|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$76.39
|
| Rate for Payer: Aetna Medicare |
$59.29
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.01
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$82.09
|
| Rate for Payer: Cofinity Commercial |
$76.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.86
|
| Rate for Payer: Nomi Health Commercial |
$68.41
|
| Rate for Payer: PACE SWMI |
$57.01
|
| Rate for Payer: PHP Medicare Advantage |
$57.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$57.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.01
|
| Rate for Payer: UHC Exchange |
$57.01
|
| Rate for Payer: UHC Medicare Advantage |
$57.01
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$95.76
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$93.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Exchange |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Medicare |
$118.52
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$113.96
|
| Rate for Payer: BCN Medicare Advantage |
$113.96
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Cofinity Commercial |
$152.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.66
|
| Rate for Payer: Nomi Health Commercial |
$136.75
|
| Rate for Payer: PACE SWMI |
$113.96
|
| Rate for Payer: PHP Medicare Advantage |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$115.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.96
|
| Rate for Payer: UHC Exchange |
$113.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.96
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$113.79 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$82.18
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$79.02
|
| Rate for Payer: BCN Medicare Advantage |
$79.02
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$113.79
|
| Rate for Payer: Cofinity Commercial |
$105.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.97
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: PACE SWMI |
$79.02
|
| Rate for Payer: PHP Medicare Advantage |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$79.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.02
|
| Rate for Payer: UHC Exchange |
$79.02
|
| Rate for Payer: UHC Medicare Advantage |
$79.02
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$36.05
|
| Rate for Payer: Aetna Medicare |
$27.98
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.25
|
| Rate for Payer: Nomi Health Commercial |
$32.28
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$27.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$59.95 |
| Rate for Payer: Aetna Commercial |
$55.78
|
| Rate for Payer: Aetna Medicare |
$43.30
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$41.63
|
| Rate for Payer: BCN Medicare Advantage |
$41.63
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.71
|
| Rate for Payer: Nomi Health Commercial |
$49.96
|
| Rate for Payer: PACE SWMI |
$41.63
|
| Rate for Payer: PHP Medicare Advantage |
$41.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$42.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.63
|
| Rate for Payer: UHC Exchange |
$41.63
|
| Rate for Payer: UHC Medicare Advantage |
$41.63
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS MAPPO |
$152.94
|
| Rate for Payer: BCN Medicare Advantage |
$152.94
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.59
|
| Rate for Payer: Nomi Health Commercial |
$183.53
|
| Rate for Payer: PACE SWMI |
$152.94
|
| Rate for Payer: PHP Medicare Advantage |
$152.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health Medicare |
$154.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.94
|
| Rate for Payer: UHC Exchange |
$152.94
|
| Rate for Payer: UHC Medicare Advantage |
$152.94
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$1,031.53 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Aetna Medicare |
$744.99
|
| Rate for Payer: BCBS Complete |
$604.00
|
| Rate for Payer: BCBS MAPPO |
$716.34
|
| Rate for Payer: BCN Medicare Advantage |
$716.34
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cofinity Commercial |
$959.90
|
| Rate for Payer: Cofinity Commercial |
$1,031.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.16
|
| Rate for Payer: Nomi Health Commercial |
$859.61
|
| Rate for Payer: PACE SWMI |
$716.34
|
| Rate for Payer: PHP Medicare Advantage |
$716.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health Medicare |
$723.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$716.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.34
|
| Rate for Payer: UHC Exchange |
$716.34
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$933.54 |
| Rate for Payer: Aetna Commercial |
$868.71
|
| Rate for Payer: Aetna Medicare |
$674.22
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$648.29
|
| Rate for Payer: BCN Medicare Advantage |
$648.29
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$933.54
|
| Rate for Payer: Cofinity Commercial |
$868.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.70
|
| Rate for Payer: Nomi Health Commercial |
$777.95
|
| Rate for Payer: PACE SWMI |
$648.29
|
| Rate for Payer: PHP Medicare Advantage |
$648.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$654.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$648.29
|
| Rate for Payer: UHC Exchange |
$648.29
|
| Rate for Payer: UHC Medicare Advantage |
$648.29
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,258.88 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Aetna Medicare |
$909.19
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$874.22
|
| Rate for Payer: BCN Medicare Advantage |
$874.22
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.93
|
| Rate for Payer: Nomi Health Commercial |
$1,049.06
|
| Rate for Payer: PACE SWMI |
$874.22
|
| Rate for Payer: PHP Medicare Advantage |
$874.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$882.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.22
|
| Rate for Payer: UHC Exchange |
$874.22
|
| Rate for Payer: UHC Medicare Advantage |
$874.22
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$253.38 |
| Max. Negotiated Rate |
$1,753.05 |
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Medicare |
$263.52
|
| Rate for Payer: BCBS Complete |
$1,078.80
|
| Rate for Payer: BCBS MAPPO |
$253.38
|
| Rate for Payer: BCN Medicare Advantage |
$253.38
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.05
|
| Rate for Payer: Nomi Health Commercial |
$304.06
|
| Rate for Payer: PACE SWMI |
$253.38
|
| Rate for Payer: PHP Medicare Advantage |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health Medicare |
$255.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.38
|
| Rate for Payer: UHC Exchange |
$253.38
|
| Rate for Payer: UHC Medicare Advantage |
$253.38
|
|
|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$1,133.26 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$1,518.57
|
| Rate for Payer: Aetna Medicare |
$1,178.59
|
| Rate for Payer: BCBS Complete |
$1,198.80
|
| Rate for Payer: BCBS MAPPO |
$1,133.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.26
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$1,631.89
|
| Rate for Payer: Cofinity Commercial |
$1,518.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.92
|
| Rate for Payer: Nomi Health Commercial |
$1,359.91
|
| Rate for Payer: PACE SWMI |
$1,133.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health Medicare |
$1,144.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,133.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.26
|
| Rate for Payer: UHC Exchange |
$1,133.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.26
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$1,116.53 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,496.15
|
| Rate for Payer: Aetna Medicare |
$1,161.19
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$1,116.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.53
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,607.80
|
| Rate for Payer: Cofinity Commercial |
$1,496.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.36
|
| Rate for Payer: Nomi Health Commercial |
$1,339.84
|
| Rate for Payer: PACE SWMI |
$1,116.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$1,127.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,116.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.53
|
| Rate for Payer: UHC Exchange |
$1,116.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.53
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$380.48 |
| Max. Negotiated Rate |
$2,779.41 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$416.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$500.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$500.62
|
| Rate for Payer: BCBS Complete |
$2,779.41
|
| Rate for Payer: BCBS MAPPO |
$400.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.00
|
| Rate for Payer: BCN Commercial |
$1,245.56
|
| Rate for Payer: BCN Medicare Advantage |
$400.50
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$400.50
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.50
|
| Rate for Payer: Mclaren Medicaid |
$2,646.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$420.52
|
| Rate for Payer: Meridian Medicaid |
$2,779.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$460.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: PACE Senior Care Partners |
$380.48
|
| Rate for Payer: PACE SWMI |
$400.50
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: PHP Medicare Advantage |
$400.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,646.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,393.74
|
| Rate for Payer: Priority Health Medicare |
$404.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,073.34
|
| Rate for Payer: Railroad Medicare Medicare |
$400.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.76
|
| Rate for Payer: UHC Core |
$1,337.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$400.50
|
| Rate for Payer: UHC Exchange |
$400.50
|
| Rate for Payer: UHC Medicare Advantage |
$400.50
|
| Rate for Payer: UHCCP Medicaid |
$2,646.88
|
| Rate for Payer: VA VA |
$400.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,041.30 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,307.71
|
| Rate for Payer: BCN Commercial |
$1,238.03
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: Nomi Health Commercial |
$1,313.64
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health HMO/PPO |
$1,393.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,073.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,409.76
|
| Rate for Payer: UHC Core |
$1,337.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$664.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$664.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Exchange |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$125.12 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$130.12
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCN Medicare Advantage |
$125.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$180.17
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Nomi Health Commercial |
$150.14
|
| Rate for Payer: PACE SWMI |
$125.12
|
| Rate for Payer: PHP Medicare Advantage |
$125.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$126.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Exchange |
$125.12
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,398.80 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,756.68
|
| Rate for Payer: BCN Commercial |
$1,663.07
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,872.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,441.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,893.76
|
| Rate for Payer: UHC Core |
$1,796.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$690.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$511.10 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna Medicare |
$559.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$672.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$672.50
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$538.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.16
|
| Rate for Payer: BCN Commercial |
$1,673.18
|
| Rate for Payer: BCN Medicare Advantage |
$538.00
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.00
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.90
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$618.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: Nomi Health Commercial |
$1,764.64
|
| Rate for Payer: PACE Senior Care Partners |
$511.10
|
| Rate for Payer: PACE SWMI |
$538.00
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: PHP Medicare Advantage |
$538.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,872.24
|
| Rate for Payer: Priority Health Medicare |
$543.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,441.84
|
| Rate for Payer: Railroad Medicare Medicare |
$538.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,893.76
|
| Rate for Payer: UHC Core |
$1,796.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$538.00
|
| Rate for Payer: UHC Exchange |
$538.00
|
| Rate for Payer: UHC Medicare Advantage |
$538.00
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$538.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$690.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Exchange |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$105.79 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: Aetna Commercial |
$141.76
|
| Rate for Payer: Aetna Medicare |
$110.02
|
| Rate for Payer: BCBS Complete |
$551.60
|
| Rate for Payer: BCBS MAPPO |
$105.79
|
| Rate for Payer: BCN Medicare Advantage |
$105.79
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$141.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.08
|
| Rate for Payer: Nomi Health Commercial |
$126.95
|
| Rate for Payer: PACE SWMI |
$105.79
|
| Rate for Payer: PHP Medicare Advantage |
$105.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health Medicare |
$106.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.79
|
| Rate for Payer: UHC Exchange |
$105.79
|
| Rate for Payer: UHC Medicare Advantage |
$105.79
|
|
