|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00673
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00674
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$1,152.22 |
| Rate for Payer: Aetna Commercial |
$278.24
|
| Rate for Payer: Aetna Medicare |
$215.95
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$207.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,152.22
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$207.64
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$299.00
|
| Rate for Payer: Cofinity Commercial |
$278.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.64
|
| Rate for Payer: Mclaren Medicaid |
$138.24
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.02
|
| Rate for Payer: PACE SWMI |
$207.64
|
| Rate for Payer: PHP Medicare Advantage |
$207.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.31
|
| Rate for Payer: Priority Health Medicare |
$207.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$376.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.64
|
| Rate for Payer: UHC Medicare Advantage |
$213.87
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,232.52 |
| Rate for Payer: Aetna Commercial |
$302.68
|
| Rate for Payer: Aetna Medicare |
$234.92
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$225.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.52
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$225.88
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$325.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.88
|
| Rate for Payer: Mclaren Medicaid |
$150.17
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.17
|
| Rate for Payer: PACE SWMI |
$225.88
|
| Rate for Payer: PHP Medicare Advantage |
$225.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.81
|
| Rate for Payer: Priority Health Medicare |
$225.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.88
|
| Rate for Payer: UHC Medicare Advantage |
$232.66
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$975.24 |
| Rate for Payer: Aetna Commercial |
$322.32
|
| Rate for Payer: Aetna Medicare |
$250.16
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$240.54
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$361.13
|
| Rate for Payer: BCN Medicare Advantage |
$240.54
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cofinity Commercial |
$322.32
|
| Rate for Payer: Cofinity Commercial |
$346.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.54
|
| Rate for Payer: Mclaren Medicaid |
$159.11
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$252.57
|
| Rate for Payer: PACE SWMI |
$240.54
|
| Rate for Payer: PHP Medicare Advantage |
$240.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.52
|
| Rate for Payer: Priority Health Medicare |
$240.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$240.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.54
|
| Rate for Payer: UHC Medicare Advantage |
$247.76
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$1,082.49 |
| Rate for Payer: Aetna Commercial |
$259.61
|
| Rate for Payer: Aetna Medicare |
$201.49
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$193.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,082.49
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: BCN Medicare Advantage |
$193.74
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cash Price |
$402.40
|
| Rate for Payer: Cofinity Commercial |
$278.99
|
| Rate for Payer: Cofinity Commercial |
$259.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.74
|
| Rate for Payer: Mclaren Medicaid |
$129.08
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.43
|
| Rate for Payer: PACE SWMI |
$193.74
|
| Rate for Payer: PHP Medicare Advantage |
$193.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$352.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.62
|
| Rate for Payer: Priority Health Medicare |
$193.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$351.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.74
|
| Rate for Payer: UHC Medicare Advantage |
$199.55
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.28
|
| Rate for Payer: BCN Commercial |
$0.24
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Cofinity Commercial |
$0.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.54
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$323.76 |
| Max. Negotiated Rate |
$979.03 |
| Rate for Payer: Aetna Commercial |
$655.33
|
| Rate for Payer: Aetna Medicare |
$508.61
|
| Rate for Payer: BCBS Complete |
$339.95
|
| Rate for Payer: BCBS MAPPO |
$489.05
|
| Rate for Payer: BCBS Trust/PPO |
$979.03
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$489.05
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$655.33
|
| Rate for Payer: Cofinity Commercial |
$704.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.05
|
| Rate for Payer: Mclaren Medicaid |
$323.76
|
| Rate for Payer: Meridian Medicaid |
$339.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$513.50
|
| Rate for Payer: PACE SWMI |
$489.05
|
| Rate for Payer: PHP Medicare Advantage |
$489.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$714.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$617.39
|
| Rate for Payer: Priority Health Medicare |
$489.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.05
|
| Rate for Payer: UHC Medicare Advantage |
$503.72
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$418.76 |
| Max. Negotiated Rate |
$1,187.00 |
| Rate for Payer: Aetna Commercial |
$852.90
|
| Rate for Payer: Aetna Medicare |
$661.95
|
| Rate for Payer: BCBS Complete |
$439.70
|
| Rate for Payer: BCBS MAPPO |
$636.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,002.07
|
| Rate for Payer: BCN Commercial |
$1,187.00
|
| Rate for Payer: BCN Medicare Advantage |
$636.49
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$852.90
|
| Rate for Payer: Cofinity Commercial |
$916.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.49
|
| Rate for Payer: Mclaren Medicaid |
$418.76
|
| Rate for Payer: Meridian Medicaid |
$439.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$668.31
|
| Rate for Payer: PACE SWMI |
$636.49
|
| Rate for Payer: PHP Medicare Advantage |
$636.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.29
|
| Rate for Payer: Priority Health Medicare |
$636.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$800.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.49
|
| Rate for Payer: UHC Medicare Advantage |
$655.58
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,693.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$226.01 |
| Max. Negotiated Rate |
$1,586.25 |
| Rate for Payer: Aetna Commercial |
$1,135.23
|
| Rate for Payer: Aetna Medicare |
$881.08
|
| Rate for Payer: BCBS Complete |
$582.61
|
| Rate for Payer: BCBS MAPPO |
$847.19
|
| Rate for Payer: BCBS Trust/PPO |
$226.01
|
| Rate for Payer: BCN Commercial |
$1,586.25
|
| Rate for Payer: BCN Medicare Advantage |
$847.19
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cash Price |
$1,354.40
|
| Rate for Payer: Cofinity Commercial |
$1,219.95
|
| Rate for Payer: Cofinity Commercial |
$1,135.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$847.19
|
| Rate for Payer: Mclaren Medicaid |
$554.87
|
| Rate for Payer: Meridian Medicaid |
$582.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$889.55
|
| Rate for Payer: PACE SWMI |
$847.19
|
| Rate for Payer: PHP Medicare Advantage |
$847.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,185.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.53
|
| Rate for Payer: Priority Health Medicare |
$847.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,062.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$847.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$847.19
|
| Rate for Payer: UHC Medicare Advantage |
$872.61
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$486.49 |
| Max. Negotiated Rate |
$1,457.41 |
| Rate for Payer: Aetna Commercial |
$989.72
|
| Rate for Payer: Aetna Medicare |
$768.14
|
| Rate for Payer: BCBS Complete |
$510.81
|
| Rate for Payer: BCBS MAPPO |
$738.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,457.41
|
| Rate for Payer: BCN Commercial |
$1,347.28
|
| Rate for Payer: BCN Medicare Advantage |
$738.60
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cash Price |
$1,266.40
|
| Rate for Payer: Cofinity Commercial |
$1,063.58
|
| Rate for Payer: Cofinity Commercial |
$989.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$738.60
|
| Rate for Payer: Mclaren Medicaid |
$486.49
|
| Rate for Payer: Meridian Medicaid |
$510.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$775.53
|
| Rate for Payer: PACE SWMI |
$738.60
|
| Rate for Payer: PHP Medicare Advantage |
$738.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$486.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,108.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.18
|
| Rate for Payer: Priority Health Medicare |
$738.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$930.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$738.60
|
| Rate for Payer: UHC Medicare Advantage |
$760.76
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$920.78
|
| Rate for Payer: Aetna Medicare |
$714.64
|
| Rate for Payer: BCBS Complete |
$475.70
|
| Rate for Payer: BCBS MAPPO |
$687.15
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$687.15
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$920.78
|
| Rate for Payer: Cofinity Commercial |
$989.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.15
|
| Rate for Payer: Mclaren Medicaid |
$453.05
|
| Rate for Payer: Meridian Medicaid |
$475.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.51
|
| Rate for Payer: PACE SWMI |
$687.15
|
| Rate for Payer: PHP Medicare Advantage |
$687.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.05
|
| Rate for Payer: Priority Health Medicare |
$687.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.15
|
| Rate for Payer: UHC Medicare Advantage |
$707.76
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,450.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,266.65 |
| Rate for Payer: Aetna Commercial |
$920.78
|
| Rate for Payer: Aetna Medicare |
$714.64
|
| Rate for Payer: BCBS Complete |
$475.70
|
| Rate for Payer: BCBS MAPPO |
$687.15
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,266.65
|
| Rate for Payer: BCN Medicare Advantage |
$687.15
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$989.50
|
| Rate for Payer: Cofinity Commercial |
$920.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.15
|
| Rate for Payer: Mclaren Medicaid |
$453.05
|
| Rate for Payer: Meridian Medicaid |
$475.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$721.51
|
| Rate for Payer: PACE SWMI |
$687.15
|
| Rate for Payer: PHP Medicare Advantage |
$687.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$866.05
|
| Rate for Payer: Priority Health Medicare |
$687.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$866.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.15
|
| Rate for Payer: UHC Medicare Advantage |
$707.76
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,450.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$344.38 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$1,232.50
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$453.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$453.12
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$362.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,127.38
|
| Rate for Payer: BCN Commercial |
$1,127.38
|
| Rate for Payer: BCN Medicare Advantage |
$362.50
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,247.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.50
|
| Rate for Payer: Healthscope Commercial |
$1,305.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.50
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$380.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$416.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.50
|
| Rate for Payer: PACE Senior Care Partners |
$344.38
|
| Rate for Payer: PACE SWMI |
$362.50
|
| Rate for Payer: PHP Commercial |
$1,232.50
|
| Rate for Payer: PHP Medicare Advantage |
$362.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.50
|
| Rate for Payer: Priority Health Medicare |
$362.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$884.36
|
| Rate for Payer: Railroad Medicare Medicare |
$362.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.00
|
| Rate for Payer: UHC Core |
$1,210.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.50
|
| Rate for Payer: UHC Medicare Advantage |
$373.38
|
| Rate for Payer: VA VA |
$362.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.50
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,450.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$884.36 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$1,232.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,120.56
|
| Rate for Payer: BCN Commercial |
$1,120.56
|
| Rate for Payer: Cash Price |
$1,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,247.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,160.00
|
| Rate for Payer: Healthscope Commercial |
$1,305.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,087.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,232.50
|
| Rate for Payer: PHP Commercial |
$1,232.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,015.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$884.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,276.00
|
| Rate for Payer: UHC Core |
$1,210.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,087.50
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,061.55
|
| Rate for Payer: Aetna Medicare |
$823.89
|
| Rate for Payer: BCBS Complete |
$548.61
|
| Rate for Payer: BCBS MAPPO |
$792.20
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$792.20
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.77
|
| Rate for Payer: Cofinity Commercial |
$1,061.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$792.20
|
| Rate for Payer: Mclaren Medicaid |
$522.49
|
| Rate for Payer: Meridian Medicaid |
$548.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$831.81
|
| Rate for Payer: PACE SWMI |
$792.20
|
| Rate for Payer: PHP Medicare Advantage |
$792.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.41
|
| Rate for Payer: Priority Health Medicare |
$792.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$998.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$792.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$792.20
|
| Rate for Payer: UHC Medicare Advantage |
$815.97
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$136.32 |
| Max. Negotiated Rate |
$312.75 |
| Rate for Payer: Aetna Commercial |
$284.78
|
| Rate for Payer: Aetna Medicare |
$221.02
|
| Rate for Payer: BCBS Complete |
$143.14
|
| Rate for Payer: BCBS MAPPO |
$212.52
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$212.52
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$284.78
|
| Rate for Payer: Cofinity Commercial |
$306.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.52
|
| Rate for Payer: Mclaren Medicaid |
$136.32
|
| Rate for Payer: Meridian Medicaid |
$143.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.15
|
| Rate for Payer: PACE SWMI |
$212.52
|
| Rate for Payer: PHP Medicare Advantage |
$212.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$212.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$212.52
|
| Rate for Payer: UHC Medicare Advantage |
$218.90
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$1,028.66 |
| Rate for Payer: Aetna Commercial |
$733.86
|
| Rate for Payer: Aetna Medicare |
$569.57
|
| Rate for Payer: BCBS Complete |
$381.55
|
| Rate for Payer: BCBS MAPPO |
$547.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$547.66
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cofinity Commercial |
$733.86
|
| Rate for Payer: Cofinity Commercial |
$788.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.66
|
| Rate for Payer: Mclaren Medicaid |
$363.38
|
| Rate for Payer: Meridian Medicaid |
$381.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$575.04
|
| Rate for Payer: PACE SWMI |
$547.66
|
| Rate for Payer: PHP Medicare Advantage |
$547.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$692.60
|
| Rate for Payer: Priority Health Medicare |
$547.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$692.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$547.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$547.66
|
| Rate for Payer: UHC Medicare Advantage |
$564.09
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,418.20 |
| Rate for Payer: Aetna Commercial |
$863.52
|
| Rate for Payer: Aetna Medicare |
$670.20
|
| Rate for Payer: BCBS Complete |
$446.19
|
| Rate for Payer: BCBS MAPPO |
$644.42
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,122.50
|
| Rate for Payer: BCN Medicare Advantage |
$644.42
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cofinity Commercial |
$863.52
|
| Rate for Payer: Cofinity Commercial |
$927.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.42
|
| Rate for Payer: Mclaren Medicaid |
$424.94
|
| Rate for Payer: Meridian Medicaid |
$446.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.64
|
| Rate for Payer: PACE SWMI |
$644.42
|
| Rate for Payer: PHP Medicare Advantage |
$644.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,418.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.62
|
| Rate for Payer: Priority Health Medicare |
$644.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$644.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.42
|
| Rate for Payer: UHC Medicare Advantage |
$663.75
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$777.01 |
| Max. Negotiated Rate |
$1,146.60 |
| Rate for Payer: Aetna Commercial |
$1,082.90
|
| Rate for Payer: BCBS Trust/PPO |
$984.55
|
| Rate for Payer: BCN Commercial |
$984.55
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.20
|
| Rate for Payer: Healthscope Commercial |
$1,146.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$955.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,082.90
|
| Rate for Payer: PHP Commercial |
$1,082.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$777.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,121.12
|
| Rate for Payer: UHC Core |
$1,063.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$955.50
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$302.58 |
| Max. Negotiated Rate |
$1,256.10 |
| Rate for Payer: Aetna Commercial |
$1,082.90
|
| Rate for Payer: Aetna Medicare |
$331.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$398.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$398.12
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$318.50
|
| Rate for Payer: BCBS Trust/PPO |
$990.54
|
| Rate for Payer: BCN Commercial |
$990.54
|
| Rate for Payer: BCN Medicare Advantage |
$318.50
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.50
|
| Rate for Payer: Healthscope Commercial |
$1,146.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$955.50
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$334.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,082.90
|
| Rate for Payer: PACE Senior Care Partners |
$302.58
|
| Rate for Payer: PACE SWMI |
$318.50
|
| Rate for Payer: PHP Commercial |
$1,082.90
|
| Rate for Payer: PHP Medicare Advantage |
$318.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.38
|
| Rate for Payer: Priority Health Medicare |
$318.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$777.01
|
| Rate for Payer: Railroad Medicare Medicare |
$318.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,121.12
|
| Rate for Payer: UHC Core |
$1,063.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.50
|
| Rate for Payer: UHC Medicare Advantage |
$328.06
|
| Rate for Payer: VA VA |
$318.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$955.50
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$809.95
|
| Rate for Payer: Aetna Medicare |
$628.62
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS MAPPO |
$604.44
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$604.44
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$870.39
|
| Rate for Payer: Cofinity Commercial |
$809.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.44
|
| Rate for Payer: Mclaren Medicaid |
$398.95
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$634.66
|
| Rate for Payer: PACE SWMI |
$604.44
|
| Rate for Payer: PHP Medicare Advantage |
$604.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Medicare |
$604.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.44
|
| Rate for Payer: UHC Medicare Advantage |
$622.57
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$809.95
|
| Rate for Payer: Aetna Medicare |
$628.62
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS MAPPO |
$604.44
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$604.44
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$809.95
|
| Rate for Payer: Cofinity Commercial |
$870.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.44
|
| Rate for Payer: Mclaren Medicaid |
$398.95
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$634.66
|
| Rate for Payer: PACE SWMI |
$604.44
|
| Rate for Payer: PHP Medicare Advantage |
$604.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Medicare |
$604.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$762.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$604.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.44
|
| Rate for Payer: UHC Medicare Advantage |
$622.57
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$108.60
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
|
