|
PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 20690
|
| Min. Negotiated Rate |
$410.00 |
| Max. Negotiated Rate |
$830.10 |
| Rate for Payer: Aetna Commercial |
$772.46
|
| Rate for Payer: Aetna Medicare |
$576.46
|
| Rate for Payer: BCBS Complete |
$410.00
|
| Rate for Payer: BCBS MAPPO |
$576.46
|
| Rate for Payer: BCN Medicare Advantage |
$576.46
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$830.10
|
| Rate for Payer: Cofinity Commercial |
$772.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.46
|
| Rate for Payer: Healthscope Commercial |
$691.75
|
| Rate for Payer: Healthscope Whirlpool |
$691.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.28
|
| Rate for Payer: Nomi Health Commercial |
$691.75
|
| Rate for Payer: PACE SWMI |
$576.46
|
| Rate for Payer: PHP Medicare Advantage |
$576.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.25
|
| Rate for Payer: Priority Health Medicare |
$576.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.46
|
| Rate for Payer: UHC Medicare Advantage |
$576.46
|
| Rate for Payer: UHCCP DNSP |
$576.46
|
|
|
PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC
|
Professional
|
Both
|
$1,803.00
|
|
|
Service Code
|
HCPCS 21110
|
| Min. Negotiated Rate |
$647.04 |
| Max. Negotiated Rate |
$1,171.95 |
| Rate for Payer: Aetna Commercial |
$867.03
|
| Rate for Payer: Aetna Medicare |
$647.04
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: BCBS MAPPO |
$647.04
|
| Rate for Payer: BCN Medicare Advantage |
$647.04
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Cofinity Commercial |
$931.74
|
| Rate for Payer: Cofinity Commercial |
$867.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.04
|
| Rate for Payer: Healthscope Commercial |
$776.45
|
| Rate for Payer: Healthscope Whirlpool |
$776.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.39
|
| Rate for Payer: Nomi Health Commercial |
$776.45
|
| Rate for Payer: PACE SWMI |
$647.04
|
| Rate for Payer: PHP Medicare Advantage |
$647.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.95
|
| Rate for Payer: Priority Health Medicare |
$647.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.04
|
| Rate for Payer: UHC Medicare Advantage |
$647.04
|
| Rate for Payer: UHCCP DNSP |
$647.04
|
|
|
PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 29581
|
| Min. Negotiated Rate |
$25.09 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$33.62
|
| Rate for Payer: Aetna Medicare |
$25.09
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$25.09
|
| Rate for Payer: BCN Medicare Advantage |
$25.09
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$36.13
|
| Rate for Payer: Cofinity Commercial |
$33.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.09
|
| Rate for Payer: Healthscope Commercial |
$30.11
|
| Rate for Payer: Healthscope Whirlpool |
$30.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$30.11
|
| Rate for Payer: PACE SWMI |
$25.09
|
| Rate for Payer: PHP Medicare Advantage |
$25.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$25.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.09
|
| Rate for Payer: UHC Medicare Advantage |
$25.09
|
| Rate for Payer: UHCCP DNSP |
$25.09
|
|
|
PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 29583
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Medicare |
$41.50
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
|
|
PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29584
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Medicare |
$14.94
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$14.94
|
| Rate for Payer: BCN Medicare Advantage |
$14.94
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$21.51
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.94
|
| Rate for Payer: Healthscope Commercial |
$17.93
|
| Rate for Payer: Healthscope Whirlpool |
$17.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$17.93
|
| Rate for Payer: PACE SWMI |
$14.94
|
| Rate for Payer: PHP Medicare Advantage |
$14.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$14.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.94
|
| Rate for Payer: UHC Medicare Advantage |
$14.94
|
| Rate for Payer: UHCCP DNSP |
$14.94
|
|
|
PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 29582
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
|
|
PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 97014
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 97032
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$18.45
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$13.77
|
| Rate for Payer: BCN Medicare Advantage |
$13.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.77
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Healthscope Whirlpool |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.46
|
| Rate for Payer: Nomi Health Commercial |
$16.52
|
| Rate for Payer: PACE SWMI |
$13.77
|
| Rate for Payer: PHP Medicare Advantage |
$13.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.77
|
| Rate for Payer: UHC Medicare Advantage |
$13.77
|
| Rate for Payer: UHCCP DNSP |
$13.77
|
|
|
PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 97033
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$24.01
|
| Rate for Payer: Aetna Medicare |
$17.92
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$17.92
|
| Rate for Payer: BCN Medicare Advantage |
$17.92
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$25.80
|
| Rate for Payer: Cofinity Commercial |
$24.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.92
|
| Rate for Payer: Healthscope Commercial |
$21.50
|
| Rate for Payer: Healthscope Whirlpool |
$21.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.82
|
| Rate for Payer: Nomi Health Commercial |
$21.50
|
| Rate for Payer: PACE SWMI |
$17.92
|
| Rate for Payer: PHP Medicare Advantage |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$17.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.92
|
| Rate for Payer: UHC Medicare Advantage |
$17.92
|
| Rate for Payer: UHCCP DNSP |
$17.92
|
|
|
PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 97035
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Aetna Commercial |
$17.90
|
| Rate for Payer: Aetna Medicare |
$13.36
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$13.36
|
| Rate for Payer: BCN Medicare Advantage |
$13.36
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Cofinity Commercial |
$17.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.36
|
| Rate for Payer: Healthscope Commercial |
$16.03
|
| Rate for Payer: Healthscope Whirlpool |
$16.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.03
|
| Rate for Payer: Nomi Health Commercial |
$16.03
|
| Rate for Payer: PACE SWMI |
$13.36
|
| Rate for Payer: PHP Medicare Advantage |
$13.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$13.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.36
|
| Rate for Payer: UHC Medicare Advantage |
$13.36
|
| Rate for Payer: UHCCP DNSP |
$13.36
|
|
|
PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE
|
Professional
|
Both
|
$3,895.00
|
|
|
Service Code
|
HCPCS 20697
|
| Min. Negotiated Rate |
$1,496.03 |
| Max. Negotiated Rate |
$2,531.75 |
| Rate for Payer: Aetna Commercial |
$2,004.68
|
| Rate for Payer: Aetna Medicare |
$1,496.03
|
| Rate for Payer: BCBS Complete |
$1,558.00
|
| Rate for Payer: BCBS MAPPO |
$1,496.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,496.03
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cash Price |
$3,116.00
|
| Rate for Payer: Cofinity Commercial |
$2,154.28
|
| Rate for Payer: Cofinity Commercial |
$2,004.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,496.03
|
| Rate for Payer: Healthscope Commercial |
$1,795.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,795.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,570.83
|
| Rate for Payer: Nomi Health Commercial |
$1,795.24
|
| Rate for Payer: PACE SWMI |
$1,496.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,496.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,531.75
|
| Rate for Payer: Priority Health Medicare |
$1,496.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,496.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,496.03
|
| Rate for Payer: UHCCP DNSP |
$1,496.03
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$91.65 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Trust/PPO |
$114.90
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$42.26
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$50.71
|
| Rate for Payer: Healthscope Whirlpool |
$50.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UHCCP DNSP |
$42.26
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$91.65 |
| Rate for Payer: Aetna Commercial |
$56.63
|
| Rate for Payer: Aetna Medicare |
$42.26
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS MAPPO |
$42.26
|
| Rate for Payer: BCN Medicare Advantage |
$42.26
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$60.85
|
| Rate for Payer: Cofinity Commercial |
$56.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$50.71
|
| Rate for Payer: Healthscope Whirlpool |
$50.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.37
|
| Rate for Payer: Nomi Health Commercial |
$50.71
|
| Rate for Payer: PACE SWMI |
$42.26
|
| Rate for Payer: PHP Medicare Advantage |
$42.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health Medicare |
$42.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.26
|
| Rate for Payer: UHC Medicare Advantage |
$42.26
|
| Rate for Payer: UHCCP DNSP |
$42.26
|
|
|
PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
15274
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: ASR ASR |
$136.77
|
| Rate for Payer: ASR Commercial |
$136.77
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.46
|
| Rate for Payer: BCN Commercial |
$109.32
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.80
|
| Rate for Payer: Healthscope Commercial |
$141.00
|
| Rate for Payer: Healthscope Whirlpool |
$136.77
|
| Rate for Payer: Mclaren Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.85
|
| Rate for Payer: Nomi Health Commercial |
$115.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Narrow Network |
$98.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$124.08
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$186.03
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Healthscope Commercial |
$223.24
|
| Rate for Payer: Healthscope Whirlpool |
$223.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UHCCP DNSP |
$186.03
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: ASR ASR |
$597.52
|
| Rate for Payer: ASR Commercial |
$597.52
|
| Rate for Payer: BCBS Trust/PPO |
$501.98
|
| Rate for Payer: BCN Commercial |
$477.58
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$579.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Healthscope Commercial |
$616.00
|
| Rate for Payer: Healthscope Whirlpool |
$597.52
|
| Rate for Payer: Mclaren Commercial |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: Nomi Health Commercial |
$505.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.08
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
HCPCS 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$186.03 |
| Max. Negotiated Rate |
$400.40 |
| Rate for Payer: Aetna Commercial |
$249.28
|
| Rate for Payer: Aetna Medicare |
$186.03
|
| Rate for Payer: BCBS Complete |
$246.40
|
| Rate for Payer: BCBS MAPPO |
$186.03
|
| Rate for Payer: BCN Medicare Advantage |
$186.03
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$267.88
|
| Rate for Payer: Cofinity Commercial |
$249.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.03
|
| Rate for Payer: Healthscope Commercial |
$223.24
|
| Rate for Payer: Healthscope Whirlpool |
$223.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.33
|
| Rate for Payer: Nomi Health Commercial |
$223.24
|
| Rate for Payer: PACE SWMI |
$186.03
|
| Rate for Payer: PHP Medicare Advantage |
$186.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health Medicare |
$186.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.03
|
| Rate for Payer: UHC Medicare Advantage |
$186.03
|
| Rate for Payer: UHCCP DNSP |
$186.03
|
|
|
PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
15273
|
| Min. Negotiated Rate |
$400.40 |
| Max. Negotiated Rate |
$5,534.23 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Medicare |
$3,570.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: ASR ASR |
$597.52
|
| Rate for Payer: ASR Commercial |
$597.52
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCBS Trust/PPO |
$504.44
|
| Rate for Payer: BCN Commercial |
$477.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cash Price |
$492.80
|
| Rate for Payer: Cofinity Commercial |
$579.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$616.00
|
| Rate for Payer: Healthscope Whirlpool |
$597.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$3,570.47
|
| Rate for Payer: Mclaren Commercial |
$554.40
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.60
|
| Rate for Payer: Nomi Health Commercial |
$505.12
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$3,927.52
|
| Rate for Payer: PHP Medicaid |
$1,913.77
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.74
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health Narrow Network |
$431.82
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$542.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$5,534.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP DNSP |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$80.36
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Healthscope Commercial |
$96.43
|
| Rate for Payer: Healthscope Whirlpool |
$96.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UHCCP DNSP |
$80.36
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$2,765.22 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: Aetna Medicare |
$1,784.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCBS Trust/PPO |
$227.65
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,784.01
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,962.41
|
| Rate for Payer: PHP Medicaid |
$956.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.58
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health Narrow Network |
$194.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$2,765.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP DNSP |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: VA VA |
$1,784.01
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Facility
|
IP
|
$278.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
15271
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: Aetna Commercial |
$250.20
|
| Rate for Payer: ASR ASR |
$269.66
|
| Rate for Payer: ASR Commercial |
$269.66
|
| Rate for Payer: BCBS Trust/PPO |
$226.54
|
| Rate for Payer: BCN Commercial |
$215.53
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$261.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.40
|
| Rate for Payer: Healthscope Commercial |
$278.00
|
| Rate for Payer: Healthscope Whirlpool |
$269.66
|
| Rate for Payer: Mclaren Commercial |
$250.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.30
|
| Rate for Payer: Nomi Health Commercial |
$227.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.64
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 15271
|
| Min. Negotiated Rate |
$80.36 |
| Max. Negotiated Rate |
$180.70 |
| Rate for Payer: Aetna Commercial |
$107.68
|
| Rate for Payer: Aetna Medicare |
$80.36
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$80.36
|
| Rate for Payer: BCN Medicare Advantage |
$80.36
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$115.72
|
| Rate for Payer: Cofinity Commercial |
$107.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.36
|
| Rate for Payer: Healthscope Commercial |
$96.43
|
| Rate for Payer: Healthscope Whirlpool |
$96.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.38
|
| Rate for Payer: Nomi Health Commercial |
$96.43
|
| Rate for Payer: PACE SWMI |
$80.36
|
| Rate for Payer: PHP Medicare Advantage |
$80.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.36
|
| Rate for Payer: UHC Medicare Advantage |
$80.36
|
| Rate for Payer: UHCCP DNSP |
$80.36
|
|
|
PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 15272
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Medicare |
$16.02
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$16.02
|
| Rate for Payer: BCN Medicare Advantage |
$16.02
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$21.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Healthscope Whirlpool |
$19.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.82
|
| Rate for Payer: Nomi Health Commercial |
$19.22
|
| Rate for Payer: PACE SWMI |
$16.02
|
| Rate for Payer: PHP Medicare Advantage |
$16.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$16.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.02
|
| Rate for Payer: UHC Medicare Advantage |
$16.02
|
| Rate for Payer: UHCCP DNSP |
$16.02
|
|
|
PR ARREST EPIPHYSEAL DISTAL FEMUR
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 27475
|
| Min. Negotiated Rate |
$641.89 |
| Max. Negotiated Rate |
$1,103.70 |
| Rate for Payer: Aetna Commercial |
$860.13
|
| Rate for Payer: Aetna Medicare |
$641.89
|
| Rate for Payer: BCBS Complete |
$679.20
|
| Rate for Payer: BCBS MAPPO |
$641.89
|
| Rate for Payer: BCN Medicare Advantage |
$641.89
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$924.32
|
| Rate for Payer: Cofinity Commercial |
$860.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.89
|
| Rate for Payer: Healthscope Commercial |
$770.27
|
| Rate for Payer: Healthscope Whirlpool |
$770.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.98
|
| Rate for Payer: Nomi Health Commercial |
$770.27
|
| Rate for Payer: PACE SWMI |
$641.89
|
| Rate for Payer: PHP Medicare Advantage |
$641.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,103.70
|
| Rate for Payer: Priority Health Medicare |
$641.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.89
|
| Rate for Payer: UHC Medicare Advantage |
$641.89
|
| Rate for Payer: UHCCP DNSP |
$641.89
|
|
