|
PR EXTERNAL ECG REC>7D<15D RECORDING
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 93246
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$13.94
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$16.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$12.48
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$10.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
|
|
PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 93248
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$44.12 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.96
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$34.34
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Healthscope Commercial |
$44.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Nomi Health Commercial |
$28.62
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$23.85
|
|
|
PR EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 32540
|
| Min. Negotiated Rate |
$1,286.40 |
| Max. Negotiated Rate |
$3,069.39 |
| Rate for Payer: Aetna Commercial |
$2,223.23
|
| Rate for Payer: Aetna Medicare |
$1,725.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,389.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,223.23
|
| Rate for Payer: BCBS Complete |
$1,286.40
|
| Rate for Payer: BCBS MAPPO |
$1,659.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,659.13
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cofinity Commercial |
$2,389.15
|
| Rate for Payer: Cofinity Commercial |
$2,223.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,659.13
|
| Rate for Payer: Healthscope Commercial |
$3,069.39
|
| Rate for Payer: Healthscope Commercial |
$2,654.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,742.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,090.40
|
| Rate for Payer: Nomi Health Commercial |
$1,990.96
|
| Rate for Payer: PACE SWMI |
$1,659.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,659.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.40
|
| Rate for Payer: Priority Health Medicare |
$1,659.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,659.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,659.13
|
|
|
PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 26111
|
| Min. Negotiated Rate |
$402.99 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$540.01
|
| Rate for Payer: Aetna Medicare |
$419.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.01
|
| Rate for Payer: BCBS Complete |
$481.60
|
| Rate for Payer: BCBS MAPPO |
$402.99
|
| Rate for Payer: BCN Medicare Advantage |
$402.99
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$580.31
|
| Rate for Payer: Cofinity Commercial |
$540.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.99
|
| Rate for Payer: Healthscope Commercial |
$644.78
|
| Rate for Payer: Healthscope Commercial |
$745.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.60
|
| Rate for Payer: Nomi Health Commercial |
$483.59
|
| Rate for Payer: PACE SWMI |
$402.99
|
| Rate for Payer: PHP Medicare Advantage |
$402.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$782.60
|
| Rate for Payer: Priority Health Medicare |
$402.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.99
|
| Rate for Payer: UHC Medicare Advantage |
$402.99
|
|
|
PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>
|
Professional
|
Both
|
$1,839.00
|
|
|
Service Code
|
HCPCS 26113
|
| Min. Negotiated Rate |
$530.18 |
| Max. Negotiated Rate |
$1,195.35 |
| Rate for Payer: Aetna Commercial |
$710.44
|
| Rate for Payer: Aetna Medicare |
$551.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.44
|
| Rate for Payer: BCBS Complete |
$735.60
|
| Rate for Payer: BCBS MAPPO |
$530.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.18
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cash Price |
$1,471.20
|
| Rate for Payer: Cofinity Commercial |
$763.46
|
| Rate for Payer: Cofinity Commercial |
$710.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.18
|
| Rate for Payer: Healthscope Commercial |
$848.29
|
| Rate for Payer: Healthscope Commercial |
$980.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$556.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.35
|
| Rate for Payer: Nomi Health Commercial |
$636.22
|
| Rate for Payer: PACE SWMI |
$530.18
|
| Rate for Payer: PHP Medicare Advantage |
$530.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,195.35
|
| Rate for Payer: Priority Health Medicare |
$530.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$530.18
|
| Rate for Payer: UHC Medicare Advantage |
$530.18
|
|
|
PR FAA PHYSICAL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00180
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR FACIAL NERVE FUNCTION STUDIES
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92516
|
| Min. Negotiated Rate |
$21.24 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$21.24
|
| Rate for Payer: BCN Medicare Advantage |
$21.24
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$28.46
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.24
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Healthscope Commercial |
$39.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Nomi Health Commercial |
$25.49
|
| Rate for Payer: PACE SWMI |
$21.24
|
| Rate for Payer: PHP Medicare Advantage |
$21.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health Medicare |
$21.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.24
|
| Rate for Payer: UHC Medicare Advantage |
$21.24
|
|
|
PR FAMILY ADAPT BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 97156
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
|
|
PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 90846
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$180.67 |
| Rate for Payer: Aetna Commercial |
$130.86
|
| Rate for Payer: Aetna Medicare |
$101.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.63
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$97.66
|
| Rate for Payer: BCN Medicare Advantage |
$97.66
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$140.63
|
| Rate for Payer: Cofinity Commercial |
$130.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.66
|
| Rate for Payer: Healthscope Commercial |
$180.67
|
| Rate for Payer: Healthscope Commercial |
$156.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.65
|
| Rate for Payer: Nomi Health Commercial |
$117.19
|
| Rate for Payer: PACE SWMI |
$97.66
|
| Rate for Payer: PHP Medicare Advantage |
$97.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$97.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.66
|
| Rate for Payer: UHC Medicare Advantage |
$97.66
|
|
|
PR FAMILY PSYCHOTHERAPY W/PATIENT PRESENT 50 MINS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 90847
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$188.35 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.61
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$122.17
|
| Rate for Payer: PACE SWMI |
$101.81
|
| Rate for Payer: PHP Medicare Advantage |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
|
|
PR FASCIA LATA GRAFT INCISION & AREA EXPOSURE
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 20922
|
| Min. Negotiated Rate |
$430.80 |
| Max. Negotiated Rate |
$891.24 |
| Rate for Payer: Aetna Commercial |
$645.54
|
| Rate for Payer: Aetna Medicare |
$501.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$693.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.54
|
| Rate for Payer: BCBS Complete |
$430.80
|
| Rate for Payer: BCBS MAPPO |
$481.75
|
| Rate for Payer: BCN Medicare Advantage |
$481.75
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$693.72
|
| Rate for Payer: Cofinity Commercial |
$645.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$481.75
|
| Rate for Payer: Healthscope Commercial |
$891.24
|
| Rate for Payer: Healthscope Commercial |
$770.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$505.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$700.05
|
| Rate for Payer: Nomi Health Commercial |
$578.10
|
| Rate for Payer: PACE SWMI |
$481.75
|
| Rate for Payer: PHP Medicare Advantage |
$481.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health Medicare |
$481.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$481.75
|
| Rate for Payer: UHC Medicare Advantage |
$481.75
|
|
|
PR FASCIECTOMY PLANTAR FASCIA PARTIAL SPX
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 28060
|
| Min. Negotiated Rate |
$344.40 |
| Max. Negotiated Rate |
$637.14 |
| Rate for Payer: Aetna Commercial |
$461.50
|
| Rate for Payer: Aetna Medicare |
$358.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.50
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$344.40
|
| Rate for Payer: BCN Medicare Advantage |
$344.40
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$495.94
|
| Rate for Payer: Cofinity Commercial |
$461.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.40
|
| Rate for Payer: Healthscope Commercial |
$551.04
|
| Rate for Payer: Healthscope Commercial |
$637.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.75
|
| Rate for Payer: Nomi Health Commercial |
$413.28
|
| Rate for Payer: PACE SWMI |
$344.40
|
| Rate for Payer: PHP Medicare Advantage |
$344.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$344.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.40
|
| Rate for Payer: UHC Medicare Advantage |
$344.40
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$377.85
|
| Rate for Payer: Aetna Medicare |
$293.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.85
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: BCBS MAPPO |
$281.98
|
| Rate for Payer: BCN Medicare Advantage |
$281.98
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Cofinity Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.98
|
| Rate for Payer: Healthscope Commercial |
$521.66
|
| Rate for Payer: Healthscope Commercial |
$451.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.35
|
| Rate for Payer: Nomi Health Commercial |
$338.38
|
| Rate for Payer: PACE SWMI |
$281.98
|
| Rate for Payer: PHP Medicare Advantage |
$281.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$281.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.98
|
| Rate for Payer: UHC Medicare Advantage |
$281.98
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$281.98 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$377.85
|
| Rate for Payer: Aetna Medicare |
$293.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.05
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: BCBS MAPPO |
$281.98
|
| Rate for Payer: BCN Medicare Advantage |
$281.98
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Cofinity Commercial |
$377.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.98
|
| Rate for Payer: Healthscope Commercial |
$451.17
|
| Rate for Payer: Healthscope Commercial |
$521.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.35
|
| Rate for Payer: Nomi Health Commercial |
$338.38
|
| Rate for Payer: PACE SWMI |
$281.98
|
| Rate for Payer: PHP Medicare Advantage |
$281.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$281.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.98
|
| Rate for Payer: UHC Medicare Advantage |
$281.98
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$452.97 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Cofinity Commercial |
$503.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$452.97
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR FASCIOTOMY FOOT&/TOE
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
28008
|
| Min. Negotiated Rate |
$452.97 |
| Max. Negotiated Rate |
$647.10 |
| Rate for Payer: Aetna Commercial |
$611.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.35
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Cofinity Commercial |
$503.30
|
| Rate for Payer: Cofinity Commercial |
$618.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$503.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$575.20
|
| Rate for Payer: Healthscope Commercial |
$647.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.15
|
| Rate for Payer: PHP Commercial |
$611.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: Priority Health SBD |
$452.97
|
|
|
PR FASCIOTOMY HIP/THIGH ANY TYPE
|
Professional
|
Both
|
$3,485.00
|
|
|
Service Code
|
HCPCS 27025
|
| Min. Negotiated Rate |
$902.59 |
| Max. Negotiated Rate |
$2,265.25 |
| Rate for Payer: Aetna Commercial |
$1,209.47
|
| Rate for Payer: Aetna Medicare |
$938.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.47
|
| Rate for Payer: BCBS Complete |
$1,394.00
|
| Rate for Payer: BCBS MAPPO |
$902.59
|
| Rate for Payer: BCN Medicare Advantage |
$902.59
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,299.73
|
| Rate for Payer: Cofinity Commercial |
$1,209.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.59
|
| Rate for Payer: Healthscope Commercial |
$1,444.14
|
| Rate for Payer: Healthscope Commercial |
$1,669.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,265.25
|
| Rate for Payer: Nomi Health Commercial |
$1,083.11
|
| Rate for Payer: PACE SWMI |
$902.59
|
| Rate for Payer: PHP Medicare Advantage |
$902.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,265.25
|
| Rate for Payer: Priority Health Medicare |
$902.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.59
|
| Rate for Payer: UHC Medicare Advantage |
$902.59
|
|
|
PR FASCIOTOMY ILIOTIBIAL OPEN
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 27305
|
| Min. Negotiated Rate |
$468.34 |
| Max. Negotiated Rate |
$866.43 |
| Rate for Payer: Aetna Commercial |
$627.58
|
| Rate for Payer: Aetna Medicare |
$487.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.58
|
| Rate for Payer: BCBS Complete |
$529.20
|
| Rate for Payer: BCBS MAPPO |
$468.34
|
| Rate for Payer: BCN Medicare Advantage |
$468.34
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cofinity Commercial |
$674.41
|
| Rate for Payer: Cofinity Commercial |
$627.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.34
|
| Rate for Payer: Healthscope Commercial |
$866.43
|
| Rate for Payer: Healthscope Commercial |
$749.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.95
|
| Rate for Payer: Nomi Health Commercial |
$562.01
|
| Rate for Payer: PACE SWMI |
$468.34
|
| Rate for Payer: PHP Medicare Advantage |
$468.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.95
|
| Rate for Payer: Priority Health Medicare |
$468.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.34
|
| Rate for Payer: UHC Medicare Advantage |
$468.34
|
|
|
PR FASCIOTOMY PALMAR OPEN PARTIAL
|
Professional
|
Both
|
$1,368.00
|
|
|
Service Code
|
HCPCS 26045
|
| Min. Negotiated Rate |
$458.19 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna Commercial |
$613.97
|
| Rate for Payer: Aetna Medicare |
$476.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.97
|
| Rate for Payer: BCBS Complete |
$547.20
|
| Rate for Payer: BCBS MAPPO |
$458.19
|
| Rate for Payer: BCN Medicare Advantage |
$458.19
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Cofinity Commercial |
$659.79
|
| Rate for Payer: Cofinity Commercial |
$613.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.19
|
| Rate for Payer: Healthscope Commercial |
$733.10
|
| Rate for Payer: Healthscope Commercial |
$847.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$889.20
|
| Rate for Payer: Nomi Health Commercial |
$549.83
|
| Rate for Payer: PACE SWMI |
$458.19
|
| Rate for Payer: PHP Medicare Advantage |
$458.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.20
|
| Rate for Payer: Priority Health Medicare |
$458.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.19
|
| Rate for Payer: UHC Medicare Advantage |
$458.19
|
|
|
PR FASCIOTOMY PALMAR PERCUTANEOUS
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 26040
|
| Min. Negotiated Rate |
$306.15 |
| Max. Negotiated Rate |
$604.50 |
| Rate for Payer: Aetna Commercial |
$410.24
|
| Rate for Payer: Aetna Medicare |
$318.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.24
|
| Rate for Payer: BCBS Complete |
$372.00
|
| Rate for Payer: BCBS MAPPO |
$306.15
|
| Rate for Payer: BCN Medicare Advantage |
$306.15
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$440.86
|
| Rate for Payer: Cofinity Commercial |
$410.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.15
|
| Rate for Payer: Healthscope Commercial |
$566.38
|
| Rate for Payer: Healthscope Commercial |
$489.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$604.50
|
| Rate for Payer: Nomi Health Commercial |
$367.38
|
| Rate for Payer: PACE SWMI |
$306.15
|
| Rate for Payer: PHP Medicare Advantage |
$306.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health Medicare |
$306.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.15
|
| Rate for Payer: UHC Medicare Advantage |
$306.15
|
|
|
PR FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT
|
Professional
|
Both
|
$2,361.00
|
|
|
Service Code
|
HCPCS 26121
|
| Min. Negotiated Rate |
$580.37 |
| Max. Negotiated Rate |
$1,534.65 |
| Rate for Payer: Aetna Commercial |
$777.70
|
| Rate for Payer: Aetna Medicare |
$603.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.70
|
| Rate for Payer: BCBS Complete |
$944.40
|
| Rate for Payer: BCBS MAPPO |
$580.37
|
| Rate for Payer: BCN Medicare Advantage |
$580.37
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cash Price |
$1,888.80
|
| Rate for Payer: Cofinity Commercial |
$835.73
|
| Rate for Payer: Cofinity Commercial |
$777.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.37
|
| Rate for Payer: Healthscope Commercial |
$1,073.68
|
| Rate for Payer: Healthscope Commercial |
$928.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,534.65
|
| Rate for Payer: Nomi Health Commercial |
$696.44
|
| Rate for Payer: PACE SWMI |
$580.37
|
| Rate for Payer: PHP Medicare Advantage |
$580.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,534.65
|
| Rate for Payer: Priority Health Medicare |
$580.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.37
|
| Rate for Payer: UHC Medicare Advantage |
$580.37
|
|
|
PR FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$2,952.00
|
|
|
Service Code
|
HCPCS 26123
|
| Min. Negotiated Rate |
$809.00 |
| Max. Negotiated Rate |
$1,918.80 |
| Rate for Payer: Aetna Commercial |
$1,084.06
|
| Rate for Payer: Aetna Medicare |
$841.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.06
|
| Rate for Payer: BCBS Complete |
$1,180.80
|
| Rate for Payer: BCBS MAPPO |
$809.00
|
| Rate for Payer: BCN Medicare Advantage |
$809.00
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cash Price |
$2,361.60
|
| Rate for Payer: Cofinity Commercial |
$1,164.96
|
| Rate for Payer: Cofinity Commercial |
$1,084.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.00
|
| Rate for Payer: Healthscope Commercial |
$1,496.65
|
| Rate for Payer: Healthscope Commercial |
$1,294.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,918.80
|
| Rate for Payer: Nomi Health Commercial |
$970.80
|
| Rate for Payer: PACE SWMI |
$809.00
|
| Rate for Payer: PHP Medicare Advantage |
$809.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,918.80
|
| Rate for Payer: Priority Health Medicare |
$809.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.00
|
| Rate for Payer: UHC Medicare Advantage |
$809.00
|
|
|
PR FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
HCPCS 26125
|
| Min. Negotiated Rate |
$257.96 |
| Max. Negotiated Rate |
$575.25 |
| Rate for Payer: Aetna Commercial |
$345.67
|
| Rate for Payer: Aetna Medicare |
$268.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.67
|
| Rate for Payer: BCBS Complete |
$354.00
|
| Rate for Payer: BCBS MAPPO |
$257.96
|
| Rate for Payer: BCN Medicare Advantage |
$257.96
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cash Price |
$708.00
|
| Rate for Payer: Cofinity Commercial |
$371.46
|
| Rate for Payer: Cofinity Commercial |
$345.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.96
|
| Rate for Payer: Healthscope Commercial |
$412.74
|
| Rate for Payer: Healthscope Commercial |
$477.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.25
|
| Rate for Payer: Nomi Health Commercial |
$309.55
|
| Rate for Payer: PACE SWMI |
$257.96
|
| Rate for Payer: PHP Medicare Advantage |
$257.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.25
|
| Rate for Payer: Priority Health Medicare |
$257.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.96
|
| Rate for Payer: UHC Medicare Advantage |
$257.96
|
|
|
PR FECAL BLOOD SCRN IMMUNOASSAY
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS G0328
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$33.39 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$18.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.19
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$18.05
|
| Rate for Payer: BCN Medicare Advantage |
$18.05
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$25.99
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.05
|
| Rate for Payer: Healthscope Commercial |
$33.39
|
| Rate for Payer: Healthscope Commercial |
$28.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$21.66
|
| Rate for Payer: PACE SWMI |
$18.05
|
| Rate for Payer: PHP Medicare Advantage |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$18.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$18.05
|
|
|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Commercial |
$89.91
|
| Rate for Payer: Aetna Medicare |
$69.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.91
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$67.10
|
| Rate for Payer: BCN Medicare Advantage |
$67.10
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$96.62
|
| Rate for Payer: Cofinity Commercial |
$89.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.10
|
| Rate for Payer: Healthscope Commercial |
$107.36
|
| Rate for Payer: Healthscope Commercial |
$124.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$80.52
|
| Rate for Payer: PACE SWMI |
$67.10
|
| Rate for Payer: PHP Medicare Advantage |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$67.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.10
|
| Rate for Payer: UHC Medicare Advantage |
$67.10
|
|
