|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 46040
|
| Hospital Charge Code |
46040
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$758.59 |
| Rate for Payer: Aetna Commercial |
$549.47
|
| Rate for Payer: Aetna Medicare |
$426.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.47
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$410.05
|
| Rate for Payer: BCN Medicare Advantage |
$410.05
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$590.47
|
| Rate for Payer: Cofinity Commercial |
$549.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.05
|
| Rate for Payer: Healthscope Commercial |
$656.08
|
| Rate for Payer: Healthscope Commercial |
$758.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$430.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.60
|
| Rate for Payer: Nomi Health Commercial |
$492.06
|
| Rate for Payer: PACE SWMI |
$410.05
|
| Rate for Payer: PHP Medicare Advantage |
$410.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$410.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.05
|
| Rate for Payer: UHC Medicare Advantage |
$410.05
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
46040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.60
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$646.80
|
| Rate for Payer: Cofinity Commercial |
$794.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Healthscope Commercial |
$831.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: PHP Commercial |
$785.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health SBD |
$582.12
|
|
|
PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
46040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$582.12 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Commercial |
$785.40
|
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$646.80
|
| Rate for Payer: Cofinity Commercial |
$794.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$646.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$739.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Healthscope Commercial |
$831.60
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$785.40
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Commercial |
$785.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Priority Health SBD |
$582.12
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$647.41
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR I&D OF BARTHOLINS GLAND ABSCESS
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 56420
|
| Min. Negotiated Rate |
$104.01 |
| Max. Negotiated Rate |
$250.90 |
| Rate for Payer: Aetna Commercial |
$139.37
|
| Rate for Payer: Aetna Medicare |
$108.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.37
|
| Rate for Payer: BCBS Complete |
$154.40
|
| Rate for Payer: BCBS MAPPO |
$104.01
|
| Rate for Payer: BCN Medicare Advantage |
$104.01
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$149.77
|
| Rate for Payer: Cofinity Commercial |
$139.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.01
|
| Rate for Payer: Healthscope Commercial |
$166.42
|
| Rate for Payer: Healthscope Commercial |
$192.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.90
|
| Rate for Payer: Nomi Health Commercial |
$124.81
|
| Rate for Payer: PACE SWMI |
$104.01
|
| Rate for Payer: PHP Medicare Advantage |
$104.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.90
|
| Rate for Payer: Priority Health Medicare |
$104.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.01
|
| Rate for Payer: UHC Medicare Advantage |
$104.01
|
|
|
PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 26991
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$934.82 |
| Rate for Payer: Aetna Commercial |
$677.12
|
| Rate for Payer: Aetna Medicare |
$525.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.12
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$505.31
|
| Rate for Payer: BCN Medicare Advantage |
$505.31
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$727.65
|
| Rate for Payer: Cofinity Commercial |
$677.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.31
|
| Rate for Payer: Healthscope Commercial |
$934.82
|
| Rate for Payer: Healthscope Commercial |
$808.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$530.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.60
|
| Rate for Payer: Nomi Health Commercial |
$606.37
|
| Rate for Payer: PACE SWMI |
$505.31
|
| Rate for Payer: PHP Medicare Advantage |
$505.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$505.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.31
|
| Rate for Payer: UHC Medicare Advantage |
$505.31
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$953.19 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna Commercial |
$1,286.05
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,301.18
|
| Rate for Payer: Cofinity Commercial |
$1,059.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,059.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,361.70
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.05
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$1,286.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$953.19
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,781.56
|
| Rate for Payer: VA VA |
$3,164.40
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 26990
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$1,197.52 |
| Rate for Payer: Aetna Commercial |
$867.40
|
| Rate for Payer: Aetna Medicare |
$673.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.40
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$647.31
|
| Rate for Payer: BCN Medicare Advantage |
$647.31
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$932.13
|
| Rate for Payer: Cofinity Commercial |
$867.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.31
|
| Rate for Payer: Healthscope Commercial |
$1,035.70
|
| Rate for Payer: Healthscope Commercial |
$1,197.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.45
|
| Rate for Payer: Nomi Health Commercial |
$776.77
|
| Rate for Payer: PACE SWMI |
$647.31
|
| Rate for Payer: PHP Medicare Advantage |
$647.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health Medicare |
$647.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.31
|
| Rate for Payer: UHC Medicare Advantage |
$647.31
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$953.19 |
| Max. Negotiated Rate |
$1,361.70 |
| Rate for Payer: Aetna Commercial |
$1,286.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.45
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$1,059.10
|
| Rate for Payer: Cofinity Commercial |
$1,301.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,059.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,210.40
|
| Rate for Payer: Healthscope Commercial |
$1,361.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,286.05
|
| Rate for Payer: PHP Commercial |
$1,286.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health SBD |
$953.19
|
|
|
PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 26990
|
| Hospital Charge Code |
26990
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$1,197.52 |
| Rate for Payer: Aetna Commercial |
$867.40
|
| Rate for Payer: Aetna Medicare |
$673.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.13
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$647.31
|
| Rate for Payer: BCN Medicare Advantage |
$647.31
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$932.13
|
| Rate for Payer: Cofinity Commercial |
$867.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.31
|
| Rate for Payer: Healthscope Commercial |
$1,035.70
|
| Rate for Payer: Healthscope Commercial |
$1,197.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.45
|
| Rate for Payer: Nomi Health Commercial |
$776.77
|
| Rate for Payer: PACE SWMI |
$647.31
|
| Rate for Payer: PHP Medicare Advantage |
$647.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health Medicare |
$647.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.31
|
| Rate for Payer: UHC Medicare Advantage |
$647.31
|
|
|
PR I&D PENIS DEEP
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 54015
|
| Min. Negotiated Rate |
$290.78 |
| Max. Negotiated Rate |
$537.94 |
| Rate for Payer: Aetna Commercial |
$389.65
|
| Rate for Payer: Aetna Medicare |
$302.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.65
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCBS MAPPO |
$290.78
|
| Rate for Payer: BCN Medicare Advantage |
$290.78
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cofinity Commercial |
$418.72
|
| Rate for Payer: Cofinity Commercial |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.78
|
| Rate for Payer: Healthscope Commercial |
$537.94
|
| Rate for Payer: Healthscope Commercial |
$465.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$497.90
|
| Rate for Payer: Nomi Health Commercial |
$348.94
|
| Rate for Payer: PACE SWMI |
$290.78
|
| Rate for Payer: PHP Medicare Advantage |
$290.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.90
|
| Rate for Payer: Priority Health Medicare |
$290.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.78
|
| Rate for Payer: UHC Medicare Advantage |
$290.78
|
|
|
PR I&D PERIANAL ABSCESS SUPERFICIAL
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 46050
|
| Min. Negotiated Rate |
$96.95 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Commercial |
$129.91
|
| Rate for Payer: Aetna Medicare |
$100.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.91
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS MAPPO |
$96.95
|
| Rate for Payer: BCN Medicare Advantage |
$96.95
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cofinity Commercial |
$139.61
|
| Rate for Payer: Cofinity Commercial |
$129.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.95
|
| Rate for Payer: Healthscope Commercial |
$155.12
|
| Rate for Payer: Healthscope Commercial |
$179.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292.50
|
| Rate for Payer: Nomi Health Commercial |
$116.34
|
| Rate for Payer: PACE SWMI |
$96.95
|
| Rate for Payer: PHP Medicare Advantage |
$96.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: Priority Health Medicare |
$96.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.95
|
| Rate for Payer: UHC Medicare Advantage |
$96.95
|
|
|
PR I&D SHOULDER DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 23030
|
| Min. Negotiated Rate |
$245.68 |
| Max. Negotiated Rate |
$465.40 |
| Rate for Payer: Aetna Commercial |
$329.21
|
| Rate for Payer: Aetna Medicare |
$255.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.21
|
| Rate for Payer: BCBS Complete |
$286.40
|
| Rate for Payer: BCBS MAPPO |
$245.68
|
| Rate for Payer: BCN Medicare Advantage |
$245.68
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$353.78
|
| Rate for Payer: Cofinity Commercial |
$329.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$245.68
|
| Rate for Payer: Healthscope Commercial |
$454.51
|
| Rate for Payer: Healthscope Commercial |
$393.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.40
|
| Rate for Payer: Nomi Health Commercial |
$294.82
|
| Rate for Payer: PACE SWMI |
$245.68
|
| Rate for Payer: PHP Medicare Advantage |
$245.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health Medicare |
$245.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$245.68
|
| Rate for Payer: UHC Medicare Advantage |
$245.68
|
|
|
PR I&D SHOULDER INFECTED BURSA
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 23031
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna Commercial |
$287.83
|
| Rate for Payer: Aetna Medicare |
$223.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.83
|
| Rate for Payer: BCBS Complete |
$288.00
|
| Rate for Payer: BCBS MAPPO |
$214.80
|
| Rate for Payer: BCN Medicare Advantage |
$214.80
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$309.31
|
| Rate for Payer: Cofinity Commercial |
$287.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.80
|
| Rate for Payer: Healthscope Commercial |
$343.68
|
| Rate for Payer: Healthscope Commercial |
$397.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$468.00
|
| Rate for Payer: Nomi Health Commercial |
$257.76
|
| Rate for Payer: PACE SWMI |
$214.80
|
| Rate for Payer: PHP Medicare Advantage |
$214.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.00
|
| Rate for Payer: Priority Health Medicare |
$214.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.80
|
| Rate for Payer: UHC Medicare Advantage |
$214.80
|
|
|
PR I&D SOFT TISSUE ABSCESS SUBFASCIAL
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 20005
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
|
|
PR I&D SUBMUCOSAL ABSCESS RECTUM
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 45005
|
| Min. Negotiated Rate |
$161.01 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Aetna Commercial |
$215.75
|
| Rate for Payer: Aetna Medicare |
$167.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.85
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS MAPPO |
$161.01
|
| Rate for Payer: BCN Medicare Advantage |
$161.01
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$231.85
|
| Rate for Payer: Cofinity Commercial |
$215.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.01
|
| Rate for Payer: Healthscope Commercial |
$297.87
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.55
|
| Rate for Payer: Nomi Health Commercial |
$193.21
|
| Rate for Payer: PACE SWMI |
$161.01
|
| Rate for Payer: PHP Medicare Advantage |
$161.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Medicare |
$161.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.01
|
| Rate for Payer: UHC Medicare Advantage |
$161.01
|
|
|
PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
HCPCS 23930
|
| Min. Negotiated Rate |
$208.73 |
| Max. Negotiated Rate |
$403.00 |
| Rate for Payer: Aetna Commercial |
$279.70
|
| Rate for Payer: Aetna Medicare |
$217.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.57
|
| Rate for Payer: BCBS Complete |
$248.00
|
| Rate for Payer: BCBS MAPPO |
$208.73
|
| Rate for Payer: BCN Medicare Advantage |
$208.73
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cash Price |
$496.00
|
| Rate for Payer: Cofinity Commercial |
$279.70
|
| Rate for Payer: Cofinity Commercial |
$300.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$208.73
|
| Rate for Payer: Healthscope Commercial |
$333.97
|
| Rate for Payer: Healthscope Commercial |
$386.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.00
|
| Rate for Payer: Nomi Health Commercial |
$250.48
|
| Rate for Payer: PACE SWMI |
$208.73
|
| Rate for Payer: PHP Medicare Advantage |
$208.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.00
|
| Rate for Payer: Priority Health Medicare |
$208.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$208.73
|
| Rate for Payer: UHC Medicare Advantage |
$208.73
|
|
|
PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
HCPCS 57023
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$566.60 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Medicare |
$318.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.40
|
| Rate for Payer: BCBS Complete |
$210.40
|
| Rate for Payer: BCBS MAPPO |
$306.27
|
| Rate for Payer: BCN Medicare Advantage |
$306.27
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cofinity Commercial |
$441.03
|
| Rate for Payer: Cofinity Commercial |
$410.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.27
|
| Rate for Payer: Healthscope Commercial |
$566.60
|
| Rate for Payer: Healthscope Commercial |
$490.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.90
|
| Rate for Payer: Nomi Health Commercial |
$367.52
|
| Rate for Payer: PACE SWMI |
$306.27
|
| Rate for Payer: PHP Medicare Advantage |
$306.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.90
|
| Rate for Payer: Priority Health Medicare |
$306.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$306.27
|
| Rate for Payer: UHC Medicare Advantage |
$306.27
|
|
|
PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 57022
|
| Min. Negotiated Rate |
$173.41 |
| Max. Negotiated Rate |
$320.81 |
| Rate for Payer: Aetna Commercial |
$232.37
|
| Rate for Payer: Aetna Medicare |
$180.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.37
|
| Rate for Payer: BCBS Complete |
$183.20
|
| Rate for Payer: BCBS MAPPO |
$173.41
|
| Rate for Payer: BCN Medicare Advantage |
$173.41
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$249.71
|
| Rate for Payer: Cofinity Commercial |
$232.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.41
|
| Rate for Payer: Healthscope Commercial |
$277.46
|
| Rate for Payer: Healthscope Commercial |
$320.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.70
|
| Rate for Payer: Nomi Health Commercial |
$208.09
|
| Rate for Payer: PACE SWMI |
$173.41
|
| Rate for Payer: PHP Medicare Advantage |
$173.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.70
|
| Rate for Payer: Priority Health Medicare |
$173.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.41
|
| Rate for Payer: UHC Medicare Advantage |
$173.41
|
|
|
PR I&D VULVA/PERINEAL ABSCESS
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 56405
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$222.06 |
| Rate for Payer: Aetna Commercial |
$160.84
|
| Rate for Payer: Aetna Medicare |
$124.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.84
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$120.03
|
| Rate for Payer: BCN Medicare Advantage |
$120.03
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$172.84
|
| Rate for Payer: Cofinity Commercial |
$160.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.03
|
| Rate for Payer: Healthscope Commercial |
$222.06
|
| Rate for Payer: Healthscope Commercial |
$192.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.70
|
| Rate for Payer: Nomi Health Commercial |
$144.04
|
| Rate for Payer: PACE SWMI |
$120.03
|
| Rate for Payer: PHP Medicare Advantage |
$120.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$120.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.03
|
| Rate for Payer: UHC Medicare Advantage |
$120.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90657
|
| Min. Negotiated Rate |
$11.03 |
| Max. Negotiated Rate |
$27.95 |
| Rate for Payer: Aetna Commercial |
$14.78
|
| Rate for Payer: Aetna Medicare |
$11.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.78
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$11.03
|
| Rate for Payer: BCN Medicare Advantage |
$11.03
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$17.65
|
| Rate for Payer: Healthscope Commercial |
$20.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$13.24
|
| Rate for Payer: PACE SWMI |
$11.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.03
|
| Rate for Payer: UHC Medicare Advantage |
$11.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90658
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$40.83 |
| Rate for Payer: Aetna Commercial |
$29.57
|
| Rate for Payer: Aetna Medicare |
$22.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.57
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$22.07
|
| Rate for Payer: BCN Medicare Advantage |
$22.07
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$31.78
|
| Rate for Payer: Cofinity Commercial |
$29.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.07
|
| Rate for Payer: Healthscope Commercial |
$40.83
|
| Rate for Payer: Healthscope Commercial |
$35.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$26.48
|
| Rate for Payer: PACE SWMI |
$22.07
|
| Rate for Payer: PHP Medicare Advantage |
$22.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$22.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.07
|
| Rate for Payer: UHC Medicare Advantage |
$22.07
|
|
|
PR IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90656
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$42.96 |
| Rate for Payer: Aetna Commercial |
$31.11
|
| Rate for Payer: Aetna Medicare |
$24.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.11
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$23.22
|
| Rate for Payer: BCN Medicare Advantage |
$23.22
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$33.44
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.22
|
| Rate for Payer: Healthscope Commercial |
$37.15
|
| Rate for Payer: Healthscope Commercial |
$42.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$27.86
|
| Rate for Payer: PACE SWMI |
$23.22
|
| Rate for Payer: PHP Medicare Advantage |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$23.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.22
|
| Rate for Payer: UHC Medicare Advantage |
$23.22
|
|
|
PR IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90655
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90686
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
