|
PR ACNE SURGERY
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 10040
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$66.25
|
| Rate for Payer: Aetna Medicare |
$51.42
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$49.44
|
| Rate for Payer: BCN Medicare Advantage |
$49.44
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$71.19
|
| Rate for Payer: Cofinity Commercial |
$66.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.91
|
| Rate for Payer: Nomi Health Commercial |
$59.33
|
| Rate for Payer: PACE SWMI |
$49.44
|
| Rate for Payer: PHP Medicare Advantage |
$49.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$49.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.44
|
| Rate for Payer: UHC Exchange |
$49.44
|
| Rate for Payer: UHC Medicare Advantage |
$49.44
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$39.02 |
| Rate for Payer: Aetna Commercial |
$36.31
|
| Rate for Payer: Aetna Medicare |
$28.18
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$27.10
|
| Rate for Payer: BCN Medicare Advantage |
$27.10
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$39.02
|
| Rate for Payer: Cofinity Commercial |
$36.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.45
|
| Rate for Payer: Nomi Health Commercial |
$32.52
|
| Rate for Payer: PACE SWMI |
$27.10
|
| Rate for Payer: PHP Medicare Advantage |
$27.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$27.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.10
|
| Rate for Payer: UHC Exchange |
$27.10
|
| Rate for Payer: UHC Medicare Advantage |
$27.10
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,143.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$457.20 |
| Max. Negotiated Rate |
$860.16 |
| Rate for Payer: Aetna Commercial |
$800.42
|
| Rate for Payer: Aetna Medicare |
$621.22
|
| Rate for Payer: BCBS Complete |
$457.20
|
| Rate for Payer: BCBS MAPPO |
$597.33
|
| Rate for Payer: BCN Medicare Advantage |
$597.33
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cash Price |
$914.40
|
| Rate for Payer: Cofinity Commercial |
$860.16
|
| Rate for Payer: Cofinity Commercial |
$800.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$597.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$627.20
|
| Rate for Payer: Nomi Health Commercial |
$716.80
|
| Rate for Payer: PACE SWMI |
$597.33
|
| Rate for Payer: PHP Medicare Advantage |
$597.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.95
|
| Rate for Payer: Priority Health Medicare |
$603.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$597.33
|
| Rate for Payer: UHC Exchange |
$597.33
|
| Rate for Payer: UHC Medicare Advantage |
$597.33
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$604.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$118.06 |
| Max. Negotiated Rate |
$392.60 |
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Commercial |
$158.20
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: Aetna Medicare |
$122.78
|
| Rate for Payer: BCBS Complete |
$241.60
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCBS MAPPO |
$118.06
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: BCN Medicare Advantage |
$118.06
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cash Price |
$483.20
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.96
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: Nomi Health Commercial |
$141.67
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PACE SWMI |
$118.06
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: PHP Medicare Advantage |
$118.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$119.24
|
| Rate for Payer: Priority Health Medicare |
$119.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.06
|
| Rate for Payer: UHC Exchange |
$118.06
|
| Rate for Payer: UHC Exchange |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
| Rate for Payer: UHC Medicare Advantage |
$118.06
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00673
|
|
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: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00674
|
|
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: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$292.84 |
| Rate for Payer: Aetna Commercial |
$272.50
|
| Rate for Payer: Aetna Medicare |
$211.49
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$203.36
|
| Rate for Payer: BCN Medicare Advantage |
$203.36
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$272.50
|
| Rate for Payer: Cofinity Commercial |
$292.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.53
|
| Rate for Payer: Nomi Health Commercial |
$244.03
|
| Rate for Payer: PACE SWMI |
$203.36
|
| Rate for Payer: PHP Medicare Advantage |
$203.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$205.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.36
|
| Rate for Payer: UHC Exchange |
$203.36
|
| Rate for Payer: UHC Medicare Advantage |
$203.36
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$220.41 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$295.35
|
| Rate for Payer: Aetna Medicare |
$229.23
|
| Rate for Payer: BCBS Complete |
$258.40
|
| Rate for Payer: BCBS MAPPO |
$220.41
|
| Rate for Payer: BCN Medicare Advantage |
$220.41
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cash Price |
$516.80
|
| Rate for Payer: Cofinity Commercial |
$317.39
|
| Rate for Payer: Cofinity Commercial |
$295.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.43
|
| Rate for Payer: Nomi Health Commercial |
$264.49
|
| Rate for Payer: PACE SWMI |
$220.41
|
| Rate for Payer: PHP Medicare Advantage |
$220.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.90
|
| Rate for Payer: Priority Health Medicare |
$222.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.41
|
| Rate for Payer: UHC Exchange |
$220.41
|
| Rate for Payer: UHC Medicare Advantage |
$220.41
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$235.43 |
| Max. Negotiated Rate |
$394.55 |
| Rate for Payer: Aetna Commercial |
$315.48
|
| Rate for Payer: Aetna Medicare |
$244.85
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS MAPPO |
$235.43
|
| Rate for Payer: BCN Medicare Advantage |
$235.43
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cofinity Commercial |
$339.02
|
| Rate for Payer: Cofinity Commercial |
$315.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.20
|
| Rate for Payer: Nomi Health Commercial |
$282.52
|
| Rate for Payer: PACE SWMI |
$235.43
|
| Rate for Payer: PHP Medicare Advantage |
$235.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.55
|
| Rate for Payer: Priority Health Medicare |
$237.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.43
|
| Rate for Payer: UHC Exchange |
$235.43
|
| Rate for Payer: UHC Medicare Advantage |
$235.43
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$189.28 |
| Max. Negotiated Rate |
$333.45 |
| Rate for Payer: Aetna Commercial |
$253.64
|
| Rate for Payer: Aetna Medicare |
$196.85
|
| Rate for Payer: BCBS Complete |
$205.20
|
| Rate for Payer: BCBS MAPPO |
$189.28
|
| Rate for Payer: BCN Medicare Advantage |
$189.28
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$272.56
|
| Rate for Payer: Cofinity Commercial |
$253.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.74
|
| Rate for Payer: Nomi Health Commercial |
$227.14
|
| Rate for Payer: PACE SWMI |
$189.28
|
| Rate for Payer: PHP Medicare Advantage |
$189.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$333.45
|
| Rate for Payer: Priority Health Medicare |
$191.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.28
|
| Rate for Payer: UHC Exchange |
$189.28
|
| Rate for Payer: UHC Medicare Advantage |
$189.28
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Aetna Commercial |
$0.75
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.56
|
| Rate for Payer: BCN Medicare Advantage |
$0.56
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$0.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.59
|
| Rate for Payer: Nomi Health Commercial |
$0.67
|
| Rate for Payer: PACE SWMI |
$0.56
|
| Rate for Payer: PHP Medicare Advantage |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.56
|
| Rate for Payer: UHC Exchange |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$416.00 |
| Max. Negotiated Rate |
$692.22 |
| Rate for Payer: Aetna Commercial |
$644.15
|
| Rate for Payer: Aetna Medicare |
$499.94
|
| Rate for Payer: BCBS Complete |
$416.00
|
| Rate for Payer: BCBS MAPPO |
$480.71
|
| Rate for Payer: BCN Medicare Advantage |
$480.71
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cofinity Commercial |
$692.22
|
| Rate for Payer: Cofinity Commercial |
$644.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.75
|
| Rate for Payer: Nomi Health Commercial |
$576.85
|
| Rate for Payer: PACE SWMI |
$480.71
|
| Rate for Payer: PHP Medicare Advantage |
$480.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.00
|
| Rate for Payer: Priority Health Medicare |
$485.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$480.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$480.71
|
| Rate for Payer: UHC Exchange |
$480.71
|
| Rate for Payer: UHC Medicare Advantage |
$480.71
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,354.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$541.60 |
| Max. Negotiated Rate |
$897.57 |
| Rate for Payer: Aetna Commercial |
$835.24
|
| Rate for Payer: Aetna Medicare |
$648.24
|
| Rate for Payer: BCBS Complete |
$541.60
|
| Rate for Payer: BCBS MAPPO |
$623.31
|
| Rate for Payer: BCN Medicare Advantage |
$623.31
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cash Price |
$1,083.20
|
| Rate for Payer: Cofinity Commercial |
$835.24
|
| Rate for Payer: Cofinity Commercial |
$897.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.48
|
| Rate for Payer: Nomi Health Commercial |
$747.97
|
| Rate for Payer: PACE SWMI |
$623.31
|
| Rate for Payer: PHP Medicare Advantage |
$623.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$880.10
|
| Rate for Payer: Priority Health Medicare |
$629.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.31
|
| Rate for Payer: UHC Exchange |
$623.31
|
| Rate for Payer: UHC Medicare Advantage |
$623.31
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$1,191.46 |
| Rate for Payer: Aetna Commercial |
$1,108.72
|
| Rate for Payer: Aetna Medicare |
$860.50
|
| Rate for Payer: BCBS Complete |
$690.80
|
| Rate for Payer: BCBS MAPPO |
$827.40
|
| Rate for Payer: BCN Medicare Advantage |
$827.40
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cofinity Commercial |
$1,191.46
|
| Rate for Payer: Cofinity Commercial |
$1,108.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.77
|
| Rate for Payer: Nomi Health Commercial |
$992.88
|
| Rate for Payer: PACE SWMI |
$827.40
|
| Rate for Payer: PHP Medicare Advantage |
$827.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,122.55
|
| Rate for Payer: Priority Health Medicare |
$835.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.40
|
| Rate for Payer: UHC Exchange |
$827.40
|
| Rate for Payer: UHC Medicare Advantage |
$827.40
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$1,049.75 |
| Rate for Payer: Aetna Commercial |
$967.67
|
| Rate for Payer: Aetna Medicare |
$751.03
|
| Rate for Payer: BCBS Complete |
$646.00
|
| Rate for Payer: BCBS MAPPO |
$722.14
|
| Rate for Payer: BCN Medicare Advantage |
$722.14
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cofinity Commercial |
$967.67
|
| Rate for Payer: Cofinity Commercial |
$1,039.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$722.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$758.25
|
| Rate for Payer: Nomi Health Commercial |
$866.57
|
| Rate for Payer: PACE SWMI |
$722.14
|
| Rate for Payer: PHP Medicare Advantage |
$722.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health Medicare |
$729.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$722.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$722.14
|
| Rate for Payer: UHC Exchange |
$722.14
|
| Rate for Payer: UHC Medicare Advantage |
$722.14
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$351.26 |
| Max. Negotiated Rate |
$1,388.75 |
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: Aetna Medicare |
$384.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$462.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$462.19
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$369.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,215.89
|
| Rate for Payer: BCN Commercial |
$1,149.92
|
| Rate for Payer: BCN Medicare Advantage |
$369.75
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.75
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.25
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.24
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$425.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: Nomi Health Commercial |
$1,212.78
|
| Rate for Payer: PACE Senior Care Partners |
$351.26
|
| Rate for Payer: PACE SWMI |
$369.75
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: PHP Medicare Advantage |
$369.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,286.73
|
| Rate for Payer: Priority Health Medicare |
$373.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.93
|
| Rate for Payer: Railroad Medicare Medicare |
$369.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,301.52
|
| Rate for Payer: UHC Core |
$1,234.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.75
|
| Rate for Payer: UHC Exchange |
$369.75
|
| Rate for Payer: UHC Medicare Advantage |
$369.75
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$369.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.25
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$961.35 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Aetna Commercial |
$1,257.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,207.31
|
| Rate for Payer: BCN Commercial |
$1,142.97
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,271.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,183.20
|
| Rate for Payer: Healthscope Commercial |
$1,331.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,109.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.15
|
| Rate for Payer: Nomi Health Commercial |
$1,212.78
|
| Rate for Payer: PHP Commercial |
$1,257.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,286.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$990.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,301.52
|
| Rate for Payer: UHC Core |
$1,234.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,109.25
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$968.49 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health Medicare |
$679.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Exchange |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$591.60 |
| Max. Negotiated Rate |
$968.49 |
| Rate for Payer: Aetna Commercial |
$901.23
|
| Rate for Payer: Aetna Medicare |
$699.46
|
| Rate for Payer: BCBS Complete |
$591.60
|
| Rate for Payer: BCBS MAPPO |
$672.56
|
| Rate for Payer: BCN Medicare Advantage |
$672.56
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$968.49
|
| Rate for Payer: Cofinity Commercial |
$901.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.19
|
| Rate for Payer: Nomi Health Commercial |
$807.07
|
| Rate for Payer: PACE SWMI |
$672.56
|
| Rate for Payer: PHP Medicare Advantage |
$672.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.35
|
| Rate for Payer: Priority Health Medicare |
$679.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$672.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$672.56
|
| Rate for Payer: UHC Exchange |
$672.56
|
| Rate for Payer: UHC Medicare Advantage |
$672.56
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$773.52 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Aetna Commercial |
$1,036.52
|
| Rate for Payer: Aetna Medicare |
$804.46
|
| Rate for Payer: BCBS Complete |
$894.00
|
| Rate for Payer: BCBS MAPPO |
$773.52
|
| Rate for Payer: BCN Medicare Advantage |
$773.52
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,113.87
|
| Rate for Payer: Cofinity Commercial |
$1,036.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.20
|
| Rate for Payer: Nomi Health Commercial |
$928.22
|
| Rate for Payer: PACE SWMI |
$773.52
|
| Rate for Payer: PHP Medicare Advantage |
$773.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.75
|
| Rate for Payer: Priority Health Medicare |
$781.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$773.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.52
|
| Rate for Payer: UHC Exchange |
$773.52
|
| Rate for Payer: UHC Medicare Advantage |
$773.52
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$296.37 |
| Rate for Payer: Aetna Commercial |
$275.79
|
| Rate for Payer: Aetna Medicare |
$214.04
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$205.81
|
| Rate for Payer: BCN Medicare Advantage |
$205.81
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$296.37
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.10
|
| Rate for Payer: Nomi Health Commercial |
$246.97
|
| Rate for Payer: PACE SWMI |
$205.81
|
| Rate for Payer: PHP Medicare Advantage |
$205.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$207.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.81
|
| Rate for Payer: UHC Exchange |
$205.81
|
| Rate for Payer: UHC Medicare Advantage |
$205.81
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,169.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$467.60 |
| Max. Negotiated Rate |
$772.78 |
| Rate for Payer: Aetna Commercial |
$719.11
|
| Rate for Payer: Aetna Medicare |
$558.12
|
| Rate for Payer: BCBS Complete |
$467.60
|
| Rate for Payer: BCBS MAPPO |
$536.65
|
| Rate for Payer: BCN Medicare Advantage |
$536.65
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cofinity Commercial |
$772.78
|
| Rate for Payer: Cofinity Commercial |
$719.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.48
|
| Rate for Payer: Nomi Health Commercial |
$643.98
|
| Rate for Payer: PACE SWMI |
$536.65
|
| Rate for Payer: PHP Medicare Advantage |
$536.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.85
|
| Rate for Payer: Priority Health Medicare |
$542.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.65
|
| Rate for Payer: UHC Exchange |
$536.65
|
| Rate for Payer: UHC Medicare Advantage |
$536.65
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,067.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$628.95 |
| Max. Negotiated Rate |
$1,343.55 |
| Rate for Payer: Aetna Commercial |
$842.79
|
| Rate for Payer: Aetna Medicare |
$654.11
|
| Rate for Payer: BCBS Complete |
$826.80
|
| Rate for Payer: BCBS MAPPO |
$628.95
|
| Rate for Payer: BCN Medicare Advantage |
$628.95
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cash Price |
$1,653.60
|
| Rate for Payer: Cofinity Commercial |
$905.69
|
| Rate for Payer: Cofinity Commercial |
$842.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$660.40
|
| Rate for Payer: Nomi Health Commercial |
$754.74
|
| Rate for Payer: PACE SWMI |
$628.95
|
| Rate for Payer: PHP Medicare Advantage |
$628.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,343.55
|
| Rate for Payer: Priority Health Medicare |
$635.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.95
|
| Rate for Payer: UHC Exchange |
$628.95
|
| Rate for Payer: UHC Medicare Advantage |
$628.95
|
|
