|
PR MH PARTIAL HOSP TX UNDER 24H
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS H0035
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$268.86
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.86
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: Cash Price |
$207.20
|
| 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 |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| 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 |
$139.52 |
| Max. Negotiated Rate |
$39,310.00 |
| 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 |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$349.21
|
| 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: Mclaren Medicaid |
$139.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: Meridian Medicaid |
$146.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,310.00
|
| 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 Choice Medicaid |
$139.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.11
|
| Rate for Payer: Priority Health Medicare |
$214.75
|
| Rate for Payer: Priority Health Narrow Network |
$317.11
|
| Rate for Payer: Priority Health SBD |
$317.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Exchange |
$256.58
|
| Rate for Payer: UHC Medicare Advantage |
$214.75
|
| Rate for Payer: UHCCP Medicaid |
$139.52
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$441.12 |
| Max. Negotiated Rate |
$121,774.00 |
| 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 |
$463.18
|
| Rate for Payer: BCBS MAPPO |
$641.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| 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 |
$924.42
|
| Rate for Payer: Cofinity Commercial |
$860.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.96
|
| Rate for Payer: Healthscope Commercial |
$1,187.63
|
| Rate for Payer: Healthscope Commercial |
$1,027.14
|
| Rate for Payer: Mclaren Medicaid |
$441.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.06
|
| Rate for Payer: Meridian Medicaid |
$463.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121,774.00
|
| 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 Choice Medicaid |
$441.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,018.47
|
| Rate for Payer: Priority Health Medicare |
$641.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,018.47
|
| Rate for Payer: Priority Health SBD |
$1,018.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.96
|
| Rate for Payer: UHC Exchange |
$700.19
|
| Rate for Payer: UHC Medicare Advantage |
$641.96
|
| Rate for Payer: UHCCP Medicaid |
$441.12
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$584.69 |
| Max. Negotiated Rate |
$159,995.00 |
| Rate for Payer: Aetna Commercial |
$1,153.36
|
| Rate for Payer: Aetna Medicare |
$895.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,239.44
|
| Rate for Payer: BCBS Complete |
$613.92
|
| Rate for Payer: BCBS MAPPO |
$860.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.99
|
| Rate for Payer: BCN Commercial |
$2,089.09
|
| 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: Mclaren Medicaid |
$584.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.76
|
| Rate for Payer: Meridian Medicaid |
$613.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159,995.00
|
| 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 Choice Medicaid |
$584.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,236.70
|
| Rate for Payer: Priority Health Medicare |
$860.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,236.70
|
| Rate for Payer: Priority Health SBD |
$1,236.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.72
|
| Rate for Payer: UHC Medicare Advantage |
$860.72
|
| Rate for Payer: UHCCP Medicaid |
$584.69
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$736.00 |
| Max. Negotiated Rate |
$112,373.00 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.70
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,103.90
|
| Rate for Payer: BCN Commercial |
$1,107.20
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Mclaren Medicaid |
$1,287.51
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112,373.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,226.20
|
| Rate for Payer: UHC Exchange |
$1,226.20
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
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 |
$0.64 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.96
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.03
|
| Rate for Payer: UHC Exchange |
$1.03
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$9,561.00 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: Aetna Medicare |
$29.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.71
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$28.27
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$28.27
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$40.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$52.30
|
| Rate for Payer: Healthscope Commercial |
$45.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,561.00
|
| Rate for Payer: Nomi Health Commercial |
$33.93
|
| Rate for Payer: PACE SWMI |
$28.27
|
| Rate for Payer: PHP Medicare Advantage |
$28.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.27
|
| Rate for Payer: UHC Exchange |
$49.13
|
| Rate for Payer: UHC Medicare Advantage |
$28.27
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$58,506.00 |
| 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) |
$526.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Commercial |
$610.36
|
| 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 |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| 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 |
$726.48
|
| Rate for Payer: Healthscope Commercial |
$628.30
|
| Rate for Payer: Healthscope Commercial |
$628.30
|
| Rate for Payer: Healthscope Commercial |
$726.48
|
| Rate for Payer: Mclaren Medicaid |
$35.78
|
| Rate for Payer: Mclaren Medicaid |
$35.78
|
| 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: Meridian Medicaid |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,506.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,506.00
|
| 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 Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.20
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: Priority Health Narrow Network |
$586.20
|
| Rate for Payer: Priority Health Narrow Network |
$586.20
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Exchange |
$760.46
|
| Rate for Payer: UHC Exchange |
$760.46
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
|
|
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
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$208.53 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$725.30
|
| Rate for Payer: BCN Commercial |
$725.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$736.80
|
| 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 |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$580.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.53
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$882.81
|
| Rate for Payer: VA VA |
$1,568.05
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$34,740.00 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.20
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| 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: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,740.00
|
| 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 Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Medicare |
$189.03
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: Priority Health SBD |
$303.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Exchange |
$252.91
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$34,740.00 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.20
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| 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: Mclaren Medicaid |
$128.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,740.00
|
| 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 Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Medicare |
$189.03
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: Priority Health SBD |
$303.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Exchange |
$252.91
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$113.69
|
| Rate for Payer: Aetna Medicare |
$88.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.17
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$84.84
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$84.84
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Cofinity Commercial |
$113.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.84
|
| Rate for Payer: Healthscope Commercial |
$135.74
|
| Rate for Payer: Healthscope Commercial |
$156.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,408.00
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: PACE SWMI |
$84.84
|
| Rate for Payer: PHP Medicare Advantage |
$84.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.35
|
| Rate for Payer: Priority Health Medicare |
$84.84
|
| Rate for Payer: Priority Health Narrow Network |
$135.35
|
| Rate for Payer: Priority Health SBD |
$135.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.84
|
| Rate for Payer: UHC Exchange |
$140.72
|
| Rate for Payer: UHC Medicare Advantage |
$84.84
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$21,487.00 |
| Rate for Payer: Aetna Commercial |
$155.64
|
| Rate for Payer: Aetna Medicare |
$120.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.26
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$116.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$116.15
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$167.26
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.15
|
| Rate for Payer: Healthscope Commercial |
$214.88
|
| Rate for Payer: Healthscope Commercial |
$185.84
|
| Rate for Payer: Mclaren Medicaid |
$76.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.96
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,487.00
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: PACE SWMI |
$116.15
|
| Rate for Payer: PHP Medicare Advantage |
$116.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.38
|
| Rate for Payer: Priority Health Medicare |
$116.15
|
| Rate for Payer: Priority Health Narrow Network |
$212.38
|
| Rate for Payer: Priority Health SBD |
$212.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.15
|
| Rate for Payer: UHC Exchange |
$158.78
|
| Rate for Payer: UHC Medicare Advantage |
$116.15
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
|
