|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$10,084.00 |
| Rate for Payer: Aetna Commercial |
$73.55
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.04
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$54.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.18
|
| Rate for Payer: BCN Commercial |
$99.20
|
| 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 |
$87.82
|
| Rate for Payer: Healthscope Commercial |
$101.55
|
| Rate for Payer: Mclaren Medicaid |
$36.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.63
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,084.00
|
| 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 Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.02
|
| Rate for Payer: Priority Health Medicare |
$54.89
|
| Rate for Payer: Priority Health Narrow Network |
$90.02
|
| Rate for Payer: Priority Health SBD |
$90.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.89
|
| Rate for Payer: UHC Exchange |
$91.57
|
| Rate for Payer: UHC Medicare Advantage |
$54.89
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$22,269.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCN Commercial |
$184.38
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,269.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$76.47 |
| Max. Negotiated Rate |
$20,630.00 |
| Rate for Payer: Aetna Commercial |
$148.86
|
| Rate for Payer: Aetna Medicare |
$115.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.97
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$111.09
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$173.48
|
| 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 |
$159.97
|
| Rate for Payer: Cofinity Commercial |
$148.86
|
| 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: Mclaren Medicaid |
$76.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.64
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,630.00
|
| 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 Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.38
|
| Rate for Payer: Priority Health Medicare |
$111.09
|
| Rate for Payer: Priority Health Narrow Network |
$166.38
|
| Rate for Payer: Priority Health SBD |
$166.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.09
|
| Rate for Payer: UHC Exchange |
$153.80
|
| Rate for Payer: UHC Medicare Advantage |
$111.09
|
| Rate for Payer: UHCCP Medicaid |
$76.47
|
|
|
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 |
$162.73 |
| Max. Negotiated Rate |
$44,005.00 |
| 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 |
$170.87
|
| Rate for Payer: BCBS MAPPO |
$236.84
|
| Rate for Payer: BCBS Trust/PPO |
$653.51
|
| Rate for Payer: BCN Commercial |
$541.46
|
| 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: Mclaren Medicaid |
$162.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.68
|
| Rate for Payer: Meridian Medicaid |
$170.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44,005.00
|
| 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 Choice Medicaid |
$162.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$369.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$454.01
|
| Rate for Payer: Priority Health Medicare |
$236.84
|
| Rate for Payer: Priority Health Narrow Network |
$454.01
|
| Rate for Payer: Priority Health SBD |
$454.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.84
|
| Rate for Payer: UHC Exchange |
$278.23
|
| Rate for Payer: UHC Medicare Advantage |
$236.84
|
| Rate for Payer: UHCCP Medicaid |
$162.73
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$126.31 |
| Max. Negotiated Rate |
$33,826.00 |
| 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 |
$132.63
|
| Rate for Payer: BCBS MAPPO |
$185.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.75
|
| Rate for Payer: BCN Commercial |
$280.99
|
| 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 |
$267.60
|
| Rate for Payer: Cofinity Commercial |
$249.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.83
|
| Rate for Payer: Healthscope Commercial |
$343.79
|
| Rate for Payer: Healthscope Commercial |
$297.33
|
| Rate for Payer: Mclaren Medicaid |
$126.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.12
|
| Rate for Payer: Meridian Medicaid |
$132.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,826.00
|
| 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 Choice Medicaid |
$126.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.64
|
| Rate for Payer: Priority Health Medicare |
$185.83
|
| Rate for Payer: Priority Health Narrow Network |
$312.64
|
| Rate for Payer: Priority Health SBD |
$312.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.83
|
| Rate for Payer: UHC Exchange |
$206.11
|
| Rate for Payer: UHC Medicare Advantage |
$185.83
|
| Rate for Payer: UHCCP Medicaid |
$126.31
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,503.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$128,821.00 |
| Rate for Payer: Aetna Commercial |
$932.44
|
| Rate for Payer: Aetna Medicare |
$723.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.44
|
| Rate for Payer: BCBS Complete |
$493.15
|
| Rate for Payer: BCBS MAPPO |
$695.85
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| 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: Mclaren Medicaid |
$469.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.64
|
| Rate for Payer: Meridian Medicaid |
$493.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128,821.00
|
| 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 Choice Medicaid |
$469.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$976.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$988.83
|
| Rate for Payer: Priority Health Medicare |
$695.85
|
| Rate for Payer: Priority Health Narrow Network |
$988.83
|
| Rate for Payer: Priority Health SBD |
$988.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.85
|
| Rate for Payer: UHC Exchange |
$772.95
|
| Rate for Payer: UHC Medicare Advantage |
$695.85
|
| Rate for Payer: UHCCP Medicaid |
$469.67
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$418.12 |
| Max. Negotiated Rate |
$113,461.00 |
| Rate for Payer: Aetna Commercial |
$824.33
|
| Rate for Payer: Aetna Medicare |
$639.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.84
|
| Rate for Payer: BCBS Complete |
$439.03
|
| Rate for Payer: BCBS MAPPO |
$615.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.40
|
| Rate for Payer: BCN Commercial |
$1,142.53
|
| 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 |
$984.27
|
| Rate for Payer: Healthscope Commercial |
$1,138.06
|
| Rate for Payer: Mclaren Medicaid |
$418.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.93
|
| Rate for Payer: Meridian Medicaid |
$439.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,461.00
|
| 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 Choice Medicaid |
$418.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$876.84
|
| Rate for Payer: Priority Health Medicare |
$615.17
|
| Rate for Payer: Priority Health Narrow Network |
$876.84
|
| Rate for Payer: Priority Health SBD |
$876.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.17
|
| Rate for Payer: UHC Exchange |
$749.60
|
| Rate for Payer: UHC Medicare Advantage |
$615.17
|
| Rate for Payer: UHCCP Medicaid |
$418.12
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,566.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$475.84 |
| Max. Negotiated Rate |
$129,440.00 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Medicare |
$730.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.62
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$702.70
|
| Rate for Payer: BCBS Trust/PPO |
$6,341.25
|
| Rate for Payer: BCN Commercial |
$1,290.60
|
| 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 |
$1,300.00
|
| Rate for Payer: Healthscope Commercial |
$1,124.32
|
| Rate for Payer: Mclaren Medicaid |
$475.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.84
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129,440.00
|
| 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 Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,000.11
|
| Rate for Payer: Priority Health Medicare |
$702.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,000.11
|
| Rate for Payer: Priority Health SBD |
$1,000.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$742.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.70
|
| Rate for Payer: UHC Exchange |
$742.48
|
| Rate for Payer: UHC Medicare Advantage |
$702.70
|
| Rate for Payer: UHCCP Medicaid |
$475.84
|
|
|
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 |
$145.43 |
| Max. Negotiated Rate |
$129,224.00 |
| Rate for Payer: Aetna Commercial |
$922.68
|
| Rate for Payer: Aetna Medicare |
$716.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.54
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$688.57
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,283.75
|
| 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 |
$1,273.85
|
| Rate for Payer: Healthscope Commercial |
$1,101.71
|
| Rate for Payer: Mclaren Medicaid |
$465.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.00
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129,224.00
|
| 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 Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,246.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,003.72
|
| Rate for Payer: Priority Health Medicare |
$688.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,003.72
|
| Rate for Payer: Priority Health SBD |
$1,003.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$782.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$688.57
|
| Rate for Payer: UHC Exchange |
$782.45
|
| Rate for Payer: UHC Medicare Advantage |
$688.57
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
|
|
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 |
$513.12 |
| Max. Negotiated Rate |
$138,460.00 |
| 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 |
$538.78
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$1,357.55
|
| 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: Mclaren Medicaid |
$513.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Meridian Medicaid |
$538.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138,460.00
|
| 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 Choice Medicaid |
$513.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.03
|
| Rate for Payer: Priority Health Medicare |
$751.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.03
|
| Rate for Payer: Priority Health SBD |
$1,080.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$873.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Exchange |
$873.14
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
| Rate for Payer: UHCCP Medicaid |
$513.12
|
|
|
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 |
$513.12 |
| Max. Negotiated Rate |
$138,460.00 |
| 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 |
$538.78
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$1,357.55
|
| 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: Mclaren Medicaid |
$513.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Meridian Medicaid |
$538.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138,460.00
|
| 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 Choice Medicaid |
$513.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,080.03
|
| Rate for Payer: Priority Health Medicare |
$751.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,080.03
|
| Rate for Payer: Priority Health SBD |
$1,080.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$873.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Exchange |
$873.14
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
| Rate for Payer: UHCCP Medicaid |
$513.12
|
|
|
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 |
$831.84 |
| Max. Negotiated Rate |
$5,632.99 |
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna Medicare |
$1,863.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$909.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,240.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,240.30
|
| Rate for Payer: BCBS Complete |
$1,008.67
|
| Rate for Payer: BCBS MAPPO |
$1,792.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.66
|
| Rate for Payer: BCN Commercial |
$1,711.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,792.24
|
| Rate for Payer: Cash Price |
$1,119.20
|
| 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 |
$1,792.24
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Mclaren Medicaid |
$960.64
|
| Rate for Payer: Mclaren Medicare |
$1,792.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.85
|
| Rate for Payer: Meridian Medicaid |
$1,008.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,061.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: Nomi Health Commercial |
$3,763.70
|
| Rate for Payer: PACE Medicare |
$1,702.63
|
| Rate for Payer: PACE SWMI |
$1,792.24
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,792.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,632.99
|
| Rate for Payer: Priority Health Medicare |
$1,792.24
|
| Rate for Payer: Priority Health Narrow Network |
$4,506.39
|
| Rate for Payer: Priority Health SBD |
$881.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,792.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$831.84
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,792.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,792.24
|
| Rate for Payer: UHCCP Medicaid |
$1,009.03
|
| Rate for Payer: VA VA |
$1,792.24
|
|
|
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 FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$23,861.00 |
| Rate for Payer: Aetna Commercial |
$171.48
|
| Rate for Payer: Aetna Medicare |
$133.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.28
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$127.97
|
| Rate for Payer: BCN Commercial |
$301.02
|
| 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 |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$204.75
|
| Rate for Payer: Mclaren Medicaid |
$85.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.37
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,861.00
|
| 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 Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.52
|
| Rate for Payer: Priority Health Medicare |
$127.97
|
| Rate for Payer: Priority Health Narrow Network |
$181.52
|
| Rate for Payer: Priority Health SBD |
$181.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.97
|
| Rate for Payer: UHC Exchange |
$220.82
|
| Rate for Payer: UHC Medicare Advantage |
$127.97
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
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 |
$35.25 |
| Max. Negotiated Rate |
$147,200.00 |
| Rate for Payer: Aetna Commercial |
$1,070.65
|
| Rate for Payer: Aetna Medicare |
$830.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.55
|
| Rate for Payer: BCBS Complete |
$572.09
|
| Rate for Payer: BCBS MAPPO |
$798.99
|
| Rate for Payer: BCBS Trust/PPO |
$35.25
|
| Rate for Payer: BCN Commercial |
$1,458.22
|
| 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: Mclaren Medicaid |
$544.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.94
|
| Rate for Payer: Meridian Medicaid |
$572.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147,200.00
|
| 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 Choice Medicaid |
$544.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,144.60
|
| Rate for Payer: Priority Health Medicare |
$798.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,144.60
|
| Rate for Payer: Priority Health SBD |
$1,144.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.99
|
| Rate for Payer: UHC Exchange |
$950.40
|
| Rate for Payer: UHC Medicare Advantage |
$798.99
|
| Rate for Payer: UHCCP Medicaid |
$544.85
|
|
|
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 |
$392.99 |
| Max. Negotiated Rate |
$106,330.00 |
| Rate for Payer: Aetna Commercial |
$772.79
|
| Rate for Payer: Aetna Medicare |
$599.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.46
|
| Rate for Payer: BCBS Complete |
$412.64
|
| Rate for Payer: BCBS MAPPO |
$576.71
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| 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 |
$922.74
|
| Rate for Payer: Healthscope Commercial |
$1,066.91
|
| Rate for Payer: Mclaren Medicaid |
$392.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.55
|
| Rate for Payer: Meridian Medicaid |
$412.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106,330.00
|
| 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 Choice Medicaid |
$392.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.08
|
| Rate for Payer: Priority Health Medicare |
$576.71
|
| Rate for Payer: Priority Health Narrow Network |
$828.08
|
| Rate for Payer: Priority Health SBD |
$828.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$762.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.71
|
| Rate for Payer: UHC Exchange |
$762.66
|
| Rate for Payer: UHC Medicare Advantage |
$576.71
|
| Rate for Payer: UHCCP Medicaid |
$392.99
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$117,947.00 |
| Rate for Payer: Aetna Commercial |
$857.98
|
| Rate for Payer: Aetna Medicare |
$665.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.00
|
| Rate for Payer: BCBS Complete |
$455.79
|
| Rate for Payer: BCBS MAPPO |
$640.28
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$640.28
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$922.00
|
| Rate for Payer: Cofinity Commercial |
$857.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.28
|
| Rate for Payer: Healthscope Commercial |
$1,184.52
|
| Rate for Payer: Healthscope Commercial |
$1,024.45
|
| Rate for Payer: Mclaren Medicaid |
$434.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.29
|
| Rate for Payer: Meridian Medicaid |
$455.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117,947.00
|
| Rate for Payer: Nomi Health Commercial |
$768.34
|
| Rate for Payer: PACE SWMI |
$640.28
|
| Rate for Payer: PHP Medicare Advantage |
$640.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$914.32
|
| Rate for Payer: Priority Health Medicare |
$640.28
|
| Rate for Payer: Priority Health Narrow Network |
$914.32
|
| Rate for Payer: Priority Health SBD |
$914.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.28
|
| Rate for Payer: UHC Exchange |
$776.12
|
| Rate for Payer: UHC Medicare Advantage |
$640.28
|
| Rate for Payer: UHCCP Medicaid |
$434.09
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$18,639.00 |
| 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 |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$253.63
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Healthscope Commercial |
$188.35
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,639.00
|
| 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 Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.58
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: Priority Health Narrow Network |
$143.58
|
| Rate for Payer: Priority Health SBD |
$143.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Exchange |
$148.07
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$12,182.00 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.91
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$65.91
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$190.59
|
| Rate for Payer: BCN Medicare Advantage |
$65.91
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.91
|
| Rate for Payer: Healthscope Commercial |
$121.93
|
| Rate for Payer: Healthscope Commercial |
$105.46
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.21
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,182.00
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE SWMI |
$65.91
|
| Rate for Payer: PHP Medicare Advantage |
$65.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.56
|
| Rate for Payer: Priority Health Medicare |
$65.91
|
| Rate for Payer: Priority Health Narrow Network |
$92.56
|
| Rate for Payer: Priority Health SBD |
$92.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.91
|
| Rate for Payer: UHC Exchange |
$95.07
|
| Rate for Payer: UHC Medicare Advantage |
$65.91
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$36,025.00 |
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCN Commercial |
$324.23
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,025.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
