|
PR MGMT LVR HEMRRG CPLX SUTR WND/INJ
|
Professional
|
Both
|
$3,454.00
|
|
|
Service Code
|
HCPCS 47360
|
| Min. Negotiated Rate |
$1,381.60 |
| Max. Negotiated Rate |
$3,364.11 |
| Rate for Payer: Aetna Commercial |
$2,436.71
|
| Rate for Payer: Aetna Medicare |
$1,891.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,436.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,618.55
|
| Rate for Payer: BCBS Complete |
$1,381.60
|
| Rate for Payer: BCBS MAPPO |
$1,818.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,818.44
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cash Price |
$2,763.20
|
| Rate for Payer: Cofinity Commercial |
$2,436.71
|
| Rate for Payer: Cofinity Commercial |
$2,618.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,818.44
|
| Rate for Payer: Healthscope Commercial |
$3,364.11
|
| Rate for Payer: Healthscope Commercial |
$2,909.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,909.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,245.10
|
| Rate for Payer: Nomi Health Commercial |
$2,182.13
|
| Rate for Payer: PACE SWMI |
$1,818.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,818.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,245.10
|
| Rate for Payer: Priority Health Medicare |
$1,818.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,818.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,818.44
|
|
|
PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR
|
Professional
|
Both
|
$6,375.00
|
|
|
Service Code
|
HCPCS 47361
|
| Min. Negotiated Rate |
$2,550.00 |
| Max. Negotiated Rate |
$5,396.28 |
| Rate for Payer: Aetna Commercial |
$3,908.66
|
| Rate for Payer: Aetna Medicare |
$3,033.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,200.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,908.66
|
| Rate for Payer: BCBS Complete |
$2,550.00
|
| Rate for Payer: BCBS MAPPO |
$2,916.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,916.91
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cash Price |
$5,100.00
|
| Rate for Payer: Cofinity Commercial |
$4,200.35
|
| Rate for Payer: Cofinity Commercial |
$3,908.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,916.91
|
| Rate for Payer: Healthscope Commercial |
$5,396.28
|
| Rate for Payer: Healthscope Commercial |
$4,667.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,062.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,143.75
|
| Rate for Payer: Nomi Health Commercial |
$3,500.29
|
| Rate for Payer: PACE SWMI |
$2,916.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,916.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,143.75
|
| Rate for Payer: Priority Health Medicare |
$2,916.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,916.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,916.91
|
|
|
PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING
|
Professional
|
Both
|
$2,999.00
|
|
|
Service Code
|
HCPCS 47362
|
| Min. Negotiated Rate |
$1,199.60 |
| Max. Negotiated Rate |
$2,540.01 |
| Rate for Payer: Aetna Commercial |
$1,839.79
|
| Rate for Payer: Aetna Medicare |
$1,427.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,977.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.79
|
| Rate for Payer: BCBS Complete |
$1,199.60
|
| Rate for Payer: BCBS MAPPO |
$1,372.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.98
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cash Price |
$2,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,977.09
|
| Rate for Payer: Cofinity Commercial |
$1,839.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.98
|
| Rate for Payer: Healthscope Commercial |
$2,196.77
|
| Rate for Payer: Healthscope Commercial |
$2,540.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,441.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,949.35
|
| Rate for Payer: Nomi Health Commercial |
$1,647.58
|
| Rate for Payer: PACE SWMI |
$1,372.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,949.35
|
| Rate for Payer: Priority Health Medicare |
$1,372.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,372.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,372.98
|
|
|
PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ
|
Professional
|
Both
|
$2,903.00
|
|
|
Service Code
|
HCPCS 47350
|
| Min. Negotiated Rate |
$1,161.20 |
| Max. Negotiated Rate |
$2,437.76 |
| Rate for Payer: Aetna Commercial |
$1,765.73
|
| Rate for Payer: Aetna Medicare |
$1,370.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,897.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,765.73
|
| Rate for Payer: BCBS Complete |
$1,161.20
|
| Rate for Payer: BCBS MAPPO |
$1,317.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,317.71
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cash Price |
$2,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,897.50
|
| Rate for Payer: Cofinity Commercial |
$1,765.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,317.71
|
| Rate for Payer: Healthscope Commercial |
$2,108.34
|
| Rate for Payer: Healthscope Commercial |
$2,437.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,383.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,886.95
|
| Rate for Payer: Nomi Health Commercial |
$1,581.25
|
| Rate for Payer: PACE SWMI |
$1,317.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,317.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,886.95
|
| Rate for Payer: Priority Health Medicare |
$1,317.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,317.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,317.71
|
|
|
PR MH PARTIAL HOSP TX UNDER 24H
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS H0035
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
|
|
PR MICRONEEDLING PIN ADB/THIGHS/BACK
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00108
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR MICRONEEDLING PIN FULL FACE
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00105
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR MICRONEEDLING PIN NECK
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00107
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR MICRONEEDLING PIN UPPER OR LOWER FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00106
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR MICRONEEDLING SCARS - UP TO 4 INCHES
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00109
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR MICRONEEDLING TAT RMVL 4-6 SQ INCHES
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00124
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00110
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$397.29 |
| Rate for Payer: Aetna Commercial |
$287.76
|
| Rate for Payer: Aetna Medicare |
$223.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.24
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCN Medicare Advantage |
$214.75
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$309.24
|
| Rate for Payer: Cofinity Commercial |
$287.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.75
|
| Rate for Payer: Healthscope Commercial |
$397.29
|
| Rate for Payer: Healthscope Commercial |
$343.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.65
|
| Rate for Payer: Nomi Health Commercial |
$257.70
|
| Rate for Payer: PACE SWMI |
$214.75
|
| Rate for Payer: PHP Medicare Advantage |
$214.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health Medicare |
$214.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Medicare Advantage |
$214.75
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$641.96 |
| Max. Negotiated Rate |
$1,187.63 |
| Rate for Payer: Aetna Commercial |
$860.23
|
| Rate for Payer: Aetna Medicare |
$667.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.42
|
| Rate for Payer: BCBS Complete |
$681.60
|
| Rate for Payer: BCBS MAPPO |
$641.96
|
| Rate for Payer: BCN Medicare Advantage |
$641.96
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$860.23
|
| Rate for Payer: Cofinity Commercial |
$924.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.96
|
| Rate for Payer: Healthscope Commercial |
$1,027.14
|
| Rate for Payer: Healthscope Commercial |
$1,187.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,107.60
|
| Rate for Payer: Nomi Health Commercial |
$770.35
|
| Rate for Payer: PACE SWMI |
$641.96
|
| Rate for Payer: PHP Medicare Advantage |
$641.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.60
|
| Rate for Payer: Priority Health Medicare |
$641.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.96
|
| Rate for Payer: UHC Medicare Advantage |
$641.96
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$860.72 |
| Max. Negotiated Rate |
$1,931.80 |
| Rate for Payer: Aetna Commercial |
$1,153.36
|
| Rate for Payer: Aetna Medicare |
$895.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,239.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.36
|
| Rate for Payer: BCBS Complete |
$1,188.80
|
| Rate for Payer: BCBS MAPPO |
$860.72
|
| Rate for Payer: BCN Medicare Advantage |
$860.72
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cofinity Commercial |
$1,239.44
|
| Rate for Payer: Cofinity Commercial |
$1,153.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.72
|
| Rate for Payer: Healthscope Commercial |
$1,377.15
|
| Rate for Payer: Healthscope Commercial |
$1,592.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,931.80
|
| Rate for Payer: Nomi Health Commercial |
$1,032.86
|
| Rate for Payer: PACE SWMI |
$860.72
|
| Rate for Payer: PHP Medicare Advantage |
$860.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health Medicare |
$860.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.72
|
| Rate for Payer: UHC Medicare Advantage |
$860.72
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: BCBS Complete |
$588.80
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$956.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
|
|
PR MISC VISION ITEM OR SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$27.27
|
| Rate for Payer: Cofinity Commercial |
$29.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Healthscope Commercial |
$32.56
|
| Rate for Payer: Healthscope Commercial |
$37.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Nomi Health Commercial |
$24.42
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$392.69 |
| Max. Negotiated Rate |
$726.48 |
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.20
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Healthscope Commercial |
$628.30
|
| Rate for Payer: Healthscope Commercial |
$628.30
|
| Rate for Payer: Healthscope Commercial |
$726.48
|
| Rate for Payer: Healthscope Commercial |
$726.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$646.75
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$189.03 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.30
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCN Medicare Advantage |
$189.03
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$272.20
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.03
|
| Rate for Payer: Healthscope Commercial |
$349.71
|
| Rate for Payer: Healthscope Commercial |
$302.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.65
|
| Rate for Payer: Nomi Health Commercial |
$226.84
|
| Rate for Payer: PACE SWMI |
$189.03
|
| Rate for Payer: PHP Medicare Advantage |
$189.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$189.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$580.23 |
| Max. Negotiated Rate |
$4,393.64 |
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna Medicare |
$1,623.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.65
|
| 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 |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$644.70
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,560.85
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| 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 |
$782.85
|
| Rate for Payer: PACE Medicare |
$1,482.81
|
| Rate for Payer: PACE SWMI |
$1,560.85
|
| Rate for Payer: PHP Commercial |
$782.85
|
| 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 |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$1,560.85
|
| Rate for Payer: Priority Health SBD |
$580.23
|
| 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 MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$580.23 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.65
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$644.70
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health SBD |
$580.23
|
|
