|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Aetna Commercial |
$460.57
|
| Rate for Payer: Aetna Medicare |
$343.71
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCN Medicare Advantage |
$343.71
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$494.94
|
| Rate for Payer: Cofinity Commercial |
$460.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.71
|
| Rate for Payer: Healthscope Commercial |
$412.45
|
| Rate for Payer: Healthscope Whirlpool |
$412.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
| Rate for Payer: UHCCP DNSP |
$343.71
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$611.65 |
| Max. Negotiated Rate |
$941.00 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: ASR ASR |
$912.77
|
| Rate for Payer: ASR Commercial |
$912.77
|
| Rate for Payer: BCBS Trust/PPO |
$766.82
|
| Rate for Payer: BCN Commercial |
$729.56
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$884.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$752.80
|
| Rate for Payer: Healthscope Commercial |
$941.00
|
| Rate for Payer: Healthscope Whirlpool |
$912.77
|
| Rate for Payer: Mclaren Commercial |
$846.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$799.85
|
| Rate for Payer: Nomi Health Commercial |
$771.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$828.08
|
|
|
PR HYSTEROSCOPY REMOVAL LEIOMYOMATA
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS 58561
|
| Hospital Charge Code |
58561
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$611.65 |
| Rate for Payer: Aetna Commercial |
$460.57
|
| Rate for Payer: Aetna Medicare |
$343.71
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$343.71
|
| Rate for Payer: BCN Medicare Advantage |
$343.71
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$494.94
|
| Rate for Payer: Cofinity Commercial |
$460.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.71
|
| Rate for Payer: Healthscope Commercial |
$412.45
|
| Rate for Payer: Healthscope Whirlpool |
$412.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.90
|
| Rate for Payer: Nomi Health Commercial |
$412.45
|
| Rate for Payer: PACE SWMI |
$343.71
|
| Rate for Payer: PHP Medicare Advantage |
$343.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$343.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.71
|
| Rate for Payer: UHC Medicare Advantage |
$343.71
|
| Rate for Payer: UHCCP DNSP |
$343.71
|
|
|
PR HYSTEROTOMY ABDOMINAL
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 59100
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,203.28 |
| Rate for Payer: Aetna Commercial |
$1,119.72
|
| Rate for Payer: Aetna Medicare |
$835.61
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$835.61
|
| Rate for Payer: BCN Medicare Advantage |
$835.61
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,203.28
|
| Rate for Payer: Cofinity Commercial |
$1,119.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.61
|
| Rate for Payer: Healthscope Commercial |
$1,002.73
|
| Rate for Payer: Healthscope Whirlpool |
$1,002.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.39
|
| Rate for Payer: Nomi Health Commercial |
$1,002.73
|
| Rate for Payer: PACE SWMI |
$835.61
|
| Rate for Payer: PHP Medicare Advantage |
$835.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$835.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.61
|
| Rate for Payer: UHC Medicare Advantage |
$835.61
|
| Rate for Payer: UHCCP DNSP |
$835.61
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 90750
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
|
|
PR I131 IODIDE CAP, RX
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS A9517
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
HCPCS 93655
|
| Min. Negotiated Rate |
$291.05 |
| Max. Negotiated Rate |
$969.80 |
| Rate for Payer: Aetna Commercial |
$390.01
|
| Rate for Payer: Aetna Medicare |
$291.05
|
| Rate for Payer: BCBS Complete |
$596.80
|
| Rate for Payer: BCBS MAPPO |
$291.05
|
| Rate for Payer: BCN Medicare Advantage |
$291.05
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cash Price |
$1,193.60
|
| Rate for Payer: Cofinity Commercial |
$419.11
|
| Rate for Payer: Cofinity Commercial |
$390.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.05
|
| Rate for Payer: Healthscope Commercial |
$349.26
|
| Rate for Payer: Healthscope Whirlpool |
$349.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.60
|
| Rate for Payer: Nomi Health Commercial |
$349.26
|
| Rate for Payer: PACE SWMI |
$291.05
|
| Rate for Payer: PHP Medicare Advantage |
$291.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$969.80
|
| Rate for Payer: Priority Health Medicare |
$291.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.05
|
| Rate for Payer: UHC Medicare Advantage |
$291.05
|
| Rate for Payer: UHCCP DNSP |
$291.05
|
|
|
PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION
|
Professional
|
Both
|
$1,840.00
|
|
|
Service Code
|
HCPCS 93650
|
| Min. Negotiated Rate |
$551.48 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$738.98
|
| Rate for Payer: Aetna Medicare |
$551.48
|
| Rate for Payer: BCBS Complete |
$736.00
|
| Rate for Payer: BCBS MAPPO |
$551.48
|
| Rate for Payer: BCN Medicare Advantage |
$551.48
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cash Price |
$1,472.00
|
| Rate for Payer: Cofinity Commercial |
$794.13
|
| Rate for Payer: Cofinity Commercial |
$738.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$551.48
|
| Rate for Payer: Healthscope Commercial |
$661.78
|
| Rate for Payer: Healthscope Whirlpool |
$661.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.05
|
| Rate for Payer: Nomi Health Commercial |
$661.78
|
| Rate for Payer: PACE SWMI |
$551.48
|
| Rate for Payer: PHP Medicare Advantage |
$551.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,196.00
|
| Rate for Payer: Priority Health Medicare |
$551.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$551.48
|
| Rate for Payer: UHC Medicare Advantage |
$551.48
|
| Rate for Payer: UHCCP DNSP |
$551.48
|
|
|
PR I&D ABSCESS PERITONSILLAR
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 42700
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$173.38
|
| Rate for Payer: Aetna Medicare |
$129.39
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$129.39
|
| Rate for Payer: BCN Medicare Advantage |
$129.39
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$186.32
|
| Rate for Payer: Cofinity Commercial |
$173.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.39
|
| Rate for Payer: Healthscope Commercial |
$155.27
|
| Rate for Payer: Healthscope Whirlpool |
$155.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.86
|
| Rate for Payer: Nomi Health Commercial |
$155.27
|
| Rate for Payer: PACE SWMI |
$129.39
|
| Rate for Payer: PHP Medicare Advantage |
$129.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$129.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.39
|
| Rate for Payer: UHC Medicare Advantage |
$129.39
|
| Rate for Payer: UHCCP DNSP |
$129.39
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 42720
|
| Min. Negotiated Rate |
$330.80 |
| Max. Negotiated Rate |
$537.55 |
| Rate for Payer: Aetna Commercial |
$494.58
|
| Rate for Payer: Aetna Medicare |
$369.09
|
| Rate for Payer: BCBS Complete |
$330.80
|
| Rate for Payer: BCBS MAPPO |
$369.09
|
| Rate for Payer: BCN Medicare Advantage |
$369.09
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$531.49
|
| Rate for Payer: Cofinity Commercial |
$494.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.09
|
| Rate for Payer: Healthscope Commercial |
$442.91
|
| Rate for Payer: Healthscope Whirlpool |
$442.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.54
|
| Rate for Payer: Nomi Health Commercial |
$442.91
|
| Rate for Payer: PACE SWMI |
$369.09
|
| Rate for Payer: PHP Medicare Advantage |
$369.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.55
|
| Rate for Payer: Priority Health Medicare |
$369.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.09
|
| Rate for Payer: UHC Medicare Advantage |
$369.09
|
| Rate for Payer: UHCCP DNSP |
$369.09
|
|
|
PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR
|
Professional
|
Both
|
$1,478.00
|
|
|
Service Code
|
HCPCS 42725
|
| Min. Negotiated Rate |
$591.20 |
| Max. Negotiated Rate |
$1,101.64 |
| Rate for Payer: Aetna Commercial |
$1,025.14
|
| Rate for Payer: Aetna Medicare |
$765.03
|
| Rate for Payer: BCBS Complete |
$591.20
|
| Rate for Payer: BCBS MAPPO |
$765.03
|
| Rate for Payer: BCN Medicare Advantage |
$765.03
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cash Price |
$1,182.40
|
| Rate for Payer: Cofinity Commercial |
$1,101.64
|
| Rate for Payer: Cofinity Commercial |
$1,025.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.03
|
| Rate for Payer: Healthscope Commercial |
$918.04
|
| Rate for Payer: Healthscope Whirlpool |
$918.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$803.28
|
| Rate for Payer: Nomi Health Commercial |
$918.04
|
| Rate for Payer: PACE SWMI |
$765.03
|
| Rate for Payer: PHP Medicare Advantage |
$765.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.70
|
| Rate for Payer: Priority Health Medicare |
$765.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.03
|
| Rate for Payer: UHC Medicare Advantage |
$765.03
|
| Rate for Payer: UHCCP DNSP |
$765.03
|
|
|
PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS 28002
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$564.20 |
| Rate for Payer: Aetna Commercial |
$179.72
|
| Rate for Payer: Aetna Medicare |
$134.12
|
| Rate for Payer: BCBS Complete |
$347.20
|
| Rate for Payer: BCBS MAPPO |
$134.12
|
| Rate for Payer: BCN Medicare Advantage |
$134.12
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cofinity Commercial |
$193.13
|
| Rate for Payer: Cofinity Commercial |
$179.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.12
|
| Rate for Payer: Healthscope Commercial |
$160.94
|
| Rate for Payer: Healthscope Whirlpool |
$160.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.83
|
| Rate for Payer: Nomi Health Commercial |
$160.94
|
| Rate for Payer: PACE SWMI |
$134.12
|
| Rate for Payer: PHP Medicare Advantage |
$134.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.20
|
| Rate for Payer: Priority Health Medicare |
$134.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.12
|
| Rate for Payer: UHC Medicare Advantage |
$134.12
|
| Rate for Payer: UHCCP DNSP |
$134.12
|
|
|
PR I&D BELOW FASCIA FOOT MULTIPLE AREAS
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 28003
|
| Min. Negotiated Rate |
$246.97 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$330.94
|
| Rate for Payer: Aetna Medicare |
$246.97
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$246.97
|
| Rate for Payer: BCN Medicare Advantage |
$246.97
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$355.64
|
| Rate for Payer: Cofinity Commercial |
$330.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.97
|
| Rate for Payer: Healthscope Commercial |
$296.36
|
| Rate for Payer: Healthscope Whirlpool |
$296.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.32
|
| Rate for Payer: Nomi Health Commercial |
$296.36
|
| Rate for Payer: PACE SWMI |
$246.97
|
| Rate for Payer: PHP Medicare Advantage |
$246.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$246.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.97
|
| Rate for Payer: UHC Medicare Advantage |
$246.97
|
| Rate for Payer: UHCCP DNSP |
$246.97
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Facility
|
OP
|
$1,665.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$4,326.52 |
| Rate for Payer: Aetna Commercial |
$1,498.50
|
| Rate for Payer: Aetna Medicare |
$2,791.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,489.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,489.12
|
| Rate for Payer: ASR ASR |
$1,615.05
|
| Rate for Payer: ASR Commercial |
$1,615.05
|
| Rate for Payer: BCBS Complete |
$1,570.94
|
| Rate for Payer: BCBS MAPPO |
$2,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.47
|
| Rate for Payer: BCN Commercial |
$1,290.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,791.30
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,565.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,791.30
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,615.05
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,791.30
|
| Rate for Payer: Mclaren Commercial |
$1,498.50
|
| Rate for Payer: Mclaren Medicaid |
$1,496.14
|
| Rate for Payer: Mclaren Medicare |
$2,791.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,930.86
|
| Rate for Payer: Meridian Medicaid |
$1,570.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,209.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: PACE Medicare |
$2,651.74
|
| Rate for Payer: PACE SWMI |
$2,791.30
|
| Rate for Payer: PHP Commercial |
$3,070.43
|
| Rate for Payer: PHP Medicaid |
$1,496.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,496.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,458.87
|
| Rate for Payer: Priority Health Medicare |
$2,791.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,167.16
|
| Rate for Payer: Railroad Medicare Medicare |
$2,791.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,465.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,791.30
|
| Rate for Payer: UHC Exchange |
$4,326.52
|
| Rate for Payer: UHC Medicare Advantage |
$2,791.30
|
| Rate for Payer: UHCCP DNSP |
$2,791.30
|
| Rate for Payer: UHCCP Medicaid |
$1,496.14
|
| Rate for Payer: VA VA |
$2,791.30
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 27301
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$491.92 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$659.17
|
| Rate for Payer: Aetna Medicare |
$491.92
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$491.92
|
| Rate for Payer: BCN Medicare Advantage |
$491.92
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$708.36
|
| Rate for Payer: Cofinity Commercial |
$659.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.92
|
| Rate for Payer: Healthscope Commercial |
$590.30
|
| Rate for Payer: Healthscope Whirlpool |
$590.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.52
|
| Rate for Payer: Nomi Health Commercial |
$590.30
|
| Rate for Payer: PACE SWMI |
$491.92
|
| Rate for Payer: PHP Medicare Advantage |
$491.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$491.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.92
|
| Rate for Payer: UHC Medicare Advantage |
$491.92
|
| Rate for Payer: UHCCP DNSP |
$491.92
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Facility
|
IP
|
$1,665.00
|
|
|
Service Code
|
CPT 27301
|
| Hospital Charge Code |
27301
|
| Min. Negotiated Rate |
$1,082.25 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Aetna Commercial |
$1,498.50
|
| Rate for Payer: ASR ASR |
$1,615.05
|
| Rate for Payer: ASR Commercial |
$1,615.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,356.81
|
| Rate for Payer: BCN Commercial |
$1,290.87
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$1,565.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,332.00
|
| Rate for Payer: Healthscope Commercial |
$1,665.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,615.05
|
| Rate for Payer: Mclaren Commercial |
$1,498.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,415.25
|
| Rate for Payer: Nomi Health Commercial |
$1,365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,465.20
|
|
|
PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION
|
Professional
|
Both
|
$1,665.00
|
|
|
Service Code
|
HCPCS 27301
|
| Min. Negotiated Rate |
$491.92 |
| Max. Negotiated Rate |
$1,082.25 |
| Rate for Payer: Aetna Commercial |
$659.17
|
| Rate for Payer: Aetna Medicare |
$491.92
|
| Rate for Payer: BCBS Complete |
$666.00
|
| Rate for Payer: BCBS MAPPO |
$491.92
|
| Rate for Payer: BCN Medicare Advantage |
$491.92
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cofinity Commercial |
$708.36
|
| Rate for Payer: Cofinity Commercial |
$659.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.92
|
| Rate for Payer: Healthscope Commercial |
$590.30
|
| Rate for Payer: Healthscope Whirlpool |
$590.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.52
|
| Rate for Payer: Nomi Health Commercial |
$590.30
|
| Rate for Payer: PACE SWMI |
$491.92
|
| Rate for Payer: PHP Medicare Advantage |
$491.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,082.25
|
| Rate for Payer: Priority Health Medicare |
$491.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.92
|
| Rate for Payer: UHC Medicare Advantage |
$491.92
|
| Rate for Payer: UHCCP DNSP |
$491.92
|
|
|
PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 22010
|
| Min. Negotiated Rate |
$950.04 |
| Max. Negotiated Rate |
$1,599.00 |
| Rate for Payer: Aetna Commercial |
$1,273.05
|
| Rate for Payer: Aetna Medicare |
$950.04
|
| Rate for Payer: BCBS Complete |
$984.00
|
| Rate for Payer: BCBS MAPPO |
$950.04
|
| Rate for Payer: BCN Medicare Advantage |
$950.04
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,368.06
|
| Rate for Payer: Cofinity Commercial |
$1,273.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$950.04
|
| Rate for Payer: Healthscope Commercial |
$1,140.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,140.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.54
|
| Rate for Payer: Nomi Health Commercial |
$1,140.05
|
| Rate for Payer: PACE SWMI |
$950.04
|
| Rate for Payer: PHP Medicare Advantage |
$950.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.00
|
| Rate for Payer: Priority Health Medicare |
$950.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$950.04
|
| Rate for Payer: UHC Medicare Advantage |
$950.04
|
| Rate for Payer: UHCCP DNSP |
$950.04
|
|
|
PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 22015
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$1,329.57 |
| Rate for Payer: Aetna Commercial |
$1,237.24
|
| Rate for Payer: Aetna Medicare |
$923.31
|
| Rate for Payer: BCBS Complete |
$690.00
|
| Rate for Payer: BCBS MAPPO |
$923.31
|
| Rate for Payer: BCN Medicare Advantage |
$923.31
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.57
|
| Rate for Payer: Cofinity Commercial |
$1,237.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$923.31
|
| Rate for Payer: Healthscope Commercial |
$1,107.97
|
| Rate for Payer: Healthscope Whirlpool |
$1,107.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$969.48
|
| Rate for Payer: Nomi Health Commercial |
$1,107.97
|
| Rate for Payer: PACE SWMI |
$923.31
|
| Rate for Payer: PHP Medicare Advantage |
$923.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.25
|
| Rate for Payer: Priority Health Medicare |
$923.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$923.31
|
| Rate for Payer: UHC Medicare Advantage |
$923.31
|
| Rate for Payer: UHCCP DNSP |
$923.31
|
|
|
PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 21501
|
| Min. Negotiated Rate |
$323.69 |
| Max. Negotiated Rate |
$759.20 |
| Rate for Payer: Aetna Commercial |
$433.74
|
| Rate for Payer: Aetna Medicare |
$323.69
|
| Rate for Payer: BCBS Complete |
$467.20
|
| Rate for Payer: BCBS MAPPO |
$323.69
|
| Rate for Payer: BCN Medicare Advantage |
$323.69
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$466.11
|
| Rate for Payer: Cofinity Commercial |
$433.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$323.69
|
| Rate for Payer: Healthscope Commercial |
$388.43
|
| Rate for Payer: Healthscope Whirlpool |
$388.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.87
|
| Rate for Payer: Nomi Health Commercial |
$388.43
|
| Rate for Payer: PACE SWMI |
$323.69
|
| Rate for Payer: PHP Medicare Advantage |
$323.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health Medicare |
$323.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$323.69
|
| Rate for Payer: UHC Medicare Advantage |
$323.69
|
| Rate for Payer: UHCCP DNSP |
$323.69
|
|
|
PR I&D DP ABSC/HMTMA SFT TIS NCK/THRX PRTL RIB OSTC
|
Professional
|
Both
|
$957.00
|
|
|
Service Code
|
HCPCS 21502
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$708.02 |
| Rate for Payer: Aetna Commercial |
$658.85
|
| Rate for Payer: Aetna Medicare |
$491.68
|
| Rate for Payer: BCBS Complete |
$382.80
|
| Rate for Payer: BCBS MAPPO |
$491.68
|
| Rate for Payer: BCN Medicare Advantage |
$491.68
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cash Price |
$765.60
|
| Rate for Payer: Cofinity Commercial |
$708.02
|
| Rate for Payer: Cofinity Commercial |
$658.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.68
|
| Rate for Payer: Healthscope Commercial |
$590.02
|
| Rate for Payer: Healthscope Whirlpool |
$590.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.26
|
| Rate for Payer: Nomi Health Commercial |
$590.02
|
| Rate for Payer: PACE SWMI |
$491.68
|
| Rate for Payer: PHP Medicare Advantage |
$491.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.05
|
| Rate for Payer: Priority Health Medicare |
$491.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.68
|
| Rate for Payer: UHC Medicare Advantage |
$491.68
|
| Rate for Payer: UHCCP DNSP |
$491.68
|
|
|
PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC
|
Professional
|
Both
|
$1,637.00
|
|
|
Service Code
|
HCPCS 45020
|
| Min. Negotiated Rate |
$552.25 |
| Max. Negotiated Rate |
$1,064.05 |
| Rate for Payer: Aetna Commercial |
$740.01
|
| Rate for Payer: Aetna Medicare |
$552.25
|
| Rate for Payer: BCBS Complete |
$654.80
|
| Rate for Payer: BCBS MAPPO |
$552.25
|
| Rate for Payer: BCN Medicare Advantage |
$552.25
|
| Rate for Payer: Cash Price |
$1,309.60
|
| Rate for Payer: Cash Price |
$1,309.60
|
| Rate for Payer: Cofinity Commercial |
$795.24
|
| Rate for Payer: Cofinity Commercial |
$740.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.25
|
| Rate for Payer: Healthscope Commercial |
$662.70
|
| Rate for Payer: Healthscope Whirlpool |
$662.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.86
|
| Rate for Payer: Nomi Health Commercial |
$662.70
|
| Rate for Payer: PACE SWMI |
$552.25
|
| Rate for Payer: PHP Medicare Advantage |
$552.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,064.05
|
| Rate for Payer: Priority Health Medicare |
$552.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.25
|
| Rate for Payer: UHC Medicare Advantage |
$552.25
|
| Rate for Payer: UHCCP DNSP |
$552.25
|
|
|
PR I&D EPIDIDYMIS TSTIS&/SCROTAL SPACE
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 54700
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$295.33 |
| Rate for Payer: Aetna Commercial |
$274.82
|
| Rate for Payer: Aetna Medicare |
$205.09
|
| Rate for Payer: BCBS Complete |
$162.00
|
| Rate for Payer: BCBS MAPPO |
$205.09
|
| Rate for Payer: BCN Medicare Advantage |
$205.09
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$295.33
|
| Rate for Payer: Cofinity Commercial |
$274.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.09
|
| Rate for Payer: Healthscope Commercial |
$246.11
|
| Rate for Payer: Healthscope Whirlpool |
$246.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.34
|
| Rate for Payer: Nomi Health Commercial |
$246.11
|
| Rate for Payer: PACE SWMI |
$205.09
|
| Rate for Payer: PHP Medicare Advantage |
$205.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.25
|
| Rate for Payer: Priority Health Medicare |
$205.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.09
|
| Rate for Payer: UHC Medicare Advantage |
$205.09
|
| Rate for Payer: UHCCP DNSP |
$205.09
|
|
|
PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
HCPCS 25028
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$917.16 |
| Rate for Payer: Aetna Commercial |
$853.47
|
| Rate for Payer: Aetna Medicare |
$636.92
|
| Rate for Payer: BCBS Complete |
$372.40
|
| Rate for Payer: BCBS MAPPO |
$636.92
|
| Rate for Payer: BCN Medicare Advantage |
$636.92
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cofinity Commercial |
$917.16
|
| Rate for Payer: Cofinity Commercial |
$853.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.92
|
| Rate for Payer: Healthscope Commercial |
$764.30
|
| Rate for Payer: Healthscope Whirlpool |
$764.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.77
|
| Rate for Payer: Nomi Health Commercial |
$764.30
|
| Rate for Payer: PACE SWMI |
$636.92
|
| Rate for Payer: PHP Medicare Advantage |
$636.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$605.15
|
| Rate for Payer: Priority Health Medicare |
$636.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$636.92
|
| Rate for Payer: UHC Medicare Advantage |
$636.92
|
| Rate for Payer: UHCCP DNSP |
$636.92
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
10140
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$174.85 |
| Max. Negotiated Rate |
$2,449.29 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Medicare |
$1,580.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,975.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,975.24
|
| Rate for Payer: ASR ASR |
$260.93
|
| Rate for Payer: ASR Commercial |
$260.93
|
| Rate for Payer: BCBS Complete |
$889.33
|
| Rate for Payer: BCBS MAPPO |
$1,580.19
|
| Rate for Payer: BCBS Trust/PPO |
$220.28
|
| Rate for Payer: BCN Commercial |
$208.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,580.19
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$252.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$269.00
|
| Rate for Payer: Healthscope Whirlpool |
$260.93
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,580.19
|
| Rate for Payer: Mclaren Commercial |
$242.10
|
| Rate for Payer: Mclaren Medicaid |
$846.98
|
| Rate for Payer: Mclaren Medicare |
$1,580.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,659.20
|
| Rate for Payer: Meridian Medicaid |
$889.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,817.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.65
|
| Rate for Payer: Nomi Health Commercial |
$220.58
|
| Rate for Payer: PACE Medicare |
$1,501.18
|
| Rate for Payer: PACE SWMI |
$1,580.19
|
| Rate for Payer: PHP Commercial |
$1,738.21
|
| Rate for Payer: PHP Medicaid |
$846.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,580.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.70
|
| Rate for Payer: Priority Health Medicare |
$1,580.19
|
| Rate for Payer: Priority Health Narrow Network |
$188.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,580.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$236.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,580.19
|
| Rate for Payer: UHC Exchange |
$2,449.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP DNSP |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: VA VA |
$1,580.19
|
|
