|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$727.65 |
| Max. Negotiated Rate |
$1,039.50 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.75
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$808.50
|
| Rate for Payer: Cofinity Commercial |
$993.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$808.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Healthscope Commercial |
$1,039.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: PHP Commercial |
$981.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health SBD |
$727.65
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Hospital Charge Code |
24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$979.46 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$550.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.39
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Healthscope Commercial |
$847.10
|
| Rate for Payer: Healthscope Commercial |
$979.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.75
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 24076
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$979.46 |
| Rate for Payer: Aetna Commercial |
$709.45
|
| Rate for Payer: Aetna Medicare |
$550.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.45
|
| Rate for Payer: BCBS Complete |
$462.00
|
| Rate for Payer: BCBS MAPPO |
$529.44
|
| Rate for Payer: BCN Medicare Advantage |
$529.44
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$762.39
|
| Rate for Payer: Cofinity Commercial |
$709.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.44
|
| Rate for Payer: Healthscope Commercial |
$847.10
|
| Rate for Payer: Healthscope Commercial |
$979.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$750.75
|
| Rate for Payer: Nomi Health Commercial |
$635.33
|
| Rate for Payer: PACE SWMI |
$529.44
|
| Rate for Payer: PHP Medicare Advantage |
$529.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$529.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.44
|
| Rate for Payer: UHC Medicare Advantage |
$529.44
|
|
|
PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 24076
|
| Hospital Charge Code |
24076
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$727.65 |
| Max. Negotiated Rate |
$7,857.23 |
| Rate for Payer: Aetna Commercial |
$981.75
|
| Rate for Payer: Aetna Medicare |
$2,902.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$808.50
|
| Rate for Payer: Cofinity Commercial |
$993.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$808.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$924.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,039.50
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$981.75
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$981.75
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health SBD |
$727.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,857.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,571.50
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Hospital Charge Code |
26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$334.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.78
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Healthscope Commercial |
$515.31
|
| Rate for Payer: Healthscope Commercial |
$595.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.85
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 26115
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$707.85 |
| Rate for Payer: Aetna Commercial |
$431.57
|
| Rate for Payer: Aetna Medicare |
$334.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.57
|
| Rate for Payer: BCBS Complete |
$435.60
|
| Rate for Payer: BCBS MAPPO |
$322.07
|
| Rate for Payer: BCN Medicare Advantage |
$322.07
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$463.78
|
| Rate for Payer: Cofinity Commercial |
$431.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.07
|
| Rate for Payer: Healthscope Commercial |
$595.83
|
| Rate for Payer: Healthscope Commercial |
$515.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$707.85
|
| Rate for Payer: Nomi Health Commercial |
$386.48
|
| Rate for Payer: PACE SWMI |
$322.07
|
| Rate for Payer: PHP Medicare Advantage |
$322.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$322.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.07
|
| Rate for Payer: UHC Medicare Advantage |
$322.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
IP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$980.10 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.85
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$762.30
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$762.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health SBD |
$686.07
|
|
|
PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM
|
Facility
|
OP
|
$1,089.00
|
|
|
Service Code
|
CPT 26115
|
| Hospital Charge Code |
26115
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$686.07 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna Commercial |
$925.65
|
| Rate for Payer: Aetna Medicare |
$1,643.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$762.30
|
| Rate for Payer: Cofinity Commercial |
$936.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$762.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$871.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$980.10
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$925.65
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$925.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$707.85
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health SBD |
$686.07
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,448.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$889.65
|
| Rate for Payer: VA VA |
$1,580.19
|
|
|
PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26116
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$681.97
|
| Rate for Payer: Aetna Medicare |
$529.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.97
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$508.93
|
| Rate for Payer: BCN Medicare Advantage |
$508.93
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$732.86
|
| Rate for Payer: Cofinity Commercial |
$681.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$508.93
|
| Rate for Payer: Healthscope Commercial |
$814.29
|
| Rate for Payer: Healthscope Commercial |
$941.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,092.00
|
| Rate for Payer: Nomi Health Commercial |
$610.72
|
| Rate for Payer: PACE SWMI |
$508.93
|
| Rate for Payer: PHP Medicare Advantage |
$508.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$508.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$508.93
|
| Rate for Payer: UHC Medicare Advantage |
$508.93
|
|
|
PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR
|
Professional
|
Both
|
$5,537.00
|
|
|
Service Code
|
HCPCS 51500
|
| Min. Negotiated Rate |
$610.21 |
| Max. Negotiated Rate |
$3,599.05 |
| Rate for Payer: Aetna Commercial |
$817.68
|
| Rate for Payer: Aetna Medicare |
$634.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.68
|
| Rate for Payer: BCBS Complete |
$2,214.80
|
| Rate for Payer: BCBS MAPPO |
$610.21
|
| Rate for Payer: BCN Medicare Advantage |
$610.21
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cash Price |
$4,429.60
|
| Rate for Payer: Cofinity Commercial |
$878.70
|
| Rate for Payer: Cofinity Commercial |
$817.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$610.21
|
| Rate for Payer: Healthscope Commercial |
$976.34
|
| Rate for Payer: Healthscope Commercial |
$1,128.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$640.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,599.05
|
| Rate for Payer: Nomi Health Commercial |
$732.25
|
| Rate for Payer: PACE SWMI |
$610.21
|
| Rate for Payer: PHP Medicare Advantage |
$610.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,599.05
|
| Rate for Payer: Priority Health Medicare |
$610.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$610.21
|
| Rate for Payer: UHC Medicare Advantage |
$610.21
|
|
|
PR EXC URETHRAL DIVERTICULUM SPX FEMALE
|
Professional
|
Both
|
$1,149.00
|
|
|
Service Code
|
HCPCS 53230
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,080.94 |
| Rate for Payer: Aetna Commercial |
$782.95
|
| Rate for Payer: Aetna Medicare |
$607.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$841.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.95
|
| Rate for Payer: BCBS Complete |
$459.60
|
| Rate for Payer: BCBS MAPPO |
$584.29
|
| Rate for Payer: BCN Medicare Advantage |
$584.29
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cash Price |
$919.20
|
| Rate for Payer: Cofinity Commercial |
$841.38
|
| Rate for Payer: Cofinity Commercial |
$782.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$584.29
|
| Rate for Payer: Healthscope Commercial |
$1,080.94
|
| Rate for Payer: Healthscope Commercial |
$934.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$613.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.85
|
| Rate for Payer: Nomi Health Commercial |
$701.15
|
| Rate for Payer: PACE SWMI |
$584.29
|
| Rate for Payer: PHP Medicare Advantage |
$584.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.85
|
| Rate for Payer: Priority Health Medicare |
$584.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$584.29
|
| Rate for Payer: UHC Medicare Advantage |
$584.29
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL
|
Professional
|
Both
|
$2,143.00
|
|
|
Service Code
|
HCPCS 55535
|
| Min. Negotiated Rate |
$411.95 |
| Max. Negotiated Rate |
$1,392.95 |
| Rate for Payer: Aetna Commercial |
$552.01
|
| Rate for Payer: Aetna Medicare |
$428.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$552.01
|
| Rate for Payer: BCBS Complete |
$857.20
|
| Rate for Payer: BCBS MAPPO |
$411.95
|
| Rate for Payer: BCN Medicare Advantage |
$411.95
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cash Price |
$1,714.40
|
| Rate for Payer: Cofinity Commercial |
$593.21
|
| Rate for Payer: Cofinity Commercial |
$552.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.95
|
| Rate for Payer: Healthscope Commercial |
$762.11
|
| Rate for Payer: Healthscope Commercial |
$659.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.95
|
| Rate for Payer: Nomi Health Commercial |
$494.34
|
| Rate for Payer: PACE SWMI |
$411.95
|
| Rate for Payer: PHP Medicare Advantage |
$411.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.95
|
| Rate for Payer: Priority Health Medicare |
$411.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.95
|
| Rate for Payer: UHC Medicare Advantage |
$411.95
|
|
|
PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
HCPCS 55530
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$623.99 |
| Rate for Payer: Aetna Commercial |
$451.97
|
| Rate for Payer: Aetna Medicare |
$350.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.97
|
| Rate for Payer: BCBS Complete |
$262.00
|
| Rate for Payer: BCBS MAPPO |
$337.29
|
| Rate for Payer: BCN Medicare Advantage |
$337.29
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cash Price |
$524.00
|
| Rate for Payer: Cofinity Commercial |
$485.70
|
| Rate for Payer: Cofinity Commercial |
$451.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.29
|
| Rate for Payer: Healthscope Commercial |
$539.66
|
| Rate for Payer: Healthscope Commercial |
$623.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.75
|
| Rate for Payer: Nomi Health Commercial |
$404.75
|
| Rate for Payer: PACE SWMI |
$337.29
|
| Rate for Payer: PHP Medicare Advantage |
$337.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.75
|
| Rate for Payer: Priority Health Medicare |
$337.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.29
|
| Rate for Payer: UHC Medicare Advantage |
$337.29
|
|
|
PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 55540
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$724.32
|
| Rate for Payer: Aetna Medicare |
$562.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.32
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCBS MAPPO |
$540.54
|
| Rate for Payer: BCN Medicare Advantage |
$540.54
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cofinity Commercial |
$778.38
|
| Rate for Payer: Cofinity Commercial |
$724.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.54
|
| Rate for Payer: Healthscope Commercial |
$864.86
|
| Rate for Payer: Healthscope Commercial |
$1,000.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$514.80
|
| Rate for Payer: Nomi Health Commercial |
$648.65
|
| Rate for Payer: PACE SWMI |
$540.54
|
| Rate for Payer: PHP Medicare Advantage |
$540.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health Medicare |
$540.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.54
|
| Rate for Payer: UHC Medicare Advantage |
$540.54
|
|
|
PR EXC XTRPARENCHYMAL LESION TESTIS
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 54512
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$954.67 |
| Rate for Payer: Aetna Commercial |
$691.49
|
| Rate for Payer: Aetna Medicare |
$536.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.49
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$516.04
|
| Rate for Payer: BCN Medicare Advantage |
$516.04
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$743.10
|
| Rate for Payer: Cofinity Commercial |
$691.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.04
|
| Rate for Payer: Healthscope Commercial |
$825.66
|
| Rate for Payer: Healthscope Commercial |
$954.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.80
|
| Rate for Payer: Nomi Health Commercial |
$619.25
|
| Rate for Payer: PACE SWMI |
$516.04
|
| Rate for Payer: PHP Medicare Advantage |
$516.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$516.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.04
|
| Rate for Payer: UHC Medicare Advantage |
$516.04
|
|
|
PR EXERCISE EQUIPMENT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A9300
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR EXISION OF SUBLINGUAL GLAND
|
Professional
|
Both
|
$767.00
|
|
|
Service Code
|
HCPCS 42450
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$641.17 |
| Rate for Payer: Aetna Commercial |
$464.42
|
| Rate for Payer: Aetna Medicare |
$360.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.08
|
| Rate for Payer: BCBS Complete |
$306.80
|
| Rate for Payer: BCBS MAPPO |
$346.58
|
| Rate for Payer: BCN Medicare Advantage |
$346.58
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cash Price |
$613.60
|
| Rate for Payer: Cofinity Commercial |
$499.08
|
| Rate for Payer: Cofinity Commercial |
$464.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.58
|
| Rate for Payer: Healthscope Commercial |
$641.17
|
| Rate for Payer: Healthscope Commercial |
$554.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$498.55
|
| Rate for Payer: Nomi Health Commercial |
$415.90
|
| Rate for Payer: PACE SWMI |
$346.58
|
| Rate for Payer: PHP Medicare Advantage |
$346.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.55
|
| Rate for Payer: Priority Health Medicare |
$346.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.58
|
| Rate for Payer: UHC Medicare Advantage |
$346.58
|
|
|
PR EXPL CONGENITAL ATRESIA BILE DUCTS
|
Professional
|
Both
|
$2,902.00
|
|
|
Service Code
|
HCPCS 47700
|
| Min. Negotiated Rate |
$1,026.35 |
| Max. Negotiated Rate |
$1,898.75 |
| Rate for Payer: Aetna Commercial |
$1,375.31
|
| Rate for Payer: Aetna Medicare |
$1,067.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,375.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.94
|
| Rate for Payer: BCBS Complete |
$1,160.80
|
| Rate for Payer: BCBS MAPPO |
$1,026.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.35
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Cash Price |
$2,321.60
|
| Rate for Payer: Cofinity Commercial |
$1,375.31
|
| Rate for Payer: Cofinity Commercial |
$1,477.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.35
|
| Rate for Payer: Healthscope Commercial |
$1,642.16
|
| Rate for Payer: Healthscope Commercial |
$1,898.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.30
|
| Rate for Payer: Nomi Health Commercial |
$1,231.62
|
| Rate for Payer: PACE SWMI |
$1,026.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.30
|
| Rate for Payer: Priority Health Medicare |
$1,026.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.35
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.35
|
|
|
PR EXPLORATION EPIDIDYMIS W/WO BIOPSY
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 54865
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$638.80 |
| Rate for Payer: Aetna Commercial |
$462.70
|
| Rate for Payer: Aetna Medicare |
$359.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.70
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS MAPPO |
$345.30
|
| Rate for Payer: BCN Medicare Advantage |
$345.30
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Cofinity Commercial |
$462.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.30
|
| Rate for Payer: Healthscope Commercial |
$552.48
|
| Rate for Payer: Healthscope Commercial |
$638.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$437.45
|
| Rate for Payer: Nomi Health Commercial |
$414.36
|
| Rate for Payer: PACE SWMI |
$345.30
|
| Rate for Payer: PHP Medicare Advantage |
$345.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.45
|
| Rate for Payer: Priority Health Medicare |
$345.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.30
|
| Rate for Payer: UHC Medicare Advantage |
$345.30
|
|
|
PR EXPLORATION, FEMORAL ARTERY
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 35721
|
| Min. Negotiated Rate |
$625.20 |
| Max. Negotiated Rate |
$1,015.95 |
| Rate for Payer: Aetna Medicare |
$781.50
|
| Rate for Payer: BCBS Complete |
$625.20
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,015.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.95
|
|
|
PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 35703
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$741.66 |
| Rate for Payer: Aetna Commercial |
$537.21
|
| Rate for Payer: Aetna Medicare |
$416.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.30
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS MAPPO |
$400.90
|
| Rate for Payer: BCN Medicare Advantage |
$400.90
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$537.21
|
| Rate for Payer: Cofinity Commercial |
$577.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.90
|
| Rate for Payer: Healthscope Commercial |
$641.44
|
| Rate for Payer: Healthscope Commercial |
$741.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$420.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.15
|
| Rate for Payer: Nomi Health Commercial |
$481.08
|
| Rate for Payer: PACE SWMI |
$400.90
|
| Rate for Payer: PHP Medicare Advantage |
$400.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health Medicare |
$400.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.90
|
| Rate for Payer: UHC Medicare Advantage |
$400.90
|
|
|
PR EXPLORATION N/FLWD SURG NECK ARTERY
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 35701
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$775.65 |
| Rate for Payer: Aetna Commercial |
$561.82
|
| Rate for Payer: Aetna Medicare |
$436.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.82
|
| Rate for Payer: BCBS Complete |
$363.20
|
| Rate for Payer: BCBS MAPPO |
$419.27
|
| Rate for Payer: BCN Medicare Advantage |
$419.27
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cofinity Commercial |
$603.75
|
| Rate for Payer: Cofinity Commercial |
$561.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$419.27
|
| Rate for Payer: Healthscope Commercial |
$775.65
|
| Rate for Payer: Healthscope Commercial |
$670.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$440.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.20
|
| Rate for Payer: Nomi Health Commercial |
$503.12
|
| Rate for Payer: PACE SWMI |
$419.27
|
| Rate for Payer: PHP Medicare Advantage |
$419.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.20
|
| Rate for Payer: Priority Health Medicare |
$419.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$419.27
|
| Rate for Payer: UHC Medicare Advantage |
$419.27
|
|
|
PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 35702
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$728.10 |
| Rate for Payer: Aetna Commercial |
$527.38
|
| Rate for Payer: Aetna Medicare |
$409.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.38
|
| Rate for Payer: BCBS Complete |
$362.00
|
| Rate for Payer: BCBS MAPPO |
$393.57
|
| Rate for Payer: BCN Medicare Advantage |
$393.57
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$566.74
|
| Rate for Payer: Cofinity Commercial |
$527.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.57
|
| Rate for Payer: Healthscope Commercial |
$629.71
|
| Rate for Payer: Healthscope Commercial |
$728.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.25
|
| Rate for Payer: Nomi Health Commercial |
$472.28
|
| Rate for Payer: PACE SWMI |
$393.57
|
| Rate for Payer: PHP Medicare Advantage |
$393.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health Medicare |
$393.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.57
|
| Rate for Payer: UHC Medicare Advantage |
$393.57
|
|
|
PR EXPLORATION OF ARTERY/VEIN
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 35761
|
| Min. Negotiated Rate |
$523.20 |
| Max. Negotiated Rate |
$850.20 |
| Rate for Payer: Aetna Medicare |
$654.00
|
| Rate for Payer: BCBS Complete |
$523.20
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$850.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$850.20
|
|
|
PR EXPLORATION PENETRATING WOUND SPX CHEST
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 20101
|
| Min. Negotiated Rate |
$202.78 |
| Max. Negotiated Rate |
$746.20 |
| Rate for Payer: Aetna Commercial |
$271.73
|
| Rate for Payer: Aetna Medicare |
$210.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.00
|
| Rate for Payer: BCBS Complete |
$459.20
|
| Rate for Payer: BCBS MAPPO |
$202.78
|
| Rate for Payer: BCN Medicare Advantage |
$202.78
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cofinity Commercial |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$271.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.78
|
| Rate for Payer: Healthscope Commercial |
$375.14
|
| Rate for Payer: Healthscope Commercial |
$324.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$746.20
|
| Rate for Payer: Nomi Health Commercial |
$243.34
|
| Rate for Payer: PACE SWMI |
$202.78
|
| Rate for Payer: PHP Medicare Advantage |
$202.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.20
|
| Rate for Payer: Priority Health Medicare |
$202.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.78
|
| Rate for Payer: UHC Medicare Advantage |
$202.78
|
|
