
| Rate for Payer: BCBS MAPPO |
$142.69
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$142.69
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$205.47
|
| Rate for Payer: Cofinity Commercial |
$191.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.69
|
| Rate for Payer: Healthscope Commercial |
$263.98
|
| Rate for Payer: Healthscope Commercial |
$228.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.23
|
| Rate for Payer: Nomi Health Commercial |
$171.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$142.69
|
| Rate for Payer: PHP Medicare Advantage |
$142.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$214.88
|
| Rate for Payer: Priority Health Medicare |
$142.69
|
| Rate for Payer: Priority Health SBD |
$214.88
|
| Rate for Payer: Priority Health Tiered Network |
$214.88
|
| Rate for Payer: Railroad Medicare Medicare |
$142.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.25
|
| Rate for Payer: UHC Core |
$244.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.69
|
| Rate for Payer: UHC Exchange |
$244.25
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Medicare |
$1.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.93
|
| Rate for Payer: UHC Exchange |
$2.17
|
|
|
PR GAS DIL/WSHOT DETER LNG VOL DSTRBJ VNTJ&CLSG VOL
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$62.06
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: BCBS MAPPO |
$46.31
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$46.31
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.31
|
| Rate for Payer: Healthscope Commercial |
$74.10
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.55
|
| Rate for Payer: Nomi Health Commercial |
$55.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: PACE SWMI |
$46.31
|
| Rate for Payer: PHP Medicare Advantage |
$46.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.00
|
| Rate for Payer: Priority Health Medicare |
$46.31
|
| Rate for Payer: Priority Health SBD |
$62.00
|
| Rate for Payer: Priority Health Tiered Network |
$62.00
|
| Rate for Payer: Railroad Medicare Medicare |
$46.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.78
|
| Rate for Payer: UHC Core |
$66.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.31
|
| Rate for Payer: UHC Exchange |
$66.78
|
|
