|
PR INCISION&DRAINAGE BURSA FOOT
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 28001
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$342.75 |
| Rate for Payer: Aetna Commercial |
$115.58
|
| Rate for Payer: Aetna Medicare |
$89.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.20
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$86.25
|
| Rate for Payer: BCN Commercial |
$143.42
|
| Rate for Payer: BCN Medicare Advantage |
$86.25
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cofinity Commercial |
$124.20
|
| Rate for Payer: Cofinity Commercial |
$115.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.25
|
| Rate for Payer: Healthscope Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$138.00
|
| Rate for Payer: Mclaren Medicaid |
$55.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.56
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.04
|
| Rate for Payer: Nomi Health Commercial |
$103.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.75
|
| Rate for Payer: PACE SWMI |
$86.25
|
| Rate for Payer: PHP Medicare Advantage |
$86.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$153.31
|
| Rate for Payer: Priority Health Medicare |
$86.25
|
| Rate for Payer: Priority Health SBD |
$153.31
|
| Rate for Payer: Priority Health Tiered Network |
$153.31
|
| Rate for Payer: Railroad Medicare Medicare |
$86.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.12
|
| Rate for Payer: UHC Core |
$300.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$86.25
|
| Rate for Payer: UHC Exchange |
$300.12
|
| Rate for Payer: UHC Medicaid |
$55.38
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$9,359.82 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna Medicare |
$3,010.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,617.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,617.84
|
| Rate for Payer: BCBS Complete |
$1,589.53
|
| Rate for Payer: BCBS MAPPO |
$2,894.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.29
|
| Rate for Payer: BCN Commercial |
$1,953.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,894.27
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,894.27
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Mclaren Medicaid |
$1,513.70
|
| Rate for Payer: Mclaren Medicare |
$2,894.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,038.98
|
| Rate for Payer: Meridian Medicaid |
$3,038.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,328.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,183.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Nomi Health Commercial |
$8,682.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE Medicare |
$2,749.56
|
| Rate for Payer: PACE SWMI |
$2,894.27
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,894.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,513.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,359.82
|
| Rate for Payer: Priority Health Medicare |
$2,894.27
|
| Rate for Payer: Priority Health SBD |
$436.59
|
| Rate for Payer: Priority Health Tiered Network |
$7,487.86
|
| Rate for Payer: Railroad Medicare Medicare |
$2,894.27
|
| Rate for Payer: UHC Medicaid |
$1,513.70
|
| Rate for Payer: UHCCP Medicaid |
$1,513.70
|
| Rate for Payer: VA VA |
$2,894.27
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
10180
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$623.70 |
| Rate for Payer: Aetna Commercial |
$589.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.45
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Advantage |
$485.10
|
| Rate for Payer: Cofinity Commercial |
$595.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$554.40
|
| Rate for Payer: Healthscope Commercial |
$623.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$589.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PHP Commercial |
$589.05
|
| Rate for Payer: Priority Health SBD |
$436.59
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 10180
|
| Hospital Charge Code |
10180
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$228.50
|
| Rate for Payer: Aetna Medicare |
$177.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.55
|
| Rate for Payer: BCBS Complete |
$117.64
|
| Rate for Payer: BCBS MAPPO |
$170.52
|
| Rate for Payer: BCN Commercial |
$270.90
|
| Rate for Payer: BCN Medicare Advantage |
$170.52
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$245.55
|
| Rate for Payer: Cofinity Commercial |
$228.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.52
|
| Rate for Payer: Healthscope Commercial |
$315.46
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.05
|
| Rate for Payer: Meridian Medicaid |
$117.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.35
|
| Rate for Payer: Nomi Health Commercial |
$204.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE SWMI |
$170.52
|
| Rate for Payer: PHP Medicare Advantage |
$170.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.94
|
| Rate for Payer: Priority Health Medicare |
$170.52
|
| Rate for Payer: Priority Health SBD |
$247.94
|
| Rate for Payer: Priority Health Tiered Network |
$247.94
|
| Rate for Payer: Railroad Medicare Medicare |
$170.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.47
|
| Rate for Payer: UHC Core |
$308.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.52
|
| Rate for Payer: UHC Exchange |
$308.47
|
| Rate for Payer: UHC Medicaid |
$112.04
|
| Rate for Payer: UHCCP Medicaid |
$112.04
|
|
|
PR INCISION & DRAINAGE COMPLEX PO WOUND INFECTION
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 10180
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$519.75 |
| Rate for Payer: Aetna Commercial |
$228.50
|
| Rate for Payer: Aetna Medicare |
$177.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.55
|
| Rate for Payer: BCBS Complete |
$117.64
|
| Rate for Payer: BCBS MAPPO |
$170.52
|
| Rate for Payer: BCN Commercial |
$270.90
|
| Rate for Payer: BCN Medicare Advantage |
$170.52
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cofinity Commercial |
$245.55
|
| Rate for Payer: Cofinity Commercial |
$228.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.52
|
| Rate for Payer: Healthscope Commercial |
$315.46
|
| Rate for Payer: Healthscope Commercial |
$272.83
|
| Rate for Payer: Mclaren Medicaid |
$112.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.05
|
| Rate for Payer: Meridian Medicaid |
$117.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.35
|
| Rate for Payer: Nomi Health Commercial |
$204.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$519.75
|
| Rate for Payer: PACE SWMI |
$170.52
|
| Rate for Payer: PHP Medicare Advantage |
$170.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$247.94
|
| Rate for Payer: Priority Health Medicare |
$170.52
|
| Rate for Payer: Priority Health SBD |
$247.94
|
| Rate for Payer: Priority Health Tiered Network |
$247.94
|
| Rate for Payer: Railroad Medicare Medicare |
$170.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.47
|
| Rate for Payer: UHC Core |
$308.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.52
|
| Rate for Payer: UHC Exchange |
$308.47
|
| Rate for Payer: UHC Medicaid |
$112.04
|
| Rate for Payer: UHCCP Medicaid |
$112.04
|
|
|
PR INCISION & DRAINAGE FOREARM&/WRIST BURSA
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
HCPCS 25031
|
| Min. Negotiated Rate |
$232.17 |
| Max. Negotiated Rate |
$654.05 |
| Rate for Payer: Aetna Commercial |
$470.18
|
| Rate for Payer: Aetna Medicare |
$364.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.27
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS MAPPO |
$350.88
|
| Rate for Payer: BCN Commercial |
$571.18
|
| Rate for Payer: BCN Medicare Advantage |
$350.88
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cash Price |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$505.27
|
| Rate for Payer: Cofinity Commercial |
$470.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.88
|
| Rate for Payer: Healthscope Commercial |
$649.13
|
| Rate for Payer: Healthscope Commercial |
$561.41
|
| Rate for Payer: Mclaren Medicaid |
$232.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.42
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$385.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$654.05
|
| Rate for Payer: Nomi Health Commercial |
$421.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$563.25
|
| Rate for Payer: PACE SWMI |
$350.88
|
| Rate for Payer: PHP Medicare Advantage |
$350.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$610.57
|
| Rate for Payer: Priority Health Medicare |
$350.88
|
| Rate for Payer: Priority Health SBD |
$610.57
|
| Rate for Payer: Priority Health Tiered Network |
$610.57
|
| Rate for Payer: Railroad Medicare Medicare |
$350.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$606.49
|
| Rate for Payer: UHC Core |
$606.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$350.88
|
| Rate for Payer: UHC Exchange |
$606.49
|
| Rate for Payer: UHC Medicaid |
$232.17
|
| Rate for Payer: UHCCP Medicaid |
$232.17
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,174.00
|
|
|
Service Code
|
HCPCS 27603
|
| Min. Negotiated Rate |
$236.86 |
| Max. Negotiated Rate |
$880.50 |
| Rate for Payer: Aetna Commercial |
$483.15
|
| Rate for Payer: Aetna Medicare |
$374.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.21
|
| Rate for Payer: BCBS Complete |
$248.70
|
| Rate for Payer: BCBS MAPPO |
$360.56
|
| Rate for Payer: BCN Commercial |
$589.61
|
| Rate for Payer: BCN Medicare Advantage |
$360.56
|
| Rate for Payer: Cash Price |
$939.20
|
| Rate for Payer: Cash Price |
$939.20
|
| Rate for Payer: Cofinity Commercial |
$519.21
|
| Rate for Payer: Cofinity Commercial |
$483.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$360.56
|
| Rate for Payer: Healthscope Commercial |
$667.04
|
| Rate for Payer: Healthscope Commercial |
$576.90
|
| Rate for Payer: Mclaren Medicaid |
$236.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$378.59
|
| Rate for Payer: Meridian Medicaid |
$248.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$396.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.19
|
| Rate for Payer: Nomi Health Commercial |
$432.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$880.50
|
| Rate for Payer: PACE SWMI |
$360.56
|
| Rate for Payer: PHP Medicare Advantage |
$360.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$236.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$630.27
|
| Rate for Payer: Priority Health Medicare |
$360.56
|
| Rate for Payer: Priority Health SBD |
$630.27
|
| Rate for Payer: Priority Health Tiered Network |
$630.27
|
| Rate for Payer: Railroad Medicare Medicare |
$360.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$678.29
|
| Rate for Payer: UHC Core |
$678.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$360.56
|
| Rate for Payer: UHC Exchange |
$678.29
|
| Rate for Payer: UHC Medicaid |
$236.86
|
| Rate for Payer: UHCCP Medicaid |
$236.86
|
|
|
PR INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA
|
Professional
|
Both
|
$915.00
|
|
|
Service Code
|
HCPCS 27604
|
| Min. Negotiated Rate |
$201.92 |
| Max. Negotiated Rate |
$686.25 |
| Rate for Payer: Aetna Commercial |
$412.76
|
| Rate for Payer: Aetna Medicare |
$320.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.56
|
| Rate for Payer: BCBS Complete |
$212.02
|
| Rate for Payer: BCBS MAPPO |
$308.03
|
| Rate for Payer: BCN Commercial |
$505.95
|
| Rate for Payer: BCN Medicare Advantage |
$308.03
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cofinity Commercial |
$443.56
|
| Rate for Payer: Cofinity Commercial |
$412.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.03
|
| Rate for Payer: Healthscope Commercial |
$569.86
|
| Rate for Payer: Healthscope Commercial |
$492.85
|
| Rate for Payer: Mclaren Medicaid |
$201.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.43
|
| Rate for Payer: Meridian Medicaid |
$212.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$338.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$569.21
|
| Rate for Payer: Nomi Health Commercial |
$369.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$686.25
|
| Rate for Payer: PACE SWMI |
$308.03
|
| Rate for Payer: PHP Medicare Advantage |
$308.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$540.84
|
| Rate for Payer: Priority Health Medicare |
$308.03
|
| Rate for Payer: Priority Health SBD |
$540.84
|
| Rate for Payer: Priority Health Tiered Network |
$540.84
|
| Rate for Payer: Railroad Medicare Medicare |
$308.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$580.26
|
| Rate for Payer: UHC Core |
$580.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.03
|
| Rate for Payer: UHC Exchange |
$580.26
|
| Rate for Payer: UHC Medicaid |
$201.92
|
| Rate for Payer: UHCCP Medicaid |
$201.92
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST COMPLICATED
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 10081
|
| Min. Negotiated Rate |
$107.57 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Medicare |
$171.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.95
|
| Rate for Payer: BCBS Complete |
$112.95
|
| Rate for Payer: BCBS MAPPO |
$164.55
|
| Rate for Payer: BCN Commercial |
$203.42
|
| Rate for Payer: BCN Medicare Advantage |
$164.55
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$236.95
|
| Rate for Payer: Cofinity Commercial |
$220.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.55
|
| Rate for Payer: Healthscope Commercial |
$304.42
|
| Rate for Payer: Healthscope Commercial |
$263.28
|
| Rate for Payer: Mclaren Medicaid |
$107.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.78
|
| Rate for Payer: Meridian Medicaid |
$112.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.39
|
| Rate for Payer: Nomi Health Commercial |
$197.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PACE SWMI |
$164.55
|
| Rate for Payer: PHP Medicare Advantage |
$164.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.09
|
| Rate for Payer: Priority Health Medicare |
$164.55
|
| Rate for Payer: Priority Health SBD |
$236.09
|
| Rate for Payer: Priority Health Tiered Network |
$236.09
|
| Rate for Payer: Railroad Medicare Medicare |
$164.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.67
|
| Rate for Payer: UHC Core |
$298.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.55
|
| Rate for Payer: UHC Exchange |
$298.67
|
| Rate for Payer: UHC Medicaid |
$107.57
|
| Rate for Payer: UHCCP Medicaid |
$107.57
|
|
|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$241.50 |
| Rate for Payer: Aetna Commercial |
$135.29
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.38
|
| Rate for Payer: BCBS Complete |
$70.45
|
| Rate for Payer: BCBS MAPPO |
$100.96
|
| Rate for Payer: BCN Commercial |
$125.27
|
| Rate for Payer: BCN Medicare Advantage |
$100.96
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$145.38
|
| Rate for Payer: Cofinity Commercial |
$135.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.96
|
| Rate for Payer: Healthscope Commercial |
$186.78
|
| Rate for Payer: Healthscope Commercial |
$161.54
|
| Rate for Payer: Mclaren Medicaid |
$67.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.01
|
| Rate for Payer: Meridian Medicaid |
$70.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.91
|
| Rate for Payer: Nomi Health Commercial |
$121.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$241.50
|
| Rate for Payer: PACE SWMI |
$100.96
|
| Rate for Payer: PHP Medicare Advantage |
$100.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.40
|
| Rate for Payer: Priority Health Medicare |
$100.96
|
| Rate for Payer: Priority Health SBD |
$145.40
|
| Rate for Payer: Priority Health Tiered Network |
$145.40
|
| Rate for Payer: Railroad Medicare Medicare |
$100.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.01
|
| Rate for Payer: UHC Core |
$177.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.96
|
| Rate for Payer: UHC Exchange |
$177.01
|
| Rate for Payer: UHC Medicaid |
$67.10
|
| Rate for Payer: UHCCP Medicaid |
$67.10
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$573.00 |
| Rate for Payer: Aetna Commercial |
$204.46
|
| Rate for Payer: Aetna Medicare |
$158.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.72
|
| Rate for Payer: BCBS Complete |
$106.24
|
| Rate for Payer: BCBS MAPPO |
$152.58
|
| Rate for Payer: BCN Commercial |
$246.00
|
| Rate for Payer: BCN Medicare Advantage |
$152.58
|
| Rate for Payer: Cash Price |
$611.20
|
| Rate for Payer: Cash Price |
$611.20
|
| Rate for Payer: Cofinity Commercial |
$219.72
|
| Rate for Payer: Cofinity Commercial |
$204.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.58
|
| Rate for Payer: Healthscope Commercial |
$282.27
|
| Rate for Payer: Healthscope Commercial |
$244.13
|
| Rate for Payer: Mclaren Medicaid |
$101.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.21
|
| Rate for Payer: Meridian Medicaid |
$106.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$167.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.57
|
| Rate for Payer: Nomi Health Commercial |
$183.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$573.00
|
| Rate for Payer: PACE SWMI |
$152.58
|
| Rate for Payer: PHP Medicare Advantage |
$152.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$262.97
|
| Rate for Payer: Priority Health Medicare |
$152.58
|
| Rate for Payer: Priority Health SBD |
$262.97
|
| Rate for Payer: Priority Health Tiered Network |
$262.97
|
| Rate for Payer: Railroad Medicare Medicare |
$152.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.34
|
| Rate for Payer: UHC Core |
$268.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$152.58
|
| Rate for Payer: UHC Exchange |
$268.34
|
| Rate for Payer: UHC Medicaid |
$101.18
|
| Rate for Payer: UHCCP Medicaid |
$101.18
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$217.05 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$436.25
|
| Rate for Payer: Aetna Medicare |
$338.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.81
|
| Rate for Payer: BCBS Complete |
$227.90
|
| Rate for Payer: BCBS MAPPO |
$325.56
|
| Rate for Payer: BCN Commercial |
$537.33
|
| Rate for Payer: BCN Medicare Advantage |
$325.56
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$468.81
|
| Rate for Payer: Cofinity Commercial |
$436.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.56
|
| Rate for Payer: Healthscope Commercial |
$602.29
|
| Rate for Payer: Healthscope Commercial |
$520.90
|
| Rate for Payer: Mclaren Medicaid |
$217.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$227.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.05
|
| Rate for Payer: Nomi Health Commercial |
$390.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$325.56
|
| Rate for Payer: PHP Medicare Advantage |
$325.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$574.38
|
| Rate for Payer: Priority Health Medicare |
$325.56
|
| Rate for Payer: Priority Health SBD |
$574.38
|
| Rate for Payer: Priority Health Tiered Network |
$574.38
|
| Rate for Payer: Railroad Medicare Medicare |
$325.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.91
|
| Rate for Payer: UHC Core |
$581.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$325.56
|
| Rate for Payer: UHC Exchange |
$581.91
|
| Rate for Payer: UHC Medicaid |
$217.05
|
| Rate for Payer: UHCCP Medicaid |
$217.05
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
25000
|
| Min. Negotiated Rate |
$217.05 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$436.25
|
| Rate for Payer: Aetna Medicare |
$338.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.81
|
| Rate for Payer: BCBS Complete |
$227.90
|
| Rate for Payer: BCBS MAPPO |
$325.56
|
| Rate for Payer: BCN Commercial |
$537.33
|
| Rate for Payer: BCN Medicare Advantage |
$325.56
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$468.81
|
| Rate for Payer: Cofinity Commercial |
$436.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.56
|
| Rate for Payer: Healthscope Commercial |
$602.29
|
| Rate for Payer: Healthscope Commercial |
$520.90
|
| Rate for Payer: Mclaren Medicaid |
$217.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$341.84
|
| Rate for Payer: Meridian Medicaid |
$227.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$611.05
|
| Rate for Payer: Nomi Health Commercial |
$390.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$325.56
|
| Rate for Payer: PHP Medicare Advantage |
$325.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$574.38
|
| Rate for Payer: Priority Health Medicare |
$325.56
|
| Rate for Payer: Priority Health SBD |
$574.38
|
| Rate for Payer: Priority Health Tiered Network |
$574.38
|
| Rate for Payer: Railroad Medicare Medicare |
$325.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$581.91
|
| Rate for Payer: UHC Core |
$581.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$325.56
|
| Rate for Payer: UHC Exchange |
$581.91
|
| Rate for Payer: UHC Medicaid |
$217.05
|
| Rate for Payer: UHCCP Medicaid |
$217.05
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
25000
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$762.30 |
| Max. Negotiated Rate |
$5,181.40 |
| Rate for Payer: Aetna Commercial |
$1,028.50
|
| Rate for Payer: Aetna Medicare |
$1,666.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,002.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,002.76
|
| Rate for Payer: BCBS Complete |
$879.93
|
| Rate for Payer: BCBS MAPPO |
$1,602.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.77
|
| Rate for Payer: BCN Commercial |
$1,317.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,602.21
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Advantage |
$847.00
|
| Rate for Payer: Cofinity Commercial |
$1,040.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,602.21
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Mclaren Medicaid |
$837.96
|
| Rate for Payer: Mclaren Medicare |
$1,602.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,682.32
|
| Rate for Payer: Meridian Medicaid |
$1,682.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,842.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,762.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.50
|
| Rate for Payer: Nomi Health Commercial |
$4,806.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE Medicare |
$1,522.10
|
| Rate for Payer: PACE SWMI |
$1,602.21
|
| Rate for Payer: PHP Commercial |
$1,028.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,602.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,181.40
|
| Rate for Payer: Priority Health Medicare |
$1,602.21
|
| Rate for Payer: Priority Health SBD |
$762.30
|
| Rate for Payer: Priority Health Tiered Network |
$4,145.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,602.21
|
| Rate for Payer: UHC Medicaid |
$837.96
|
| Rate for Payer: UHCCP Medicaid |
$837.96
|
| Rate for Payer: VA VA |
$1,602.21
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
25000
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$762.30 |
| Max. Negotiated Rate |
$1,089.00 |
| Rate for Payer: Aetna Commercial |
$1,028.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.50
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Advantage |
$847.00
|
| Rate for Payer: Cofinity Commercial |
$1,040.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$968.00
|
| Rate for Payer: Healthscope Commercial |
$1,089.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,028.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PHP Commercial |
$1,028.50
|
| Rate for Payer: Priority Health SBD |
$762.30
|
|
|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$217.69 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$438.70
|
| Rate for Payer: Aetna Medicare |
$340.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.44
|
| Rate for Payer: BCBS Complete |
$228.57
|
| Rate for Payer: BCBS MAPPO |
$327.39
|
| Rate for Payer: BCN Commercial |
$542.80
|
| Rate for Payer: BCN Medicare Advantage |
$327.39
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$471.44
|
| Rate for Payer: Cofinity Commercial |
$438.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.39
|
| Rate for Payer: Healthscope Commercial |
$605.67
|
| Rate for Payer: Healthscope Commercial |
$523.82
|
| Rate for Payer: Mclaren Medicaid |
$217.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.76
|
| Rate for Payer: Meridian Medicaid |
$228.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$360.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$613.21
|
| Rate for Payer: Nomi Health Commercial |
$392.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$327.39
|
| Rate for Payer: PHP Medicare Advantage |
$327.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$580.24
|
| Rate for Payer: Priority Health Medicare |
$327.39
|
| Rate for Payer: Priority Health SBD |
$580.24
|
| Rate for Payer: Priority Health Tiered Network |
$580.24
|
| Rate for Payer: Railroad Medicare Medicare |
$327.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.39
|
| Rate for Payer: UHC Core |
$591.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$327.39
|
| Rate for Payer: UHC Exchange |
$591.39
|
| Rate for Payer: UHC Medicaid |
$217.69
|
| Rate for Payer: UHCCP Medicaid |
$217.69
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Aetna Commercial |
$36.89
|
| Rate for Payer: Aetna Medicare |
$28.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.64
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$27.53
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.53
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$36.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$50.93
|
| Rate for Payer: Healthscope Commercial |
$44.05
|
| Rate for Payer: Mclaren Medicaid |
$18.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.91
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.88
|
| Rate for Payer: Nomi Health Commercial |
$33.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.25
|
| Rate for Payer: PACE SWMI |
$27.53
|
| Rate for Payer: PHP Medicare Advantage |
$27.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$55.22
|
| Rate for Payer: Priority Health Medicare |
$27.53
|
| Rate for Payer: Priority Health SBD |
$55.22
|
| Rate for Payer: Priority Health Tiered Network |
$55.22
|
| Rate for Payer: Railroad Medicare Medicare |
$27.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.90
|
| Rate for Payer: UHC Core |
$51.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.53
|
| Rate for Payer: UHC Exchange |
$51.90
|
| Rate for Payer: UHC Medicaid |
$18.32
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$742.52
|
| Rate for Payer: Aetna Medicare |
$576.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$742.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.93
|
| Rate for Payer: BCBS Complete |
$379.75
|
| Rate for Payer: BCBS MAPPO |
$554.12
|
| Rate for Payer: BCN Commercial |
$908.82
|
| Rate for Payer: BCN Medicare Advantage |
$554.12
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Commercial |
$797.93
|
| Rate for Payer: Cofinity Commercial |
$742.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.12
|
| Rate for Payer: Healthscope Commercial |
$886.59
|
| Rate for Payer: Healthscope Commercial |
$1,025.12
|
| Rate for Payer: Mclaren Medicaid |
$361.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$581.83
|
| Rate for Payer: Meridian Medicaid |
$379.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$609.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.79
|
| Rate for Payer: Nomi Health Commercial |
$664.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PACE SWMI |
$554.12
|
| Rate for Payer: PHP Medicare Advantage |
$554.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$971.49
|
| Rate for Payer: Priority Health Medicare |
$554.12
|
| Rate for Payer: Priority Health SBD |
$971.49
|
| Rate for Payer: Priority Health Tiered Network |
$971.49
|
| Rate for Payer: Railroad Medicare Medicare |
$554.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.93
|
| Rate for Payer: UHC Core |
$1,056.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$554.12
|
| Rate for Payer: UHC Exchange |
$1,056.93
|
| Rate for Payer: UHC Medicaid |
$361.67
|
| Rate for Payer: UHCCP Medicaid |
$361.67
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$65.39 |
| Max. Negotiated Rate |
$282.75 |
| Rate for Payer: Aetna Commercial |
$131.20
|
| Rate for Payer: Aetna Medicare |
$101.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.99
|
| Rate for Payer: BCBS Complete |
$68.66
|
| Rate for Payer: BCBS MAPPO |
$97.91
|
| Rate for Payer: BCN Commercial |
$165.33
|
| Rate for Payer: BCN Medicare Advantage |
$97.91
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$140.99
|
| Rate for Payer: Cofinity Commercial |
$131.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.91
|
| Rate for Payer: Healthscope Commercial |
$181.13
|
| Rate for Payer: Healthscope Commercial |
$156.66
|
| Rate for Payer: Mclaren Medicaid |
$65.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.81
|
| Rate for Payer: Meridian Medicaid |
$68.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.22
|
| Rate for Payer: Nomi Health Commercial |
$117.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.75
|
| Rate for Payer: PACE SWMI |
$97.91
|
| Rate for Payer: PHP Medicare Advantage |
$97.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.44
|
| Rate for Payer: Priority Health Medicare |
$97.91
|
| Rate for Payer: Priority Health SBD |
$201.44
|
| Rate for Payer: Priority Health Tiered Network |
$201.44
|
| Rate for Payer: Railroad Medicare Medicare |
$97.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.27
|
| Rate for Payer: UHC Core |
$184.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$97.91
|
| Rate for Payer: UHC Exchange |
$184.27
|
| Rate for Payer: UHC Medicaid |
$65.39
|
| Rate for Payer: UHCCP Medicaid |
$65.39
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$386.25 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Medicare |
$173.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.83
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$167.24
|
| Rate for Payer: BCN Commercial |
$276.38
|
| Rate for Payer: BCN Medicare Advantage |
$167.24
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cofinity Commercial |
$240.83
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.24
|
| Rate for Payer: Healthscope Commercial |
$309.39
|
| Rate for Payer: Healthscope Commercial |
$267.58
|
| Rate for Payer: Mclaren Medicaid |
$109.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.60
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$322.65
|
| Rate for Payer: Nomi Health Commercial |
$200.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$386.25
|
| Rate for Payer: PACE SWMI |
$167.24
|
| Rate for Payer: PHP Medicare Advantage |
$167.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$252.95
|
| Rate for Payer: Priority Health Medicare |
$167.24
|
| Rate for Payer: Priority Health SBD |
$252.95
|
| Rate for Payer: Priority Health Tiered Network |
$252.95
|
| Rate for Payer: Railroad Medicare Medicare |
$167.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.05
|
| Rate for Payer: UHC Core |
$323.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.24
|
| Rate for Payer: UHC Exchange |
$323.05
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$1,309.90 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Aetna Medicare |
$421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$506.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$506.31
|
| Rate for Payer: BCBS Complete |
$222.45
|
| Rate for Payer: BCBS MAPPO |
$405.05
|
| Rate for Payer: BCBS Trust/PPO |
$307.60
|
| Rate for Payer: BCN Commercial |
$307.60
|
| Rate for Payer: BCN Medicare Advantage |
$405.05
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Advantage |
$181.30
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$405.05
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| Rate for Payer: Mclaren Medicaid |
$211.84
|
| Rate for Payer: Mclaren Medicare |
$405.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$425.30
|
| Rate for Payer: Meridian Medicaid |
$425.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$465.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$445.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$1,215.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PACE Medicare |
$384.80
|
| Rate for Payer: PACE SWMI |
$405.05
|
| Rate for Payer: PHP Commercial |
$220.15
|
| Rate for Payer: PHP Medicare Advantage |
$405.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$211.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.90
|
| Rate for Payer: Priority Health Medicare |
$405.05
|
| Rate for Payer: Priority Health SBD |
$163.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,047.92
|
| Rate for Payer: Railroad Medicare Medicare |
$405.05
|
| Rate for Payer: UHC Medicaid |
$211.84
|
| Rate for Payer: UHCCP Medicaid |
$211.84
|
| Rate for Payer: VA VA |
$405.05
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.35
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Advantage |
$181.30
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PHP Commercial |
$220.15
|
| Rate for Payer: Priority Health SBD |
$163.17
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Aetna Medicare |
$101.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.80
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$97.78
|
| Rate for Payer: BCN Commercial |
$159.35
|
| Rate for Payer: BCN Medicare Advantage |
$97.78
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$131.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.78
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Healthscope Commercial |
$156.45
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.67
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.83
|
| Rate for Payer: Nomi Health Commercial |
$117.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PACE SWMI |
$97.78
|
| Rate for Payer: PHP Medicare Advantage |
$97.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.85
|
| Rate for Payer: Priority Health Medicare |
$97.78
|
| Rate for Payer: Priority Health SBD |
$145.85
|
| Rate for Payer: Priority Health Tiered Network |
$145.85
|
| Rate for Payer: Railroad Medicare Medicare |
$97.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.12
|
| Rate for Payer: UHC Core |
$176.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$97.78
|
| Rate for Payer: UHC Exchange |
$176.12
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$131.03
|
| Rate for Payer: Aetna Medicare |
$101.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.80
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$97.78
|
| Rate for Payer: BCN Commercial |
$159.35
|
| Rate for Payer: BCN Medicare Advantage |
$97.78
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$131.03
|
| Rate for Payer: Cofinity Commercial |
$140.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.78
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Healthscope Commercial |
$156.45
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.67
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.83
|
| Rate for Payer: Nomi Health Commercial |
$117.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PACE SWMI |
$97.78
|
| Rate for Payer: PHP Medicare Advantage |
$97.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.85
|
| Rate for Payer: Priority Health Medicare |
$97.78
|
| Rate for Payer: Priority Health SBD |
$145.85
|
| Rate for Payer: Priority Health Tiered Network |
$145.85
|
| Rate for Payer: Railroad Medicare Medicare |
$97.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.12
|
| Rate for Payer: UHC Core |
$176.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$97.78
|
| Rate for Payer: UHC Exchange |
$176.12
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR INCISION&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,641.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$1,230.75 |
| Rate for Payer: Aetna Commercial |
$108.38
|
| Rate for Payer: Aetna Medicare |
$84.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.47
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$80.88
|
| Rate for Payer: BCN Commercial |
$182.32
|
| Rate for Payer: BCN Medicare Advantage |
$80.88
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cash Price |
$1,312.80
|
| Rate for Payer: Cofinity Commercial |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$108.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.88
|
| Rate for Payer: Healthscope Commercial |
$149.63
|
| Rate for Payer: Healthscope Commercial |
$129.41
|
| Rate for Payer: Mclaren Medicaid |
$50.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.92
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158.78
|
| Rate for Payer: Nomi Health Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,230.75
|
| Rate for Payer: PACE SWMI |
$80.88
|
| Rate for Payer: PHP Medicare Advantage |
$80.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$153.28
|
| Rate for Payer: Priority Health Medicare |
$80.88
|
| Rate for Payer: Priority Health SBD |
$153.28
|
| Rate for Payer: Priority Health Tiered Network |
$153.28
|
| Rate for Payer: Railroad Medicare Medicare |
$80.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.06
|
| Rate for Payer: UHC Core |
$156.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.88
|
| Rate for Payer: UHC Exchange |
$156.06
|
| Rate for Payer: UHC Medicaid |
$50.91
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
|
