|
PR INCISION EXTENSOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25000
|
| Min. Negotiated Rate |
$173.81 |
| Max. Negotiated Rate |
$61,105.00 |
| 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 |
$241.32
|
| Rate for Payer: BCBS MAPPO |
$333.77
|
| Rate for Payer: BCBS Trust/PPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$514.58
|
| 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 |
$617.47
|
| Rate for Payer: Healthscope Commercial |
$534.03
|
| Rate for Payer: Mclaren Medicaid |
$229.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.46
|
| Rate for Payer: Meridian Medicaid |
$241.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,105.00
|
| 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 Choice Medicaid |
$229.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.46
|
| Rate for Payer: Priority Health Medicare |
$333.77
|
| Rate for Payer: Priority Health Narrow Network |
$543.46
|
| Rate for Payer: Priority Health SBD |
$543.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.77
|
| Rate for Payer: UHC Exchange |
$492.67
|
| Rate for Payer: UHC Medicare Advantage |
$333.77
|
| Rate for Payer: UHCCP Medicaid |
$229.83
|
|
|
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 FLEXOR TENDON SHEATH WRIST
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 25001
|
| Min. Negotiated Rate |
$232.17 |
| Max. Negotiated Rate |
$61,321.00 |
| Rate for Payer: Aetna Commercial |
$453.09
|
| Rate for Payer: Aetna Medicare |
$351.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.91
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS MAPPO |
$338.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.75
|
| Rate for Payer: BCN Commercial |
$515.07
|
| 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: Mclaren Medicaid |
$232.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.04
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61,321.00
|
| 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 Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.00
|
| Rate for Payer: Priority Health Medicare |
$338.13
|
| Rate for Payer: Priority Health Narrow Network |
$546.00
|
| Rate for Payer: Priority Health SBD |
$546.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$337.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.13
|
| Rate for Payer: UHC Exchange |
$337.62
|
| Rate for Payer: UHC Medicare Advantage |
$338.13
|
| Rate for Payer: UHCCP Medicaid |
$232.17
|
|
|
PR INCISION LABIAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 40806
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$4,988.00 |
| Rate for Payer: Aetna Commercial |
$37.59
|
| Rate for Payer: Aetna Medicare |
$29.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.39
|
| Rate for Payer: BCBS Complete |
$20.35
|
| Rate for Payer: BCBS MAPPO |
$28.05
|
| Rate for Payer: BCBS Trust/PPO |
$393.58
|
| Rate for Payer: BCN Commercial |
$146.11
|
| 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 |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$44.88
|
| Rate for Payer: Mclaren Medicaid |
$19.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.45
|
| Rate for Payer: Meridian Medicaid |
$20.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,988.00
|
| 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 Choice Medicaid |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.10
|
| Rate for Payer: Priority Health Medicare |
$28.05
|
| Rate for Payer: Priority Health Narrow Network |
$53.10
|
| Rate for Payer: Priority Health SBD |
$53.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.05
|
| Rate for Payer: UHC Exchange |
$67.28
|
| Rate for Payer: UHC Medicare Advantage |
$28.05
|
| Rate for Payer: UHCCP Medicaid |
$19.38
|
|
|
PR INCISION LEG/ANKLE
|
Professional
|
Both
|
$1,734.00
|
|
|
Service Code
|
HCPCS 27607
|
| Min. Negotiated Rate |
$388.73 |
| Max. Negotiated Rate |
$105,779.00 |
| Rate for Payer: Aetna Commercial |
$771.60
|
| Rate for Payer: Aetna Medicare |
$598.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$829.18
|
| Rate for Payer: BCBS Complete |
$408.17
|
| Rate for Payer: BCBS MAPPO |
$575.82
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: BCN Commercial |
$876.69
|
| 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: Mclaren Medicaid |
$388.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.61
|
| Rate for Payer: Meridian Medicaid |
$408.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105,779.00
|
| 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 Choice Medicaid |
$388.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$924.09
|
| Rate for Payer: Priority Health Medicare |
$575.82
|
| Rate for Payer: Priority Health Narrow Network |
$924.09
|
| Rate for Payer: Priority Health SBD |
$924.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$919.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.82
|
| Rate for Payer: UHC Exchange |
$919.14
|
| Rate for Payer: UHC Medicare Advantage |
$575.82
|
| Rate for Payer: UHCCP Medicaid |
$388.73
|
|
|
PR INCISION LINGUAL FRENUM FRENOTOMY
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 41010
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$19,222.00 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.43
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCBS Trust/PPO |
$971.54
|
| Rate for Payer: BCN Commercial |
$322.04
|
| 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 |
$189.40
|
| Rate for Payer: Healthscope Commercial |
$163.81
|
| Rate for Payer: Mclaren Medicaid |
$70.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,222.00
|
| 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 Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.67
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: Priority Health SBD |
$198.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Exchange |
$181.66
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
| Rate for Payer: UHCCP Medicaid |
$70.72
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMP
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 10121
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$32,265.00 |
| Rate for Payer: Aetna Commercial |
$234.15
|
| Rate for Payer: Aetna Medicare |
$181.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.63
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS MAPPO |
$174.74
|
| Rate for Payer: BCBS Trust/PPO |
$234.52
|
| Rate for Payer: BCN Commercial |
$387.52
|
| 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: Mclaren Medicaid |
$118.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.48
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,265.00
|
| 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 Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.24
|
| Rate for Payer: Priority Health Medicare |
$174.74
|
| Rate for Payer: Priority Health Narrow Network |
$249.24
|
| Rate for Payer: Priority Health SBD |
$249.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.74
|
| Rate for Payer: UHC Exchange |
$250.13
|
| Rate for Payer: UHC Medicare Advantage |
$174.74
|
| Rate for Payer: UHCCP Medicaid |
$118.22
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$18,283.00 |
| 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 |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$221.86
|
| 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 |
$183.30
|
| Rate for Payer: Healthscope Commercial |
$158.53
|
| Rate for Payer: Mclaren Medicaid |
$68.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,283.00
|
| 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 Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.04
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: Priority Health Narrow Network |
$144.04
|
| Rate for Payer: Priority Health SBD |
$144.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Exchange |
$110.81
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
|
|
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 |
$110.00 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Commercial |
$213.35
|
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$240.15
|
| Rate for Payer: BCN Commercial |
$240.15
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Cash Price |
$200.80
|
| 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 |
$391.45
|
| Rate for Payer: Healthscope Commercial |
$225.90
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.35
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Commercial |
$213.35
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Priority Health SBD |
$158.13
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.00
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$220.39
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PR INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 10120
|
| Hospital Charge Code |
10120
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$18,283.00 |
| 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 |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$99.08
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$221.86
|
| 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: Mclaren Medicaid |
$68.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.03
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,283.00
|
| 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 Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.04
|
| Rate for Payer: Priority Health Medicare |
$99.08
|
| Rate for Payer: Priority Health Narrow Network |
$144.04
|
| Rate for Payer: Priority Health SBD |
$144.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.08
|
| Rate for Payer: UHC Exchange |
$110.81
|
| Rate for Payer: UHC Medicare Advantage |
$99.08
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
|
|
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&SUBCUTANEOUS PLMT CRANIAL BONE GRAFT
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
HCPCS 61316
|
| Min. Negotiated Rate |
$56.45 |
| Max. Negotiated Rate |
$15,878.00 |
| Rate for Payer: Aetna Commercial |
$116.59
|
| Rate for Payer: Aetna Medicare |
$90.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.29
|
| Rate for Payer: BCBS Complete |
$59.27
|
| Rate for Payer: BCBS MAPPO |
$87.01
|
| Rate for Payer: BCBS Trust/PPO |
$305.36
|
| Rate for Payer: BCN Commercial |
$177.62
|
| 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: Mclaren Medicaid |
$56.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.36
|
| Rate for Payer: Meridian Medicaid |
$59.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,878.00
|
| 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 Choice Medicaid |
$56.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,035.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.58
|
| Rate for Payer: Priority Health Medicare |
$87.01
|
| Rate for Payer: Priority Health Narrow Network |
$149.58
|
| Rate for Payer: Priority Health SBD |
$149.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.01
|
| Rate for Payer: UHC Exchange |
$109.83
|
| Rate for Payer: UHC Medicare Advantage |
$87.01
|
| Rate for Payer: UHCCP Medicaid |
$56.45
|
|
|
PR INCISION THROMBOSED HEMORRHOID EXTERNAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 46083
|
| Min. Negotiated Rate |
$71.57 |
| Max. Negotiated Rate |
$19,341.00 |
| Rate for Payer: Aetna Commercial |
$141.45
|
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.01
|
| Rate for Payer: BCBS Complete |
$75.15
|
| Rate for Payer: BCBS MAPPO |
$105.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,366.78
|
| Rate for Payer: BCN Commercial |
$306.40
|
| 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 |
$195.29
|
| Rate for Payer: Healthscope Commercial |
$168.90
|
| Rate for Payer: Mclaren Medicaid |
$71.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.84
|
| Rate for Payer: Meridian Medicaid |
$75.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,341.00
|
| 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 Choice Medicaid |
$71.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.67
|
| Rate for Payer: Priority Health Medicare |
$105.56
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: Priority Health SBD |
$198.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.56
|
| Rate for Payer: UHC Exchange |
$251.93
|
| Rate for Payer: UHC Medicare Advantage |
$105.56
|
| Rate for Payer: UHCCP Medicaid |
$71.57
|
|
|
PR INCOBOTULINUMTOXIN A
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0588
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$519.00 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$5.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$5.21
|
| Rate for Payer: BCN Medicare Advantage |
$5.31
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$7.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.31
|
| Rate for Payer: Healthscope Commercial |
$8.49
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$519.00
|
| Rate for Payer: Nomi Health Commercial |
$6.37
|
| Rate for Payer: PACE SWMI |
$5.31
|
| Rate for Payer: PHP Medicare Advantage |
$5.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.31
|
| Rate for Payer: UHC Exchange |
$5.63
|
| Rate for Payer: UHC Medicare Advantage |
$5.31
|
|
|
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 |
$320.99 |
| Max. Negotiated Rate |
$89,982.00 |
| 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 |
$337.04
|
| Rate for Payer: BCBS MAPPO |
$486.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,248.90
|
| Rate for Payer: BCN Commercial |
$733.51
|
| 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 |
$700.56
|
| Rate for Payer: Cofinity Commercial |
$651.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$486.50
|
| Rate for Payer: Healthscope Commercial |
$900.02
|
| Rate for Payer: Healthscope Commercial |
$778.40
|
| Rate for Payer: Mclaren Medicaid |
$320.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$510.82
|
| Rate for Payer: Meridian Medicaid |
$337.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89,982.00
|
| 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 Choice Medicaid |
$320.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.30
|
| Rate for Payer: Priority Health Medicare |
$486.50
|
| Rate for Payer: Priority Health Narrow Network |
$703.30
|
| Rate for Payer: Priority Health SBD |
$703.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$607.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$486.50
|
| Rate for Payer: UHC Exchange |
$607.18
|
| Rate for Payer: UHC Medicare Advantage |
$486.50
|
| Rate for Payer: UHCCP Medicaid |
$320.99
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$105,062.00 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: Aetna Medicare |
$590.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.80
|
| Rate for Payer: BCBS Complete |
$392.51
|
| Rate for Payer: BCBS MAPPO |
$567.92
|
| Rate for Payer: BCBS Trust/PPO |
$756.53
|
| Rate for Payer: BCN Commercial |
$854.70
|
| 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: Mclaren Medicaid |
$373.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.32
|
| Rate for Payer: Meridian Medicaid |
$392.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105,062.00
|
| 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 Choice Medicaid |
$373.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$818.34
|
| Rate for Payer: Priority Health Medicare |
$567.92
|
| Rate for Payer: Priority Health Narrow Network |
$818.34
|
| Rate for Payer: Priority Health SBD |
$818.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.92
|
| Rate for Payer: UHC Exchange |
$738.30
|
| Rate for Payer: UHC Medicare Advantage |
$567.92
|
| Rate for Payer: UHCCP Medicaid |
$373.82
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$76,783.00 |
| Rate for Payer: Aetna Commercial |
$555.15
|
| Rate for Payer: Aetna Medicare |
$430.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.58
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$414.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.13
|
| Rate for Payer: BCN Commercial |
$627.46
|
| 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 |
$766.44
|
| Rate for Payer: Healthscope Commercial |
$662.86
|
| Rate for Payer: Mclaren Medicaid |
$274.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.00
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76,783.00
|
| 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 Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.76
|
| Rate for Payer: Priority Health Medicare |
$414.29
|
| Rate for Payer: Priority Health Narrow Network |
$601.76
|
| Rate for Payer: Priority Health SBD |
$601.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.29
|
| Rate for Payer: UHC Exchange |
$459.79
|
| Rate for Payer: UHC Medicare Advantage |
$414.29
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$39,827.00 |
| Rate for Payer: Aetna Commercial |
$286.40
|
| Rate for Payer: Aetna Medicare |
$222.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.77
|
| Rate for Payer: BCBS Complete |
$149.85
|
| Rate for Payer: BCBS MAPPO |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$369.44
|
| 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: Mclaren Medicaid |
$142.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.42
|
| Rate for Payer: Meridian Medicaid |
$149.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,827.00
|
| 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 Choice Medicaid |
$142.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$213.73
|
| Rate for Payer: Priority Health Narrow Network |
$314.85
|
| Rate for Payer: Priority Health SBD |
$314.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.73
|
| Rate for Payer: UHC Exchange |
$320.77
|
| Rate for Payer: UHC Medicare Advantage |
$213.73
|
| Rate for Payer: UHCCP Medicaid |
$142.71
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$67,151.00 |
| Rate for Payer: Aetna Commercial |
$487.53
|
| Rate for Payer: Aetna Medicare |
$378.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.92
|
| Rate for Payer: BCBS Complete |
$252.72
|
| Rate for Payer: BCBS MAPPO |
$363.83
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$630.40
|
| 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 |
$673.09
|
| Rate for Payer: Healthscope Commercial |
$582.13
|
| Rate for Payer: Mclaren Medicaid |
$240.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.02
|
| Rate for Payer: Meridian Medicaid |
$252.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,151.00
|
| 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 Choice Medicaid |
$240.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.77
|
| Rate for Payer: Priority Health Medicare |
$363.83
|
| Rate for Payer: Priority Health Narrow Network |
$526.77
|
| Rate for Payer: Priority Health SBD |
$526.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$517.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.83
|
| Rate for Payer: UHC Exchange |
$517.17
|
| Rate for Payer: UHC Medicare Advantage |
$363.83
|
| Rate for Payer: UHCCP Medicaid |
$240.69
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$3,589.00 |
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCN Commercial |
$29.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,589.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,965.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$548,696.00 |
| Rate for Payer: Aetna Commercial |
$3,963.81
|
| Rate for Payer: Aetna Medicare |
$3,076.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,963.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,259.62
|
| Rate for Payer: BCBS Complete |
$2,073.91
|
| Rate for Payer: BCBS MAPPO |
$2,958.07
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: BCN Commercial |
$4,510.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,958.07
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cofinity Commercial |
$3,963.81
|
| Rate for Payer: Cofinity Commercial |
$4,259.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,958.07
|
| Rate for Payer: Healthscope Commercial |
$5,472.43
|
| Rate for Payer: Healthscope Commercial |
$4,732.91
|
| Rate for Payer: Mclaren Medicaid |
$1,975.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,105.97
|
| Rate for Payer: Meridian Medicaid |
$2,073.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$548,696.00
|
| Rate for Payer: Nomi Health Commercial |
$3,549.68
|
| Rate for Payer: PACE SWMI |
$2,958.07
|
| Rate for Payer: PHP Medicare Advantage |
$2,958.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,975.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,127.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,253.23
|
| Rate for Payer: Priority Health Medicare |
$2,958.07
|
| Rate for Payer: Priority Health Narrow Network |
$5,253.23
|
| Rate for Payer: Priority Health SBD |
$5,253.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,800.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,958.07
|
| Rate for Payer: UHC Exchange |
$3,800.28
|
| Rate for Payer: UHC Medicare Advantage |
$2,958.07
|
| Rate for Payer: UHCCP Medicaid |
$1,975.15
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$514.56 |
| Max. Negotiated Rate |
$538,942.00 |
| Rate for Payer: Aetna Commercial |
$3,853.99
|
| Rate for Payer: Aetna Medicare |
$2,991.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,853.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,141.60
|
| Rate for Payer: BCBS Complete |
$2,022.92
|
| Rate for Payer: BCBS MAPPO |
$2,876.11
|
| Rate for Payer: BCBS Trust/PPO |
$514.56
|
| Rate for Payer: BCN Commercial |
$4,435.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,876.11
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cofinity Commercial |
$4,141.60
|
| Rate for Payer: Cofinity Commercial |
$3,853.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,876.11
|
| Rate for Payer: Healthscope Commercial |
$5,320.80
|
| Rate for Payer: Healthscope Commercial |
$4,601.78
|
| Rate for Payer: Mclaren Medicaid |
$1,926.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.92
|
| Rate for Payer: Meridian Medicaid |
$2,022.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$538,942.00
|
| Rate for Payer: Nomi Health Commercial |
$3,451.33
|
| Rate for Payer: PACE SWMI |
$2,876.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,876.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,926.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,271.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,159.95
|
| Rate for Payer: Priority Health Medicare |
$2,876.11
|
| Rate for Payer: Priority Health Narrow Network |
$5,159.95
|
| Rate for Payer: Priority Health SBD |
$5,159.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,623.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,876.11
|
| Rate for Payer: UHC Exchange |
$3,623.42
|
| Rate for Payer: UHC Medicare Advantage |
$2,876.11
|
| Rate for Payer: UHCCP Medicaid |
$1,926.59
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$9,936.00 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$66.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.04
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$376.15
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: BCN Medicare Advantage |
$63.92
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Cofinity Commercial |
$85.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$102.27
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Mclaren Medicaid |
$43.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.12
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,936.00
|
| Rate for Payer: Nomi Health Commercial |
$76.70
|
| Rate for Payer: PACE SWMI |
$63.92
|
| Rate for Payer: PHP Medicare Advantage |
$63.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.05
|
| Rate for Payer: Priority Health Medicare |
$63.92
|
| Rate for Payer: Priority Health Narrow Network |
$92.05
|
| Rate for Payer: Priority Health SBD |
$92.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.92
|
| Rate for Payer: UHC Medicare Advantage |
$63.92
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$10,778.00 |
| Rate for Payer: Aetna Commercial |
$92.84
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.76
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$69.28
|
| Rate for Payer: BCBS Trust/PPO |
$262.04
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$69.28
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Cofinity Commercial |
$92.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.28
|
| Rate for Payer: Healthscope Commercial |
$110.85
|
| Rate for Payer: Healthscope Commercial |
$128.17
|
| Rate for Payer: Mclaren Medicaid |
$46.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.74
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,778.00
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: PACE SWMI |
$69.28
|
| Rate for Payer: PHP Medicare Advantage |
$69.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.83
|
| Rate for Payer: Priority Health Medicare |
$69.28
|
| Rate for Payer: Priority Health Narrow Network |
$99.83
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.28
|
| Rate for Payer: UHC Medicare Advantage |
$69.28
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
