|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$113.39 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$63.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.13
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$61.29
|
| Rate for Payer: BCN Medicare Advantage |
$61.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$88.26
|
| Rate for Payer: Cofinity Commercial |
$82.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.29
|
| Rate for Payer: Healthscope Commercial |
$113.39
|
| Rate for Payer: Healthscope Commercial |
$98.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.50
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: PACE SWMI |
$61.29
|
| Rate for Payer: PHP Medicare Advantage |
$61.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$61.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.29
|
| Rate for Payer: UHC Medicare Advantage |
$61.29
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$133.26 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare |
$74.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.72
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$72.03
|
| Rate for Payer: BCN Medicare Advantage |
$72.03
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.03
|
| Rate for Payer: Healthscope Commercial |
$133.26
|
| Rate for Payer: Healthscope Commercial |
$115.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.30
|
| Rate for Payer: Nomi Health Commercial |
$86.44
|
| Rate for Payer: PACE SWMI |
$72.03
|
| Rate for Payer: PHP Medicare Advantage |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$72.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.03
|
| Rate for Payer: UHC Medicare Advantage |
$72.03
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$1,386.09 |
| Rate for Payer: Aetna Commercial |
$1,003.98
|
| Rate for Payer: Aetna Medicare |
$779.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.98
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$749.24
|
| Rate for Payer: BCN Medicare Advantage |
$749.24
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$1,078.91
|
| Rate for Payer: Cofinity Commercial |
$1,003.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.24
|
| Rate for Payer: Healthscope Commercial |
$1,198.78
|
| Rate for Payer: Healthscope Commercial |
$1,386.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.70
|
| Rate for Payer: Nomi Health Commercial |
$899.09
|
| Rate for Payer: PACE SWMI |
$749.24
|
| Rate for Payer: PHP Medicare Advantage |
$749.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$749.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.24
|
| Rate for Payer: UHC Medicare Advantage |
$749.24
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,259.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$903.60 |
| Max. Negotiated Rate |
$1,750.65 |
| Rate for Payer: Aetna Commercial |
$1,268.04
|
| Rate for Payer: Aetna Medicare |
$984.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,268.04
|
| Rate for Payer: BCBS Complete |
$903.60
|
| Rate for Payer: BCBS MAPPO |
$946.30
|
| Rate for Payer: BCN Medicare Advantage |
$946.30
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.67
|
| Rate for Payer: Cofinity Commercial |
$1,268.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.30
|
| Rate for Payer: Healthscope Commercial |
$1,750.65
|
| Rate for Payer: Healthscope Commercial |
$1,514.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,468.35
|
| Rate for Payer: Nomi Health Commercial |
$1,135.56
|
| Rate for Payer: PACE SWMI |
$946.30
|
| Rate for Payer: PHP Medicare Advantage |
$946.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,468.35
|
| Rate for Payer: Priority Health Medicare |
$946.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.30
|
| Rate for Payer: UHC Medicare Advantage |
$946.30
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$54.89 |
| Max. Negotiated Rate |
$101.55 |
| Rate for Payer: Aetna Commercial |
$73.55
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.55
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$54.89
|
| Rate for Payer: BCN Medicare Advantage |
$54.89
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$79.04
|
| Rate for Payer: Cofinity Commercial |
$73.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.89
|
| Rate for Payer: Healthscope Commercial |
$101.55
|
| Rate for Payer: Healthscope Commercial |
$87.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: PACE SWMI |
$54.89
|
| Rate for Payer: PHP Medicare Advantage |
$54.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$54.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.89
|
| Rate for Payer: UHC Medicare Advantage |
$54.89
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$432.83 |
| Rate for Payer: Aetna Commercial |
$313.51
|
| Rate for Payer: Aetna Medicare |
$243.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.51
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$233.96
|
| Rate for Payer: BCN Medicare Advantage |
$233.96
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$336.90
|
| Rate for Payer: Cofinity Commercial |
$313.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.96
|
| Rate for Payer: Healthscope Commercial |
$374.34
|
| Rate for Payer: Healthscope Commercial |
$432.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$280.75
|
| Rate for Payer: PACE SWMI |
$233.96
|
| Rate for Payer: PHP Medicare Advantage |
$233.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Medicare |
$233.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.96
|
| Rate for Payer: UHC Medicare Advantage |
$233.96
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR FRAC NECK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00102
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00104
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00103
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$148.86
|
| Rate for Payer: Aetna Medicare |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.86
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$111.09
|
| Rate for Payer: BCN Medicare Advantage |
$111.09
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| Rate for Payer: Cofinity Commercial |
$159.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.09
|
| Rate for Payer: Healthscope Commercial |
$205.52
|
| Rate for Payer: Healthscope Commercial |
$177.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.80
|
| Rate for Payer: Nomi Health Commercial |
$133.31
|
| Rate for Payer: PACE SWMI |
$111.09
|
| Rate for Payer: PHP Medicare Advantage |
$111.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$111.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.09
|
| Rate for Payer: UHC Medicare Advantage |
$111.09
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00101
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$569.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$438.15 |
| Rate for Payer: Aetna Commercial |
$317.37
|
| Rate for Payer: Aetna Medicare |
$246.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.05
|
| Rate for Payer: BCBS Complete |
$227.60
|
| Rate for Payer: BCBS MAPPO |
$236.84
|
| Rate for Payer: BCN Medicare Advantage |
$236.84
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cofinity Commercial |
$341.05
|
| Rate for Payer: Cofinity Commercial |
$317.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.84
|
| Rate for Payer: Healthscope Commercial |
$438.15
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.85
|
| Rate for Payer: Nomi Health Commercial |
$284.21
|
| Rate for Payer: PACE SWMI |
$236.84
|
| Rate for Payer: PHP Medicare Advantage |
$236.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.84
|
| Rate for Payer: UHC Medicare Advantage |
$236.84
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$185.83 |
| Max. Negotiated Rate |
$536.25 |
| Rate for Payer: Aetna Commercial |
$249.01
|
| Rate for Payer: Aetna Medicare |
$193.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.60
|
| Rate for Payer: BCBS Complete |
$330.00
|
| Rate for Payer: BCBS MAPPO |
$185.83
|
| Rate for Payer: BCN Medicare Advantage |
$185.83
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$249.01
|
| Rate for Payer: Cofinity Commercial |
$267.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.83
|
| Rate for Payer: Healthscope Commercial |
$297.33
|
| Rate for Payer: Healthscope Commercial |
$343.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$536.25
|
| Rate for Payer: Nomi Health Commercial |
$223.00
|
| Rate for Payer: PACE SWMI |
$185.83
|
| Rate for Payer: PHP Medicare Advantage |
$185.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health Medicare |
$185.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.83
|
| Rate for Payer: UHC Medicare Advantage |
$185.83
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$601.20 |
| Max. Negotiated Rate |
$1,287.32 |
| Rate for Payer: Aetna Commercial |
$932.44
|
| Rate for Payer: Aetna Medicare |
$723.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.02
|
| Rate for Payer: BCBS Complete |
$601.20
|
| Rate for Payer: BCBS MAPPO |
$695.85
|
| Rate for Payer: BCN Medicare Advantage |
$695.85
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cash Price |
$1,202.40
|
| Rate for Payer: Cofinity Commercial |
$932.44
|
| Rate for Payer: Cofinity Commercial |
$1,002.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.85
|
| Rate for Payer: Healthscope Commercial |
$1,287.32
|
| Rate for Payer: Healthscope Commercial |
$1,113.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.95
|
| Rate for Payer: Nomi Health Commercial |
$835.02
|
| Rate for Payer: PACE SWMI |
$695.85
|
| Rate for Payer: PHP Medicare Advantage |
$695.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health Medicare |
$695.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.85
|
| Rate for Payer: UHC Medicare Advantage |
$695.85
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$615.17 |
| Max. Negotiated Rate |
$1,138.06 |
| Rate for Payer: Aetna Commercial |
$824.33
|
| Rate for Payer: Aetna Medicare |
$639.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.33
|
| Rate for Payer: BCBS Complete |
$649.20
|
| Rate for Payer: BCBS MAPPO |
$615.17
|
| Rate for Payer: BCN Medicare Advantage |
$615.17
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$885.84
|
| Rate for Payer: Cofinity Commercial |
$824.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.17
|
| Rate for Payer: Healthscope Commercial |
$1,138.06
|
| Rate for Payer: Healthscope Commercial |
$984.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.95
|
| Rate for Payer: Nomi Health Commercial |
$738.20
|
| Rate for Payer: PACE SWMI |
$615.17
|
| Rate for Payer: PHP Medicare Advantage |
$615.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health Medicare |
$615.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.17
|
| Rate for Payer: UHC Medicare Advantage |
$615.17
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,566.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$626.40 |
| Max. Negotiated Rate |
$1,299.99 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Medicare |
$730.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.89
|
| Rate for Payer: BCBS Complete |
$626.40
|
| Rate for Payer: BCBS MAPPO |
$702.70
|
| Rate for Payer: BCN Medicare Advantage |
$702.70
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cash Price |
$1,252.80
|
| Rate for Payer: Cofinity Commercial |
$941.62
|
| Rate for Payer: Cofinity Commercial |
$1,011.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.70
|
| Rate for Payer: Healthscope Commercial |
$1,299.99
|
| Rate for Payer: Healthscope Commercial |
$1,124.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,017.90
|
| Rate for Payer: Nomi Health Commercial |
$843.24
|
| Rate for Payer: PACE SWMI |
$702.70
|
| Rate for Payer: PHP Medicare Advantage |
$702.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.90
|
| Rate for Payer: Priority Health Medicare |
$702.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.70
|
| Rate for Payer: UHC Medicare Advantage |
$702.70
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,918.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$688.57 |
| Max. Negotiated Rate |
$1,273.85 |
| Rate for Payer: Aetna Commercial |
$922.68
|
| Rate for Payer: Aetna Medicare |
$716.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.68
|
| Rate for Payer: BCBS Complete |
$767.20
|
| Rate for Payer: BCBS MAPPO |
$688.57
|
| Rate for Payer: BCN Medicare Advantage |
$688.57
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: Cash Price |
$1,534.40
|
| Rate for Payer: Cofinity Commercial |
$991.54
|
| Rate for Payer: Cofinity Commercial |
$922.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$688.57
|
| Rate for Payer: Healthscope Commercial |
$1,101.71
|
| Rate for Payer: Healthscope Commercial |
$1,273.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,246.70
|
| Rate for Payer: Nomi Health Commercial |
$826.28
|
| Rate for Payer: PACE SWMI |
$688.57
|
| Rate for Payer: PHP Medicare Advantage |
$688.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health Medicare |
$688.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.57
|
| Rate for Payer: UHC Medicare Advantage |
$688.57
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$881.37 |
| Max. Negotiated Rate |
$1,259.10 |
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.35
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,203.14
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$979.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.20
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health SBD |
$881.37
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
15240
|
| Min. Negotiated Rate |
$559.60 |
| Max. Negotiated Rate |
$1,390.81 |
| Rate for Payer: Aetna Commercial |
$1,007.40
|
| Rate for Payer: Aetna Medicare |
$781.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.58
|
| Rate for Payer: BCBS Complete |
$559.60
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCN Medicare Advantage |
$751.79
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Cofinity Commercial |
$1,082.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.79
|
| Rate for Payer: Healthscope Commercial |
$1,390.81
|
| Rate for Payer: Healthscope Commercial |
$1,202.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$909.35
|
| Rate for Payer: Nomi Health Commercial |
$902.15
|
| Rate for Payer: PACE SWMI |
$751.79
|
| Rate for Payer: PHP Medicare Advantage |
$751.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health Medicare |
$751.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$559.60 |
| Max. Negotiated Rate |
$1,390.81 |
| Rate for Payer: Aetna Commercial |
$1,007.40
|
| Rate for Payer: Aetna Medicare |
$781.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.40
|
| Rate for Payer: BCBS Complete |
$559.60
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCN Medicare Advantage |
$751.79
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.79
|
| Rate for Payer: Healthscope Commercial |
$1,390.81
|
| Rate for Payer: Healthscope Commercial |
$1,202.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$909.35
|
| Rate for Payer: Nomi Health Commercial |
$902.15
|
| Rate for Payer: PACE SWMI |
$751.79
|
| Rate for Payer: PHP Medicare Advantage |
$751.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health Medicare |
$751.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$881.37 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Cofinity Commercial |
$1,203.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$979.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$881.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$1,004.40
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$276.90 |
| Rate for Payer: Aetna Commercial |
$171.48
|
| Rate for Payer: Aetna Medicare |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.48
|
| Rate for Payer: BCBS Complete |
$170.40
|
| Rate for Payer: BCBS MAPPO |
$127.97
|
| Rate for Payer: BCN Medicare Advantage |
$127.97
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cofinity Commercial |
$184.28
|
| Rate for Payer: Cofinity Commercial |
$171.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.97
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$236.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.90
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: PACE SWMI |
$127.97
|
| Rate for Payer: PHP Medicare Advantage |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.90
|
| Rate for Payer: Priority Health Medicare |
$127.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.97
|
| Rate for Payer: UHC Medicare Advantage |
$127.97
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$680.00 |
| Max. Negotiated Rate |
$1,478.13 |
| Rate for Payer: Aetna Commercial |
$1,070.65
|
| Rate for Payer: Aetna Medicare |
$830.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.65
|
| Rate for Payer: BCBS Complete |
$680.00
|
| Rate for Payer: BCBS MAPPO |
$798.99
|
| Rate for Payer: BCN Medicare Advantage |
$798.99
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$1,150.55
|
| Rate for Payer: Cofinity Commercial |
$1,070.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.99
|
| Rate for Payer: Healthscope Commercial |
$1,478.13
|
| Rate for Payer: Healthscope Commercial |
$1,278.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,105.00
|
| Rate for Payer: Nomi Health Commercial |
$958.79
|
| Rate for Payer: PACE SWMI |
$798.99
|
| Rate for Payer: PHP Medicare Advantage |
$798.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.00
|
| Rate for Payer: Priority Health Medicare |
$798.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.99
|
| Rate for Payer: UHC Medicare Advantage |
$798.99
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$1,097.85 |
| Rate for Payer: Aetna Commercial |
$772.79
|
| Rate for Payer: Aetna Medicare |
$599.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.79
|
| Rate for Payer: BCBS Complete |
$675.60
|
| Rate for Payer: BCBS MAPPO |
$576.71
|
| Rate for Payer: BCN Medicare Advantage |
$576.71
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cofinity Commercial |
$830.46
|
| Rate for Payer: Cofinity Commercial |
$772.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.71
|
| Rate for Payer: Healthscope Commercial |
$1,066.91
|
| Rate for Payer: Healthscope Commercial |
$922.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,097.85
|
| Rate for Payer: Nomi Health Commercial |
$692.05
|
| Rate for Payer: PACE SWMI |
$576.71
|
| Rate for Payer: PHP Medicare Advantage |
$576.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.85
|
| Rate for Payer: Priority Health Medicare |
$576.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.71
|
| Rate for Payer: UHC Medicare Advantage |
$576.71
|
|
