|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$715.04 |
| Max. Negotiated Rate |
$2,681.25 |
| Rate for Payer: Aetna Commercial |
$1,477.07
|
| Rate for Payer: Aetna Medicare |
$1,146.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,587.30
|
| Rate for Payer: BCBS Complete |
$750.79
|
| Rate for Payer: BCBS MAPPO |
$1,102.29
|
| Rate for Payer: BCN Commercial |
$2,040.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,102.29
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,477.07
|
| Rate for Payer: Cofinity Commercial |
$1,587.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,102.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,157.40
|
| Rate for Payer: Meridian Medicaid |
$750.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,212.52
|
| Rate for Payer: Nomi Health Commercial |
$1,322.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,681.25
|
| Rate for Payer: PACE SWMI |
$1,102.29
|
| Rate for Payer: PHP Commercial |
$1,543.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,102.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,985.58
|
| Rate for Payer: Priority Health Medicare |
$1,102.29
|
| Rate for Payer: Priority Health SBD |
$1,985.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,985.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,102.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,157.98
|
| Rate for Payer: UHC Core |
$2,157.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,102.29
|
| Rate for Payer: UHC Exchange |
$2,157.98
|
| Rate for Payer: UHC Medicaid |
$715.04
|
| Rate for Payer: UHCCP Medicaid |
$715.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,644.50
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$224.08 |
| Max. Negotiated Rate |
$651.06 |
| Rate for Payer: Aetna Commercial |
$462.77
|
| Rate for Payer: Aetna Medicare |
$359.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.30
|
| Rate for Payer: BCBS Complete |
$235.28
|
| Rate for Payer: BCBS MAPPO |
$345.35
|
| Rate for Payer: BCN Commercial |
$584.13
|
| Rate for Payer: BCN Medicare Advantage |
$345.35
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cofinity Commercial |
$462.77
|
| Rate for Payer: Cofinity Commercial |
$497.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$362.62
|
| Rate for Payer: Meridian Medicaid |
$235.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$379.88
|
| Rate for Payer: Nomi Health Commercial |
$414.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: PACE SWMI |
$345.35
|
| Rate for Payer: PHP Commercial |
$483.49
|
| Rate for Payer: PHP Medicare Advantage |
$345.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$551.42
|
| Rate for Payer: Priority Health Medicare |
$345.35
|
| Rate for Payer: Priority Health SBD |
$551.42
|
| Rate for Payer: Priority Health Tiered Network |
$551.42
|
| Rate for Payer: Railroad Medicare Medicare |
$345.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.06
|
| Rate for Payer: UHC Core |
$651.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$345.35
|
| Rate for Payer: UHC Exchange |
$651.06
|
| Rate for Payer: UHC Medicaid |
$224.08
|
| Rate for Payer: UHCCP Medicaid |
$224.08
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$219.39 |
| Max. Negotiated Rate |
$647.11 |
| Rate for Payer: Aetna Commercial |
$455.57
|
| Rate for Payer: Aetna Medicare |
$353.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.57
|
| Rate for Payer: BCBS Complete |
$230.36
|
| Rate for Payer: BCBS MAPPO |
$339.98
|
| Rate for Payer: BCN Commercial |
$570.69
|
| Rate for Payer: BCN Medicare Advantage |
$339.98
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cofinity Commercial |
$455.57
|
| Rate for Payer: Cofinity Commercial |
$489.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.98
|
| Rate for Payer: Meridian Medicaid |
$230.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$373.98
|
| Rate for Payer: Nomi Health Commercial |
$407.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: PACE SWMI |
$339.98
|
| Rate for Payer: PHP Commercial |
$475.97
|
| Rate for Payer: PHP Medicare Advantage |
$339.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$219.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$538.73
|
| Rate for Payer: Priority Health Medicare |
$339.98
|
| Rate for Payer: Priority Health SBD |
$538.73
|
| Rate for Payer: Priority Health Tiered Network |
$538.73
|
| Rate for Payer: Railroad Medicare Medicare |
$339.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.11
|
| Rate for Payer: UHC Core |
$647.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$339.98
|
| Rate for Payer: UHC Exchange |
$647.11
|
| Rate for Payer: UHC Medicaid |
$219.39
|
| Rate for Payer: UHCCP Medicaid |
$219.39
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Aetna Commercial |
$299.38
|
| Rate for Payer: Aetna Medicare |
$232.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.72
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS MAPPO |
$223.42
|
| Rate for Payer: BCN Commercial |
$366.51
|
| Rate for Payer: BCN Medicare Advantage |
$223.42
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cofinity Commercial |
$299.38
|
| Rate for Payer: Cofinity Commercial |
$321.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.59
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$245.76
|
| Rate for Payer: Nomi Health Commercial |
$268.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$490.50
|
| Rate for Payer: PACE SWMI |
$223.42
|
| Rate for Payer: PHP Commercial |
$312.79
|
| Rate for Payer: PHP Medicare Advantage |
$223.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$391.79
|
| Rate for Payer: Priority Health Medicare |
$223.42
|
| Rate for Payer: Priority Health SBD |
$391.79
|
| Rate for Payer: Priority Health Tiered Network |
$391.79
|
| Rate for Payer: Railroad Medicare Medicare |
$223.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.76
|
| Rate for Payer: UHC Core |
$419.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$223.42
|
| Rate for Payer: UHC Exchange |
$419.76
|
| Rate for Payer: UHC Medicaid |
$147.40
|
| Rate for Payer: UHCCP Medicaid |
$147.40
|
| Rate for Payer: UMR Bronson Commercial |
$300.84
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$172.10 |
| Max. Negotiated Rate |
$494.30 |
| Rate for Payer: Aetna Commercial |
$350.88
|
| Rate for Payer: Aetna Medicare |
$272.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$377.06
|
| Rate for Payer: BCBS Complete |
$180.71
|
| Rate for Payer: BCBS MAPPO |
$261.85
|
| Rate for Payer: BCN Commercial |
$434.74
|
| Rate for Payer: BCN Medicare Advantage |
$261.85
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Cofinity Commercial |
$377.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$261.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$274.94
|
| Rate for Payer: Meridian Medicaid |
$180.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.04
|
| Rate for Payer: Nomi Health Commercial |
$314.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.00
|
| Rate for Payer: PACE SWMI |
$261.85
|
| Rate for Payer: PHP Commercial |
$366.59
|
| Rate for Payer: PHP Medicare Advantage |
$261.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$464.71
|
| Rate for Payer: Priority Health Medicare |
$261.85
|
| Rate for Payer: Priority Health SBD |
$464.71
|
| Rate for Payer: Priority Health Tiered Network |
$464.71
|
| Rate for Payer: Railroad Medicare Medicare |
$261.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$494.30
|
| Rate for Payer: UHC Core |
$494.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$261.85
|
| Rate for Payer: UHC Exchange |
$494.30
|
| Rate for Payer: UHC Medicaid |
$172.10
|
| Rate for Payer: UHCCP Medicaid |
$172.10
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$798.57 |
| Rate for Payer: Aetna Commercial |
$557.79
|
| Rate for Payer: Aetna Medicare |
$432.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$557.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.41
|
| Rate for Payer: BCBS Complete |
$280.69
|
| Rate for Payer: BCBS MAPPO |
$416.26
|
| Rate for Payer: BCN Commercial |
$698.67
|
| Rate for Payer: BCN Medicare Advantage |
$416.26
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cash Price |
$824.00
|
| Rate for Payer: Cofinity Commercial |
$557.79
|
| Rate for Payer: Cofinity Commercial |
$599.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.07
|
| Rate for Payer: Meridian Medicaid |
$280.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.89
|
| Rate for Payer: Nomi Health Commercial |
$499.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$772.50
|
| Rate for Payer: PACE SWMI |
$416.26
|
| Rate for Payer: PHP Commercial |
$582.76
|
| Rate for Payer: PHP Medicare Advantage |
$416.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$659.54
|
| Rate for Payer: Priority Health Medicare |
$416.26
|
| Rate for Payer: Priority Health SBD |
$659.54
|
| Rate for Payer: Priority Health Tiered Network |
$659.54
|
| Rate for Payer: Railroad Medicare Medicare |
$416.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.57
|
| Rate for Payer: UHC Core |
$798.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.26
|
| Rate for Payer: UHC Exchange |
$798.57
|
| Rate for Payer: UHC Medicaid |
$267.32
|
| Rate for Payer: UHCCP Medicaid |
$267.32
|
| Rate for Payer: UMR Bronson Commercial |
$473.80
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,649.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$4,986.75 |
| Rate for Payer: Aetna Commercial |
$1,123.12
|
| Rate for Payer: Aetna Medicare |
$871.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.94
|
| Rate for Payer: BCBS Complete |
$573.67
|
| Rate for Payer: BCBS MAPPO |
$838.15
|
| Rate for Payer: BCN Commercial |
$1,403.31
|
| Rate for Payer: BCN Medicare Advantage |
$838.15
|
| Rate for Payer: Cash Price |
$5,319.20
|
| Rate for Payer: Cash Price |
$5,319.20
|
| Rate for Payer: Cofinity Commercial |
$1,123.12
|
| Rate for Payer: Cofinity Commercial |
$1,206.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$838.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$880.06
|
| Rate for Payer: Meridian Medicaid |
$573.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$921.97
|
| Rate for Payer: Nomi Health Commercial |
$1,005.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,986.75
|
| Rate for Payer: PACE SWMI |
$838.15
|
| Rate for Payer: PHP Commercial |
$1,173.41
|
| Rate for Payer: PHP Medicare Advantage |
$838.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$546.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,500.09
|
| Rate for Payer: Priority Health Medicare |
$838.15
|
| Rate for Payer: Priority Health SBD |
$1,500.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,500.09
|
| Rate for Payer: Railroad Medicare Medicare |
$838.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,609.13
|
| Rate for Payer: UHC Core |
$1,609.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$838.15
|
| Rate for Payer: UHC Exchange |
$1,609.13
|
| Rate for Payer: UHC Medicaid |
$546.35
|
| Rate for Payer: UHCCP Medicaid |
$546.35
|
| Rate for Payer: UMR Bronson Commercial |
$3,058.54
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$674.25 |
| Rate for Payer: Aetna Commercial |
$434.59
|
| Rate for Payer: Aetna Medicare |
$337.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.02
|
| Rate for Payer: BCBS Complete |
$220.74
|
| Rate for Payer: BCBS MAPPO |
$324.32
|
| Rate for Payer: BCN Commercial |
$547.78
|
| Rate for Payer: BCN Medicare Advantage |
$324.32
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cofinity Commercial |
$434.59
|
| Rate for Payer: Cofinity Commercial |
$467.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.54
|
| Rate for Payer: Meridian Medicaid |
$220.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$356.75
|
| Rate for Payer: Nomi Health Commercial |
$389.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.25
|
| Rate for Payer: PACE SWMI |
$324.32
|
| Rate for Payer: PHP Commercial |
$454.05
|
| Rate for Payer: PHP Medicare Advantage |
$324.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$585.56
|
| Rate for Payer: Priority Health Medicare |
$324.32
|
| Rate for Payer: Priority Health SBD |
$585.56
|
| Rate for Payer: Priority Health Tiered Network |
$585.56
|
| Rate for Payer: Railroad Medicare Medicare |
$324.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.13
|
| Rate for Payer: UHC Core |
$634.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$324.32
|
| Rate for Payer: UHC Exchange |
$634.13
|
| Rate for Payer: UHC Medicaid |
$210.23
|
| Rate for Payer: UHCCP Medicaid |
$210.23
|
| Rate for Payer: UMR Bronson Commercial |
$413.54
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$232.91
|
| Rate for Payer: Aetna Medicare |
$180.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.29
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$284.85
|
| Rate for Payer: BCN Medicare Advantage |
$173.81
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$232.91
|
| Rate for Payer: Cofinity Commercial |
$250.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.50
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.19
|
| Rate for Payer: Nomi Health Commercial |
$208.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE SWMI |
$173.81
|
| Rate for Payer: PHP Commercial |
$243.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$260.70
|
| Rate for Payer: Priority Health Medicare |
$173.81
|
| Rate for Payer: Priority Health SBD |
$260.70
|
| Rate for Payer: Priority Health Tiered Network |
$260.70
|
| Rate for Payer: Railroad Medicare Medicare |
$173.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.51
|
| Rate for Payer: UHC Core |
$328.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.81
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
| Rate for Payer: UMR Bronson Commercial |
$222.64
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$232.91
|
| Rate for Payer: Aetna Medicare |
$180.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.29
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$173.81
|
| Rate for Payer: BCN Commercial |
$284.85
|
| Rate for Payer: BCN Medicare Advantage |
$173.81
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Commercial |
$232.91
|
| Rate for Payer: Cofinity Commercial |
$250.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.50
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.19
|
| Rate for Payer: Nomi Health Commercial |
$208.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE SWMI |
$173.81
|
| Rate for Payer: PHP Commercial |
$243.33
|
| Rate for Payer: PHP Medicare Advantage |
$173.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$260.70
|
| Rate for Payer: Priority Health Medicare |
$173.81
|
| Rate for Payer: Priority Health SBD |
$260.70
|
| Rate for Payer: Priority Health Tiered Network |
$260.70
|
| Rate for Payer: Railroad Medicare Medicare |
$173.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$328.51
|
| Rate for Payer: UHC Core |
$328.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$173.81
|
| Rate for Payer: UHC Exchange |
$328.51
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
| Rate for Payer: UMR Bronson Commercial |
$222.64
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$2,381.49 |
| Rate for Payer: Aetna American Axle |
$314.60
|
| Rate for Payer: Aetna Commercial |
$411.40
|
| Rate for Payer: Aetna Medicare |
$765.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$920.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$920.51
|
| Rate for Payer: BCBS Complete |
$404.44
|
| Rate for Payer: BCBS MAPPO |
$736.41
|
| Rate for Payer: BCBS Trust/PPO |
$787.19
|
| Rate for Payer: BCN Commercial |
$787.19
|
| Rate for Payer: BCN Medicare Advantage |
$736.41
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Advantage |
$338.80
|
| Rate for Payer: Cofinity Commercial |
$416.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$736.41
|
| Rate for Payer: Healthscope Commercial |
$435.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.00
|
| Rate for Payer: Mclaren Medicaid |
$736.41
|
| Rate for Payer: Mclaren Medicare |
$736.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$773.23
|
| Rate for Payer: Meridian Medicaid |
$773.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$846.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$810.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.40
|
| Rate for Payer: Nomi Health Commercial |
$2,209.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PACE Medicare |
$699.59
|
| Rate for Payer: PACE SWMI |
$736.41
|
| Rate for Payer: PHP Commercial |
$411.40
|
| Rate for Payer: PHP Medicare Advantage |
$736.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,381.49
|
| Rate for Payer: Priority Health Medicare |
$736.41
|
| Rate for Payer: Priority Health SBD |
$304.92
|
| Rate for Payer: Priority Health Tiered Network |
$1,905.19
|
| Rate for Payer: Railroad Medicare Medicare |
$736.41
|
| Rate for Payer: UHC Medicaid |
$385.14
|
| Rate for Payer: UHCCP Medicaid |
$385.14
|
| Rate for Payer: UMR Bronson Commercial |
$179.08
|
| Rate for Payer: VA VA |
$736.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.00
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$212.96 |
| Max. Negotiated Rate |
$435.60 |
| Rate for Payer: Aetna American Axle |
$314.60
|
| Rate for Payer: Aetna Commercial |
$411.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.60
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cofinity Advantage |
$338.80
|
| Rate for Payer: Cofinity Commercial |
$416.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.20
|
| Rate for Payer: Healthscope Commercial |
$435.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$363.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.00
|
| Rate for Payer: PHP Commercial |
$411.40
|
| Rate for Payer: Priority Health SBD |
$304.92
|
| Rate for Payer: UMR Bronson Commercial |
$212.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$363.00
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Medicare |
$135.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.09
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$130.62
|
| Rate for Payer: BCN Commercial |
$211.65
|
| Rate for Payer: BCN Medicare Advantage |
$130.62
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$175.03
|
| Rate for Payer: Cofinity Commercial |
$188.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$137.15
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.68
|
| Rate for Payer: Nomi Health Commercial |
$156.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.25
|
| Rate for Payer: PACE SWMI |
$130.62
|
| Rate for Payer: PHP Commercial |
$182.87
|
| Rate for Payer: PHP Medicare Advantage |
$130.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$193.70
|
| Rate for Payer: Priority Health Medicare |
$130.62
|
| Rate for Payer: Priority Health SBD |
$193.70
|
| Rate for Payer: Priority Health Tiered Network |
$193.70
|
| Rate for Payer: Railroad Medicare Medicare |
$130.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.19
|
| Rate for Payer: UHC Core |
$242.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.62
|
| Rate for Payer: UHC Exchange |
$242.19
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
| Rate for Payer: UMR Bronson Commercial |
$165.14
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCNS W/O MNPJ EACH
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$450.00 |
| Rate for Payer: Aetna Commercial |
$248.24
|
| Rate for Payer: Aetna Medicare |
$192.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.76
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS MAPPO |
$185.25
|
| Rate for Payer: BCN Commercial |
$298.79
|
| Rate for Payer: BCN Medicare Advantage |
$185.25
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$248.24
|
| Rate for Payer: Cofinity Commercial |
$266.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.51
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.78
|
| Rate for Payer: Nomi Health Commercial |
$222.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: PACE SWMI |
$185.25
|
| Rate for Payer: PHP Commercial |
$259.35
|
| Rate for Payer: PHP Medicare Advantage |
$185.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$319.40
|
| Rate for Payer: Priority Health Medicare |
$185.25
|
| Rate for Payer: Priority Health SBD |
$319.40
|
| Rate for Payer: Priority Health Tiered Network |
$319.40
|
| Rate for Payer: Railroad Medicare Medicare |
$185.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.62
|
| Rate for Payer: UHC Core |
$326.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.25
|
| Rate for Payer: UHC Exchange |
$326.62
|
| Rate for Payer: UHC Medicaid |
$123.97
|
| Rate for Payer: UHCCP Medicaid |
$123.97
|
| Rate for Payer: UMR Bronson Commercial |
$276.00
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MNPJ EACH
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$141.01 |
| Max. Negotiated Rate |
$624.00 |
| Rate for Payer: Aetna Commercial |
$285.34
|
| Rate for Payer: Aetna Medicare |
$221.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.63
|
| Rate for Payer: BCBS Complete |
$148.06
|
| Rate for Payer: BCBS MAPPO |
$212.94
|
| Rate for Payer: BCN Commercial |
$353.07
|
| Rate for Payer: BCN Medicare Advantage |
$212.94
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$285.34
|
| Rate for Payer: Cofinity Commercial |
$306.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.59
|
| Rate for Payer: Meridian Medicaid |
$148.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.23
|
| Rate for Payer: Nomi Health Commercial |
$255.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$624.00
|
| Rate for Payer: PACE SWMI |
$212.94
|
| Rate for Payer: PHP Commercial |
$298.12
|
| Rate for Payer: PHP Medicare Advantage |
$212.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$377.43
|
| Rate for Payer: Priority Health Medicare |
$212.94
|
| Rate for Payer: Priority Health SBD |
$377.43
|
| Rate for Payer: Priority Health Tiered Network |
$377.43
|
| Rate for Payer: Railroad Medicare Medicare |
$212.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.48
|
| Rate for Payer: UHC Core |
$444.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.94
|
| Rate for Payer: UHC Exchange |
$444.48
|
| Rate for Payer: UHC Medicaid |
$141.01
|
| Rate for Payer: UHCCP Medicaid |
$141.01
|
| Rate for Payer: UMR Bronson Commercial |
$382.72
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,393.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$585.54 |
| Max. Negotiated Rate |
$3,294.75 |
| Rate for Payer: Aetna Commercial |
$1,206.91
|
| Rate for Payer: Aetna Medicare |
$936.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,206.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,296.98
|
| Rate for Payer: BCBS Complete |
$614.82
|
| Rate for Payer: BCBS MAPPO |
$900.68
|
| Rate for Payer: BCN Commercial |
$1,662.54
|
| Rate for Payer: BCN Medicare Advantage |
$900.68
|
| Rate for Payer: Cash Price |
$3,514.40
|
| Rate for Payer: Cash Price |
$3,514.40
|
| Rate for Payer: Cofinity Commercial |
$1,206.91
|
| Rate for Payer: Cofinity Commercial |
$1,296.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$900.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$945.71
|
| Rate for Payer: Meridian Medicaid |
$614.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$990.75
|
| Rate for Payer: Nomi Health Commercial |
$1,080.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,294.75
|
| Rate for Payer: PACE SWMI |
$900.68
|
| Rate for Payer: PHP Commercial |
$1,260.95
|
| Rate for Payer: PHP Medicare Advantage |
$900.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$585.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,617.74
|
| Rate for Payer: Priority Health Medicare |
$900.68
|
| Rate for Payer: Priority Health SBD |
$1,617.74
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.74
|
| Rate for Payer: Railroad Medicare Medicare |
$900.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,749.78
|
| Rate for Payer: UHC Core |
$1,749.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$900.68
|
| Rate for Payer: UHC Exchange |
$1,749.78
|
| Rate for Payer: UHC Medicaid |
$585.54
|
| Rate for Payer: UHCCP Medicaid |
$585.54
|
| Rate for Payer: UMR Bronson Commercial |
$2,020.78
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$688.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$159.11 |
| Max. Negotiated Rate |
$516.00 |
| Rate for Payer: Aetna Commercial |
$328.22
|
| Rate for Payer: Aetna Medicare |
$254.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.71
|
| Rate for Payer: BCBS Complete |
$167.07
|
| Rate for Payer: BCBS MAPPO |
$244.94
|
| Rate for Payer: BCN Commercial |
$431.75
|
| Rate for Payer: BCN Medicare Advantage |
$244.94
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cash Price |
$550.40
|
| Rate for Payer: Cofinity Commercial |
$328.22
|
| Rate for Payer: Cofinity Commercial |
$352.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$257.19
|
| Rate for Payer: Meridian Medicaid |
$167.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$269.43
|
| Rate for Payer: Nomi Health Commercial |
$293.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.00
|
| Rate for Payer: PACE SWMI |
$244.94
|
| Rate for Payer: PHP Commercial |
$342.92
|
| Rate for Payer: PHP Medicare Advantage |
$244.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$426.60
|
| Rate for Payer: Priority Health Medicare |
$244.94
|
| Rate for Payer: Priority Health SBD |
$426.60
|
| Rate for Payer: Priority Health Tiered Network |
$426.60
|
| Rate for Payer: Railroad Medicare Medicare |
$244.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$500.58
|
| Rate for Payer: UHC Core |
$500.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$244.94
|
| Rate for Payer: UHC Exchange |
$500.58
|
| Rate for Payer: UHC Medicaid |
$159.11
|
| Rate for Payer: UHCCP Medicaid |
$159.11
|
| Rate for Payer: UMR Bronson Commercial |
$316.48
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$11.50
|
| Rate for Payer: Aetna Medicare |
$8.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.36
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.58
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.58
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$12.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.01
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.44
|
| Rate for Payer: Nomi Health Commercial |
$10.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE SWMI |
$8.58
|
| Rate for Payer: PHP Commercial |
$12.01
|
| Rate for Payer: PHP Medicare Advantage |
$8.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.69
|
| Rate for Payer: Priority Health Medicare |
$8.58
|
| Rate for Payer: Priority Health SBD |
$14.69
|
| Rate for Payer: Priority Health Tiered Network |
$14.69
|
| Rate for Payer: Railroad Medicare Medicare |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$17.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.58
|
| Rate for Payer: UHC Exchange |
$17.52
|
| Rate for Payer: UHC Medicaid |
$5.54
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$35.32 |
| Rate for Payer: Aetna Commercial |
$28.02
|
| Rate for Payer: Aetna Medicare |
$21.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: BCBS MAPPO |
$20.91
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$20.91
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.00
|
| Rate for Payer: Nomi Health Commercial |
$25.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: PACE SWMI |
$20.91
|
| Rate for Payer: PHP Commercial |
$29.27
|
| Rate for Payer: PHP Medicare Advantage |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.86
|
| Rate for Payer: Priority Health Medicare |
$20.91
|
| Rate for Payer: Priority Health SBD |
$29.86
|
| Rate for Payer: Priority Health Tiered Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$20.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.32
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.91
|
| Rate for Payer: UHC Exchange |
$35.32
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,877.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$912.71 |
| Max. Negotiated Rate |
$2,630.32 |
| Rate for Payer: Aetna Commercial |
$1,847.12
|
| Rate for Payer: Aetna Medicare |
$1,433.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.97
|
| Rate for Payer: BCBS Complete |
$958.35
|
| Rate for Payer: BCBS MAPPO |
$1,378.45
|
| Rate for Payer: BCN Commercial |
$2,342.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.45
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cash Price |
$2,301.60
|
| Rate for Payer: Cofinity Commercial |
$1,984.97
|
| Rate for Payer: Cofinity Commercial |
$1,847.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,447.37
|
| Rate for Payer: Meridian Medicaid |
$958.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,516.30
|
| Rate for Payer: Nomi Health Commercial |
$1,654.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,157.75
|
| Rate for Payer: PACE SWMI |
$1,378.45
|
| Rate for Payer: PHP Commercial |
$1,929.83
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$912.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,314.14
|
| Rate for Payer: Priority Health Medicare |
$1,378.45
|
| Rate for Payer: Priority Health SBD |
$2,314.14
|
| Rate for Payer: Priority Health Tiered Network |
$2,314.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1,378.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,630.32
|
| Rate for Payer: UHC Core |
$2,630.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,378.45
|
| Rate for Payer: UHC Exchange |
$2,630.32
|
| Rate for Payer: UHC Medicaid |
$912.71
|
| Rate for Payer: UHCCP Medicaid |
$912.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,323.42
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$861.37 |
| Max. Negotiated Rate |
$2,477.95 |
| Rate for Payer: Aetna Commercial |
$1,739.33
|
| Rate for Payer: Aetna Medicare |
$1,349.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,739.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.13
|
| Rate for Payer: BCBS Complete |
$904.44
|
| Rate for Payer: BCBS MAPPO |
$1,298.01
|
| Rate for Payer: BCN Commercial |
$2,214.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.01
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,739.33
|
| Rate for Payer: Cofinity Commercial |
$1,869.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,362.91
|
| Rate for Payer: Meridian Medicaid |
$904.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,427.81
|
| Rate for Payer: Nomi Health Commercial |
$1,557.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,049.00
|
| Rate for Payer: PACE SWMI |
$1,298.01
|
| Rate for Payer: PHP Commercial |
$1,817.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$861.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,187.68
|
| Rate for Payer: Priority Health Medicare |
$1,298.01
|
| Rate for Payer: Priority Health SBD |
$2,187.68
|
| Rate for Payer: Priority Health Tiered Network |
$2,187.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,298.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,477.95
|
| Rate for Payer: UHC Core |
$2,477.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,298.01
|
| Rate for Payer: UHC Exchange |
$2,477.95
|
| Rate for Payer: UHC Medicaid |
$861.37
|
| Rate for Payer: UHCCP Medicaid |
$861.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,256.72
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,945.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$601.51 |
| Max. Negotiated Rate |
$1,776.54 |
| Rate for Payer: Aetna Commercial |
$1,218.69
|
| Rate for Payer: Aetna Medicare |
$945.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,218.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,309.64
|
| Rate for Payer: BCBS Complete |
$631.59
|
| Rate for Payer: BCBS MAPPO |
$909.47
|
| Rate for Payer: BCN Commercial |
$1,571.13
|
| Rate for Payer: BCN Medicare Advantage |
$909.47
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cash Price |
$1,556.00
|
| Rate for Payer: Cofinity Commercial |
$1,218.69
|
| Rate for Payer: Cofinity Commercial |
$1,309.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$954.94
|
| Rate for Payer: Meridian Medicaid |
$631.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,000.42
|
| Rate for Payer: Nomi Health Commercial |
$1,091.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,458.75
|
| Rate for Payer: PACE SWMI |
$909.47
|
| Rate for Payer: PHP Commercial |
$1,273.26
|
| Rate for Payer: PHP Medicare Advantage |
$909.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$601.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,552.43
|
| Rate for Payer: Priority Health Medicare |
$909.47
|
| Rate for Payer: Priority Health SBD |
$1,552.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,552.43
|
| Rate for Payer: Railroad Medicare Medicare |
$909.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,776.54
|
| Rate for Payer: UHC Core |
$1,776.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$909.47
|
| Rate for Payer: UHC Exchange |
$1,776.54
|
| Rate for Payer: UHC Medicaid |
$601.51
|
| Rate for Payer: UHCCP Medicaid |
$601.51
|
| Rate for Payer: UMR Bronson Commercial |
$894.70
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$509.71 |
| Max. Negotiated Rate |
$2,429.25 |
| Rate for Payer: Aetna Commercial |
$1,029.94
|
| Rate for Payer: Aetna Medicare |
$799.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,106.80
|
| Rate for Payer: BCBS Complete |
$535.20
|
| Rate for Payer: BCBS MAPPO |
$768.61
|
| Rate for Payer: BCN Commercial |
$1,325.62
|
| Rate for Payer: BCN Medicare Advantage |
$768.61
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$1,029.94
|
| Rate for Payer: Cofinity Commercial |
$1,106.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$768.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$807.04
|
| Rate for Payer: Meridian Medicaid |
$535.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$845.47
|
| Rate for Payer: Nomi Health Commercial |
$922.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,429.25
|
| Rate for Payer: PACE SWMI |
$768.61
|
| Rate for Payer: PHP Commercial |
$1,076.05
|
| Rate for Payer: PHP Medicare Advantage |
$768.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,309.84
|
| Rate for Payer: Priority Health Medicare |
$768.61
|
| Rate for Payer: Priority Health SBD |
$1,309.84
|
| Rate for Payer: Priority Health Tiered Network |
$1,309.84
|
| Rate for Payer: Railroad Medicare Medicare |
$768.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,502.49
|
| Rate for Payer: UHC Core |
$1,502.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$768.61
|
| Rate for Payer: UHC Exchange |
$1,502.49
|
| Rate for Payer: UHC Medicaid |
$509.71
|
| Rate for Payer: UHCCP Medicaid |
$509.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,489.94
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$92.23 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna Commercial |
$187.28
|
| Rate for Payer: Aetna Medicare |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.25
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.76
|
| Rate for Payer: BCN Commercial |
$241.52
|
| Rate for Payer: BCN Medicare Advantage |
$139.76
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$187.28
|
| Rate for Payer: Cofinity Commercial |
$201.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.75
|
| Rate for Payer: Meridian Medicaid |
$96.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$153.74
|
| Rate for Payer: Nomi Health Commercial |
$167.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$139.76
|
| Rate for Payer: PHP Commercial |
$195.66
|
| Rate for Payer: PHP Medicare Advantage |
$139.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$238.65
|
| Rate for Payer: Priority Health Medicare |
$139.76
|
| Rate for Payer: Priority Health SBD |
$238.65
|
| Rate for Payer: Priority Health Tiered Network |
$238.65
|
| Rate for Payer: Railroad Medicare Medicare |
$139.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.61
|
| Rate for Payer: UHC Core |
$269.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$139.76
|
| Rate for Payer: UHC Exchange |
$269.61
|
| Rate for Payer: UHC Medicaid |
$92.23
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$254.25 |
| Rate for Payer: Aetna Commercial |
$154.27
|
| Rate for Payer: Aetna Medicare |
$119.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.79
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$115.13
|
| Rate for Payer: BCN Commercial |
$158.26
|
| Rate for Payer: BCN Medicare Advantage |
$115.13
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$154.27
|
| Rate for Payer: Cofinity Commercial |
$165.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.89
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$126.64
|
| Rate for Payer: Nomi Health Commercial |
$138.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$254.25
|
| Rate for Payer: PACE SWMI |
$115.13
|
| Rate for Payer: PHP Commercial |
$161.18
|
| Rate for Payer: PHP Medicare Advantage |
$115.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.30
|
| Rate for Payer: Priority Health Medicare |
$115.13
|
| Rate for Payer: Priority Health SBD |
$198.30
|
| Rate for Payer: Priority Health Tiered Network |
$198.30
|
| Rate for Payer: Railroad Medicare Medicare |
$115.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.28
|
| Rate for Payer: UHC Core |
$223.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.13
|
| Rate for Payer: UHC Exchange |
$223.28
|
| Rate for Payer: UHC Medicaid |
$76.25
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
| Rate for Payer: UMR Bronson Commercial |
$155.94
|
|
