|
PR TIS CLTR SKN AGRFT F/S/N/H/F/G/M/DGT 1ST 25SQCM/
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 15155
|
| Min. Negotiated Rate |
$530.00 |
| Max. Negotiated Rate |
$1,002.76 |
| Rate for Payer: Aetna Commercial |
$933.12
|
| Rate for Payer: Aetna Medicare |
$724.21
|
| Rate for Payer: BCBS Complete |
$530.00
|
| Rate for Payer: BCBS MAPPO |
$696.36
|
| Rate for Payer: BCN Medicare Advantage |
$696.36
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cofinity Commercial |
$933.12
|
| Rate for Payer: Cofinity Commercial |
$1,002.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.18
|
| Rate for Payer: Nomi Health Commercial |
$835.63
|
| Rate for Payer: PACE SWMI |
$696.36
|
| Rate for Payer: PHP Medicare Advantage |
$696.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.25
|
| Rate for Payer: Priority Health Medicare |
$703.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$696.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.36
|
| Rate for Payer: UHC Exchange |
$696.36
|
| Rate for Payer: UHC Medicare Advantage |
$696.36
|
|
|
PR TIS CLTR SKN AGRFT F/S/N/H/F/G/M/DGT AD 1-75SQCM
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 15156
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$196.36
|
| Rate for Payer: Aetna Medicare |
$152.40
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$146.54
|
| Rate for Payer: BCN Medicare Advantage |
$146.54
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$211.02
|
| Rate for Payer: Cofinity Commercial |
$196.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.87
|
| Rate for Payer: Nomi Health Commercial |
$175.85
|
| Rate for Payer: PACE SWMI |
$146.54
|
| Rate for Payer: PHP Medicare Advantage |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$148.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.54
|
| Rate for Payer: UHC Exchange |
$146.54
|
| Rate for Payer: UHC Medicare Advantage |
$146.54
|
|
|
PR TISS CLTR SKIN AGRFT T/A/L EA ADD 100 SQCM/EA 1%
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 15152
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$144.77
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$139.20
|
| Rate for Payer: BCN Medicare Advantage |
$139.20
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$200.45
|
| Rate for Payer: Cofinity Commercial |
$186.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.16
|
| Rate for Payer: Nomi Health Commercial |
$167.04
|
| Rate for Payer: PACE SWMI |
$139.20
|
| Rate for Payer: PHP Medicare Advantage |
$139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$140.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.20
|
| Rate for Payer: UHC Exchange |
$139.20
|
| Rate for Payer: UHC Medicare Advantage |
$139.20
|
|
|
PR TISS CLTR SKIN AUTOGRAFT T/A/L 1ST 25 SQ CM/<
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 15150
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$890.04 |
| Rate for Payer: Aetna Commercial |
$828.23
|
| Rate for Payer: Aetna Medicare |
$642.80
|
| Rate for Payer: BCBS Complete |
$482.00
|
| Rate for Payer: BCBS MAPPO |
$618.08
|
| Rate for Payer: BCN Medicare Advantage |
$618.08
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$890.04
|
| Rate for Payer: Cofinity Commercial |
$828.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$618.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$741.70
|
| Rate for Payer: PACE SWMI |
$618.08
|
| Rate for Payer: PHP Medicare Advantage |
$618.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.25
|
| Rate for Payer: Priority Health Medicare |
$624.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$618.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$618.08
|
| Rate for Payer: UHC Exchange |
$618.08
|
| Rate for Payer: UHC Medicare Advantage |
$618.08
|
|
|
PR TISS CLTR SKIN AUTOGRAFT T/A/L ADDL 1-75 SQCM
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 15151
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Aetna Commercial |
$142.23
|
| Rate for Payer: Aetna Medicare |
$110.39
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$106.14
|
| Rate for Payer: BCN Medicare Advantage |
$106.14
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$152.84
|
| Rate for Payer: Cofinity Commercial |
$142.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.45
|
| Rate for Payer: Nomi Health Commercial |
$127.37
|
| Rate for Payer: PACE SWMI |
$106.14
|
| Rate for Payer: PHP Medicare Advantage |
$106.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$107.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.14
|
| Rate for Payer: UHC Exchange |
$106.14
|
| Rate for Payer: UHC Medicare Advantage |
$106.14
|
|
|
PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 19357
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$1,591.29 |
| Rate for Payer: Aetna Commercial |
$1,480.78
|
| Rate for Payer: Aetna Medicare |
$1,149.26
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$1,105.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,105.06
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,591.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,105.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,160.31
|
| Rate for Payer: Nomi Health Commercial |
$1,326.07
|
| Rate for Payer: PACE SWMI |
$1,105.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$1,116.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,105.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,105.06
|
| Rate for Payer: UHC Exchange |
$1,105.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,105.06
|
|
|
PR TIXAGEV AND CILGAV INJ
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| 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 TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 69637
|
| Min. Negotiated Rate |
$1,303.80 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Aetna Commercial |
$1,747.09
|
| Rate for Payer: Aetna Medicare |
$1,355.95
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: BCBS MAPPO |
$1,303.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.80
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,877.47
|
| Rate for Payer: Cofinity Commercial |
$1,747.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.99
|
| Rate for Payer: Nomi Health Commercial |
$1,564.56
|
| Rate for Payer: PACE SWMI |
$1,303.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health Medicare |
$1,316.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,303.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.80
|
| Rate for Payer: UHC Exchange |
$1,303.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.80
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR
|
Professional
|
Both
|
$4,310.00
|
|
|
Service Code
|
HCPCS 69644
|
| Min. Negotiated Rate |
$1,406.10 |
| Max. Negotiated Rate |
$2,801.50 |
| Rate for Payer: Aetna Commercial |
$1,884.17
|
| Rate for Payer: Aetna Medicare |
$1,462.34
|
| Rate for Payer: BCBS Complete |
$1,724.00
|
| Rate for Payer: BCBS MAPPO |
$1,406.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,406.10
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,024.78
|
| Rate for Payer: Cofinity Commercial |
$1,884.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,406.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,476.40
|
| Rate for Payer: Nomi Health Commercial |
$1,687.32
|
| Rate for Payer: PACE SWMI |
$1,406.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,406.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,801.50
|
| Rate for Payer: Priority Health Medicare |
$1,420.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,406.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,406.10
|
| Rate for Payer: UHC Exchange |
$1,406.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,406.10
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 69643
|
| Min. Negotiated Rate |
$1,143.06 |
| Max. Negotiated Rate |
$2,649.40 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,188.78
|
| Rate for Payer: BCBS Complete |
$1,630.40
|
| Rate for Payer: BCBS MAPPO |
$1,143.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,143.06
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cofinity Commercial |
$1,646.01
|
| Rate for Payer: Cofinity Commercial |
$1,531.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,143.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,200.21
|
| Rate for Payer: Nomi Health Commercial |
$1,371.67
|
| Rate for Payer: PACE SWMI |
$1,143.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,143.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health Medicare |
$1,154.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,143.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,143.06
|
| Rate for Payer: UHC Exchange |
$1,143.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,143.06
|
|
|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,931.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$972.81 |
| Max. Negotiated Rate |
$2,555.15 |
| Rate for Payer: Aetna Commercial |
$1,303.57
|
| Rate for Payer: Aetna Medicare |
$1,011.72
|
| Rate for Payer: BCBS Complete |
$1,572.40
|
| Rate for Payer: BCBS MAPPO |
$972.81
|
| Rate for Payer: BCN Medicare Advantage |
$972.81
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cofinity Commercial |
$1,400.85
|
| Rate for Payer: Cofinity Commercial |
$1,303.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$972.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.45
|
| Rate for Payer: Nomi Health Commercial |
$1,167.37
|
| Rate for Payer: PACE SWMI |
$972.81
|
| Rate for Payer: PHP Medicare Advantage |
$972.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,555.15
|
| Rate for Payer: Priority Health Medicare |
$982.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$972.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$972.81
|
| Rate for Payer: UHC Exchange |
$972.81
|
| Rate for Payer: UHC Medicare Advantage |
$972.81
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$1,073.60 |
| Max. Negotiated Rate |
$1,799.24 |
| Rate for Payer: Aetna Commercial |
$1,674.29
|
| Rate for Payer: Aetna Medicare |
$1,299.45
|
| Rate for Payer: BCBS Complete |
$1,073.60
|
| Rate for Payer: BCBS MAPPO |
$1,249.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,249.47
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,799.24
|
| Rate for Payer: Cofinity Commercial |
$1,674.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,249.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,311.94
|
| Rate for Payer: Nomi Health Commercial |
$1,499.36
|
| Rate for Payer: PACE SWMI |
$1,249.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,249.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health Medicare |
$1,261.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,249.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,249.47
|
| Rate for Payer: UHC Exchange |
$1,249.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,249.47
|
|
|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$1,503.60 |
| Max. Negotiated Rate |
$2,443.35 |
| Rate for Payer: Aetna Medicare |
$1,879.50
|
| Rate for Payer: BCBS Complete |
$1,503.60
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.35
|
|
|
PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27681
|
| Min. Negotiated Rate |
$490.12 |
| Max. Negotiated Rate |
$1,127.75 |
| Rate for Payer: Aetna Commercial |
$656.76
|
| Rate for Payer: Aetna Medicare |
$509.72
|
| Rate for Payer: BCBS Complete |
$694.00
|
| Rate for Payer: BCBS MAPPO |
$490.12
|
| Rate for Payer: BCN Medicare Advantage |
$490.12
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cofinity Commercial |
$705.77
|
| Rate for Payer: Cofinity Commercial |
$656.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.63
|
| Rate for Payer: Nomi Health Commercial |
$588.14
|
| Rate for Payer: PACE SWMI |
$490.12
|
| Rate for Payer: PHP Medicare Advantage |
$490.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.75
|
| Rate for Payer: Priority Health Medicare |
$495.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.12
|
| Rate for Payer: UHC Exchange |
$490.12
|
| Rate for Payer: UHC Medicare Advantage |
$490.12
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$531.16
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$515.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Exchange |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$350.07 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: Aetna Commercial |
$1,252.90
|
| Rate for Payer: Aetna Medicare |
$383.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$460.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$460.62
|
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: BCBS MAPPO |
$368.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,211.78
|
| Rate for Payer: BCN Commercial |
$1,146.04
|
| Rate for Payer: BCN Medicare Advantage |
$368.50
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,267.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.50
|
| Rate for Payer: Healthscope Commercial |
$1,326.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,105.50
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$386.93
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$423.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: Nomi Health Commercial |
$1,208.68
|
| Rate for Payer: PACE Senior Care Partners |
$350.07
|
| Rate for Payer: PACE SWMI |
$368.50
|
| Rate for Payer: PHP Commercial |
$1,252.90
|
| Rate for Payer: PHP Medicare Advantage |
$368.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,282.38
|
| Rate for Payer: Priority Health Medicare |
$372.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$987.58
|
| Rate for Payer: Railroad Medicare Medicare |
$368.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,297.12
|
| Rate for Payer: UHC Core |
$1,230.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$368.50
|
| Rate for Payer: UHC Exchange |
$368.50
|
| Rate for Payer: UHC Medicare Advantage |
$368.50
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
| Rate for Payer: VA VA |
$368.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.50
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$958.10 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna Commercial |
$1,252.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,203.23
|
| Rate for Payer: BCN Commercial |
$1,139.11
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,267.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.20
|
| Rate for Payer: Healthscope Commercial |
$1,326.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,105.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: Nomi Health Commercial |
$1,208.68
|
| Rate for Payer: PHP Commercial |
$1,252.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,282.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$987.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,297.12
|
| Rate for Payer: UHC Core |
$1,230.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.50
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$531.16
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$515.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Exchange |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$513.88 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$688.60
|
| Rate for Payer: Aetna Medicare |
$534.44
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$513.88
|
| Rate for Payer: BCN Medicare Advantage |
$513.88
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$739.99
|
| Rate for Payer: Cofinity Commercial |
$688.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$539.57
|
| Rate for Payer: Nomi Health Commercial |
$616.66
|
| Rate for Payer: PACE SWMI |
$513.88
|
| Rate for Payer: PHP Medicare Advantage |
$513.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$519.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.88
|
| Rate for Payer: UHC Exchange |
$513.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.88
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$667.63
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$648.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Exchange |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$667.63
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$648.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Exchange |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$440.09 |
| Max. Negotiated Rate |
$2,463.31 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Aetna Medicare |
$481.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$579.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$579.06
|
| Rate for Payer: BCBS Complete |
$2,463.31
|
| Rate for Payer: BCBS MAPPO |
$463.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.35
|
| Rate for Payer: BCN Commercial |
$1,440.71
|
| Rate for Payer: BCN Medicare Advantage |
$463.25
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,593.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$463.25
|
| Rate for Payer: Healthscope Commercial |
$1,667.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.75
|
| Rate for Payer: Mclaren Medicaid |
$2,345.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$486.41
|
| Rate for Payer: Meridian Medicaid |
$2,463.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$532.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: Nomi Health Commercial |
$1,519.46
|
| Rate for Payer: PACE Senior Care Partners |
$440.09
|
| Rate for Payer: PACE SWMI |
$463.25
|
| Rate for Payer: PHP Commercial |
$1,575.05
|
| Rate for Payer: PHP Medicare Advantage |
$463.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,345.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,612.11
|
| Rate for Payer: Priority Health Medicare |
$467.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,241.51
|
| Rate for Payer: Railroad Medicare Medicare |
$463.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.64
|
| Rate for Payer: UHC Core |
$1,547.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$463.25
|
| Rate for Payer: UHC Exchange |
$463.25
|
| Rate for Payer: UHC Medicare Advantage |
$463.25
|
| Rate for Payer: UHCCP Medicaid |
$2,345.85
|
| Rate for Payer: VA VA |
$463.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$1,204.45 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.60
|
| Rate for Payer: BCN Commercial |
$1,432.00
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,593.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Healthscope Commercial |
$1,667.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: Nomi Health Commercial |
$1,519.46
|
| Rate for Payer: PHP Commercial |
$1,575.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,612.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,241.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,630.64
|
| Rate for Payer: UHC Core |
$1,547.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.75
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$423.48 |
| Max. Negotiated Rate |
$829.40 |
| Rate for Payer: Aetna Commercial |
$567.46
|
| Rate for Payer: Aetna Medicare |
$440.42
|
| Rate for Payer: BCBS Complete |
$510.40
|
| Rate for Payer: BCBS MAPPO |
$423.48
|
| Rate for Payer: BCN Medicare Advantage |
$423.48
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cofinity Commercial |
$609.81
|
| Rate for Payer: Cofinity Commercial |
$567.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.65
|
| Rate for Payer: Nomi Health Commercial |
$508.18
|
| Rate for Payer: PACE SWMI |
$423.48
|
| Rate for Payer: PHP Medicare Advantage |
$423.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health Medicare |
$427.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.48
|
| Rate for Payer: UHC Exchange |
$423.48
|
| Rate for Payer: UHC Medicare Advantage |
$423.48
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Medicare |
$24.52
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$23.58
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$31.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$28.30
|
| Rate for Payer: PACE SWMI |
$23.58
|
| Rate for Payer: PHP Medicare Advantage |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$23.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.58
|
| Rate for Payer: UHC Exchange |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.58
|
|
