|
PR INCISION & DRAINAGE PILONIDAL CYST SIMPLE
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
HCPCS 10080
|
| Min. Negotiated Rate |
$99.21 |
| Max. Negotiated Rate |
$203.45 |
| Rate for Payer: Aetna Commercial |
$132.94
|
| Rate for Payer: Aetna Medicare |
$103.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.94
|
| Rate for Payer: BCBS Complete |
$125.20
|
| Rate for Payer: BCBS MAPPO |
$99.21
|
| Rate for Payer: BCN Medicare Advantage |
$99.21
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cofinity Commercial |
$142.86
|
| Rate for Payer: Cofinity Commercial |
$132.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.21
|
| Rate for Payer: Healthscope Commercial |
$158.74
|
| Rate for Payer: Healthscope Commercial |
$183.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.45
|
| Rate for Payer: Nomi Health Commercial |
$119.05
|
| Rate for Payer: PACE SWMI |
$99.21
|
| Rate for Payer: PHP Medicare Advantage |
$99.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.45
|
| Rate for Payer: Priority Health Medicare |
$99.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.21
|
| Rate for Payer: UHC Medicare Advantage |
$99.21
|
|
|
PR INCISION&DRAINAGE UPPER ARM/ELBOW BURSA
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 23931
|
| Min. Negotiated Rate |
$153.83 |
| Max. Negotiated Rate |
$482.30 |
| Rate for Payer: Aetna Commercial |
$206.13
|
| Rate for Payer: Aetna Medicare |
$159.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.13
|
| Rate for Payer: BCBS Complete |
$296.80
|
| Rate for Payer: BCBS MAPPO |
$153.83
|
| Rate for Payer: BCN Medicare Advantage |
$153.83
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$221.52
|
| Rate for Payer: Cofinity Commercial |
$206.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.83
|
| Rate for Payer: Healthscope Commercial |
$284.59
|
| Rate for Payer: Healthscope Commercial |
$246.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$482.30
|
| Rate for Payer: Nomi Health Commercial |
$184.60
|
| Rate for Payer: PACE SWMI |
$153.83
|
| Rate for Payer: PHP Medicare Advantage |
$153.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.30
|
| Rate for Payer: Priority Health Medicare |
$153.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.83
|
| Rate for Payer: UHC Medicare Advantage |
$153.83
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Facility
|
OP
|
$1,175.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
25000
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$740.25 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$998.75
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,951.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,951.06
|
| Rate for Payer: BCBS Complete |
$878.45
|
| Rate for Payer: BCBS MAPPO |
$1,560.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,560.85
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$1,010.50
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$1,057.50
|
| Rate for Payer: Mclaren Medicaid |
$836.62
|
| Rate for Payer: Mclaren Medicare |
$1,560.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,638.89
|
| Rate for Payer: Meridian Medicaid |
$878.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,794.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.75
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$998.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,560.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$740.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,560.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,393.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,560.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.85
|
| Rate for Payer: UHCCP Medicaid |
$878.76
|
| Rate for Payer: VA VA |
$1,560.85
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$333.77 |
| Max. Negotiated Rate |
$763.75 |
| Rate for Payer: Aetna Commercial |
$447.25
|
| Rate for Payer: Aetna Medicare |
$347.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.25
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCBS MAPPO |
$333.77
|
| Rate for Payer: BCN Medicare Advantage |
$333.77
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$480.63
|
| Rate for Payer: Cofinity Commercial |
$447.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.77
|
| Rate for Payer: Healthscope Commercial |
$534.03
|
| Rate for Payer: Healthscope Commercial |
$617.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.75
|
| Rate for Payer: Nomi Health Commercial |
$400.52
|
| Rate for Payer: PACE SWMI |
$333.77
|
| Rate for Payer: PHP Medicare Advantage |
$333.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$333.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.77
|
| Rate for Payer: UHC Medicare Advantage |
$333.77
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Facility
|
IP
|
$1,175.00
|
|
|
Service Code
|
CPT 25000
|
| Hospital Charge Code |
25000
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$740.25 |
| Max. Negotiated Rate |
$1,057.50 |
| Rate for Payer: Aetna Commercial |
$998.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.75
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$1,010.50
|
| Rate for Payer: Cofinity Commercial |
$822.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$822.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$940.00
|
| Rate for Payer: Healthscope Commercial |
$1,057.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.75
|
| Rate for Payer: PHP Commercial |
$998.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health SBD |
$740.25
|
|
|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
25000
|
| Min. Negotiated Rate |
$333.77 |
| Max. Negotiated Rate |
$763.75 |
| Rate for Payer: Aetna Commercial |
$447.25
|
| Rate for Payer: Aetna Medicare |
$347.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.63
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCBS MAPPO |
$333.77
|
| Rate for Payer: BCN Medicare Advantage |
$333.77
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$480.63
|
| Rate for Payer: Cofinity Commercial |
$447.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.77
|
| Rate for Payer: Healthscope Commercial |
$534.03
|
| Rate for Payer: Healthscope Commercial |
$617.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.75
|
| Rate for Payer: Nomi Health Commercial |
$400.52
|
| Rate for Payer: PACE SWMI |
$333.77
|
| Rate for Payer: PHP Medicare Advantage |
$333.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$333.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.77
|
| Rate for Payer: UHC Medicare Advantage |
$333.77
|
|
|
PR INCISION FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$763.75 |
| Rate for Payer: Aetna Commercial |
$453.09
|
| Rate for Payer: Aetna Medicare |
$351.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.09
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCBS MAPPO |
$338.13
|
| Rate for Payer: BCN Medicare Advantage |
$338.13
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$486.91
|
| Rate for Payer: Cofinity Commercial |
$453.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.13
|
| Rate for Payer: Healthscope Commercial |
$625.54
|
| Rate for Payer: Healthscope Commercial |
$541.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.75
|
| Rate for Payer: Nomi Health Commercial |
$405.76
|
| Rate for Payer: PACE SWMI |
$338.13
|
| Rate for Payer: PHP Medicare Advantage |
$338.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health Medicare |
$338.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.13
|
| Rate for Payer: UHC Medicare Advantage |
$338.13
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$231.40 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.59
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCN Medicare Advantage |
$28.05
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$40.39
|
| Rate for Payer: Cofinity Commercial |
$37.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.05
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.40
|
| Rate for Payer: Nomi Health Commercial |
$33.66
|
| Rate for Payer: PACE SWMI |
$28.05
|
| Rate for Payer: PHP Medicare Advantage |
$28.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health Medicare |
$28.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$575.82 |
| Max. Negotiated Rate |
$1,127.10 |
| Rate for Payer: Aetna Commercial |
$771.60
|
| Rate for Payer: Aetna Medicare |
$598.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.60
|
| Rate for Payer: BCBS Complete |
$693.60
|
| Rate for Payer: BCBS MAPPO |
$575.82
|
| Rate for Payer: BCN Medicare Advantage |
$575.82
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cash Price |
$1,387.20
|
| Rate for Payer: Cofinity Commercial |
$829.18
|
| Rate for Payer: Cofinity Commercial |
$771.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.82
|
| Rate for Payer: Healthscope Commercial |
$921.31
|
| Rate for Payer: Healthscope Commercial |
$1,065.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,127.10
|
| Rate for Payer: Nomi Health Commercial |
$690.98
|
| Rate for Payer: PACE SWMI |
$575.82
|
| Rate for Payer: PHP Medicare Advantage |
$575.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health Medicare |
$575.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.82
|
| Rate for Payer: UHC Medicare Advantage |
$575.82
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$102.38 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.19
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$163.81
|
| Rate for Payer: Healthscope Commercial |
$189.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.90
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$174.74 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$234.15
|
| Rate for Payer: Aetna Medicare |
$181.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.15
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$174.74
|
| Rate for Payer: BCN Medicare Advantage |
$174.74
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$251.63
|
| Rate for Payer: Cofinity Commercial |
$234.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.74
|
| Rate for Payer: Healthscope Commercial |
$323.27
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.00
|
| Rate for Payer: Nomi Health Commercial |
$209.69
|
| Rate for Payer: PACE SWMI |
$174.74
|
| Rate for Payer: PHP Medicare Advantage |
$174.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$174.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.74
|
| Rate for Payer: UHC Medicare Advantage |
$174.74
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Commercial |
$213.35
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$215.86
|
| Rate for Payer: Cofinity Commercial |
$175.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$225.90
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$213.35
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$158.13
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$103.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.77
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCN Medicare Advantage |
$99.08
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Cofinity Commercial |
$132.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.08
|
| Rate for Payer: Healthscope Commercial |
$158.53
|
| Rate for Payer: Healthscope Commercial |
$183.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.15
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE SWMI |
$99.08
|
| Rate for Payer: PHP Medicare Advantage |
$99.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
10120
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$158.13 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Aetna Commercial |
$213.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.15
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$175.70
|
| Rate for Payer: Cofinity Commercial |
$215.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$175.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.80
|
| Rate for Payer: Healthscope Commercial |
$225.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: PHP Commercial |
$213.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health SBD |
$158.13
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$99.08 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$132.77
|
| Rate for Payer: Aetna Medicare |
$103.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.68
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCN Medicare Advantage |
$99.08
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$132.77
|
| Rate for Payer: Cofinity Commercial |
$142.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.08
|
| Rate for Payer: Healthscope Commercial |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$158.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.15
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE SWMI |
$99.08
|
| Rate for Payer: PHP Medicare Advantage |
$99.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
|
|
PR INCISION&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$87.01 |
| Max. Negotiated Rate |
$1,035.45 |
| Rate for Payer: Aetna Commercial |
$116.59
|
| Rate for Payer: Aetna Medicare |
$90.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.59
|
| Rate for Payer: BCBS Complete |
$637.20
|
| Rate for Payer: BCBS MAPPO |
$87.01
|
| Rate for Payer: BCN Medicare Advantage |
$87.01
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cofinity Commercial |
$125.29
|
| Rate for Payer: Cofinity Commercial |
$116.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.01
|
| Rate for Payer: Healthscope Commercial |
$160.97
|
| Rate for Payer: Healthscope Commercial |
$139.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.45
|
| Rate for Payer: Nomi Health Commercial |
$104.41
|
| Rate for Payer: PACE SWMI |
$87.01
|
| Rate for Payer: PHP Medicare Advantage |
$87.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,035.45
|
| Rate for Payer: Priority Health Medicare |
$87.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.01
|
| Rate for Payer: UHC Medicare Advantage |
$87.01
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$105.56 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Aetna Commercial |
$141.45
|
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: BCBS MAPPO |
$105.56
|
| Rate for Payer: BCN Medicare Advantage |
$105.56
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$152.01
|
| Rate for Payer: Cofinity Commercial |
$141.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.56
|
| Rate for Payer: Healthscope Commercial |
$168.90
|
| Rate for Payer: Healthscope Commercial |
$195.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.35
|
| Rate for Payer: Nomi Health Commercial |
$126.67
|
| Rate for Payer: PACE SWMI |
$105.56
|
| Rate for Payer: PHP Medicare Advantage |
$105.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health Medicare |
$105.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.56
|
| Rate for Payer: UHC Medicare Advantage |
$105.56
|
|
|
PR INCOBOTULINUMTOXIN A
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0588
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.30 |
| Rate for Payer: Aetna Commercial |
$7.46
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$8.02
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$8.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.20
|
| Rate for Payer: Nomi Health Commercial |
$6.68
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$5.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
|
|
PR INDIV PHYS SUPVJ HOME/DOM/R-HOME MO 30 MIN/>
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 99340
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
|
|
PR INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 59856
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$900.02 |
| Rate for Payer: Aetna Commercial |
$651.91
|
| Rate for Payer: Aetna Medicare |
$505.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$700.56
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$486.50
|
| Rate for Payer: BCN Medicare Advantage |
$486.50
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$651.91
|
| Rate for Payer: Cofinity Commercial |
$700.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.50
|
| Rate for Payer: Healthscope Commercial |
$778.40
|
| Rate for Payer: Healthscope Commercial |
$900.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$596.70
|
| Rate for Payer: Nomi Health Commercial |
$583.80
|
| Rate for Payer: PACE SWMI |
$486.50
|
| Rate for Payer: PHP Medicare Advantage |
$486.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$486.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.50
|
| Rate for Payer: UHC Medicare Advantage |
$486.50
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$567.92 |
| Max. Negotiated Rate |
$1,188.85 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: Aetna Medicare |
$590.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.01
|
| Rate for Payer: BCBS Complete |
$731.60
|
| Rate for Payer: BCBS MAPPO |
$567.92
|
| Rate for Payer: BCN Medicare Advantage |
$567.92
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cofinity Commercial |
$817.80
|
| Rate for Payer: Cofinity Commercial |
$761.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.92
|
| Rate for Payer: Healthscope Commercial |
$908.67
|
| Rate for Payer: Healthscope Commercial |
$1,050.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,188.85
|
| Rate for Payer: Nomi Health Commercial |
$681.50
|
| Rate for Payer: PACE SWMI |
$567.92
|
| Rate for Payer: PHP Medicare Advantage |
$567.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.85
|
| Rate for Payer: Priority Health Medicare |
$567.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.92
|
| Rate for Payer: UHC Medicare Advantage |
$567.92
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$766.44 |
| Rate for Payer: Aetna Commercial |
$555.15
|
| Rate for Payer: Aetna Medicare |
$430.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.15
|
| Rate for Payer: BCBS Complete |
$369.60
|
| Rate for Payer: BCBS MAPPO |
$414.29
|
| Rate for Payer: BCN Medicare Advantage |
$414.29
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$596.58
|
| Rate for Payer: Cofinity Commercial |
$555.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.29
|
| Rate for Payer: Healthscope Commercial |
$662.86
|
| Rate for Payer: Healthscope Commercial |
$766.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$600.60
|
| Rate for Payer: Nomi Health Commercial |
$497.15
|
| Rate for Payer: PACE SWMI |
$414.29
|
| Rate for Payer: PHP Medicare Advantage |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health Medicare |
$414.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.29
|
| Rate for Payer: UHC Medicare Advantage |
$414.29
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$213.73 |
| Max. Negotiated Rate |
$523.90 |
| Rate for Payer: Aetna Commercial |
$286.40
|
| Rate for Payer: Aetna Medicare |
$222.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.40
|
| Rate for Payer: BCBS Complete |
$322.40
|
| Rate for Payer: BCBS MAPPO |
$213.73
|
| Rate for Payer: BCN Medicare Advantage |
$213.73
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$307.77
|
| Rate for Payer: Cofinity Commercial |
$286.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.73
|
| Rate for Payer: Healthscope Commercial |
$395.40
|
| Rate for Payer: Healthscope Commercial |
$341.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.90
|
| Rate for Payer: Nomi Health Commercial |
$256.48
|
| Rate for Payer: PACE SWMI |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health Medicare |
$213.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.73
|
| Rate for Payer: UHC Medicare Advantage |
$213.73
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$338.80 |
| Max. Negotiated Rate |
$673.09 |
| Rate for Payer: Aetna Commercial |
$487.53
|
| Rate for Payer: Aetna Medicare |
$378.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.53
|
| Rate for Payer: BCBS Complete |
$338.80
|
| Rate for Payer: BCBS MAPPO |
$363.83
|
| Rate for Payer: BCN Medicare Advantage |
$363.83
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$523.92
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.83
|
| Rate for Payer: Healthscope Commercial |
$582.13
|
| Rate for Payer: Healthscope Commercial |
$673.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$550.55
|
| Rate for Payer: Nomi Health Commercial |
$436.60
|
| Rate for Payer: PACE SWMI |
$363.83
|
| Rate for Payer: PHP Medicare Advantage |
$363.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.55
|
| Rate for Payer: Priority Health Medicare |
$363.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.83
|
| Rate for Payer: UHC Medicare Advantage |
$363.83
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$69.76 |
| Rate for Payer: Aetna Commercial |
$50.53
|
| Rate for Payer: Aetna Medicare |
$39.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.53
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$37.71
|
| Rate for Payer: BCN Medicare Advantage |
$37.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$54.30
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.71
|
| Rate for Payer: Healthscope Commercial |
$69.76
|
| Rate for Payer: Healthscope Commercial |
$60.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.55
|
| Rate for Payer: Nomi Health Commercial |
$45.25
|
| Rate for Payer: PACE SWMI |
$37.71
|
| Rate for Payer: PHP Medicare Advantage |
$37.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$37.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.71
|
| Rate for Payer: UHC Medicare Advantage |
$37.71
|
|
