|
PR CARPECTOMY 1 BONE
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,071.63 |
| Max. Negotiated Rate |
$1,530.90 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,190.70
|
| Rate for Payer: Cofinity Commercial |
$1,462.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,190.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Healthscope Commercial |
$1,530.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: PHP Commercial |
$1,445.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health SBD |
$1,071.63
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Hospital Charge Code |
25210
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$87,646.00 |
| Rate for Payer: Aetna Commercial |
$640.43
|
| Rate for Payer: Aetna Medicare |
$497.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.22
|
| Rate for Payer: BCBS Complete |
$341.96
|
| Rate for Payer: BCBS MAPPO |
$477.93
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: BCN Medicare Advantage |
$477.93
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$688.22
|
| Rate for Payer: Cofinity Commercial |
$640.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.93
|
| Rate for Payer: Healthscope Commercial |
$884.17
|
| Rate for Payer: Healthscope Commercial |
$764.69
|
| Rate for Payer: Mclaren Medicaid |
$325.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.83
|
| Rate for Payer: Meridian Medicaid |
$341.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87,646.00
|
| Rate for Payer: Nomi Health Commercial |
$573.52
|
| Rate for Payer: PACE SWMI |
$477.93
|
| Rate for Payer: PHP Medicare Advantage |
$477.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.41
|
| Rate for Payer: Priority Health Medicare |
$477.93
|
| Rate for Payer: Priority Health Narrow Network |
$770.41
|
| Rate for Payer: Priority Health SBD |
$770.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.93
|
| Rate for Payer: UHC Exchange |
$599.36
|
| Rate for Payer: UHC Medicare Advantage |
$477.93
|
| Rate for Payer: UHCCP Medicaid |
$325.68
|
|
|
PR CARPECTOMY 1 BONE
|
Facility
|
OP
|
$1,701.00
|
|
|
Service Code
|
CPT 25210
|
| Hospital Charge Code |
25210
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$527.45 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna Commercial |
$1,445.85
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,271.09
|
| Rate for Payer: BCN Commercial |
$1,271.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,190.70
|
| Rate for Payer: Cofinity Commercial |
$1,462.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,190.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,360.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,179.00
|
| Rate for Payer: Healthscope Commercial |
$1,530.90
|
| Rate for Payer: Mclaren Medicaid |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,445.85
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$1,445.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$1,071.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.45
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$5,811.00
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,789.78
|
| Rate for Payer: VA VA |
$3,179.00
|
|
|
PR CARPECTOMY 1 BONE
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 25210
|
| Min. Negotiated Rate |
$325.68 |
| Max. Negotiated Rate |
$87,646.00 |
| Rate for Payer: Aetna Commercial |
$640.43
|
| Rate for Payer: Aetna Medicare |
$497.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.22
|
| Rate for Payer: BCBS Complete |
$341.96
|
| Rate for Payer: BCBS MAPPO |
$477.93
|
| Rate for Payer: BCBS Trust/PPO |
$637.66
|
| Rate for Payer: BCN Commercial |
$731.55
|
| Rate for Payer: BCN Medicare Advantage |
$477.93
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$688.22
|
| Rate for Payer: Cofinity Commercial |
$640.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.93
|
| Rate for Payer: Healthscope Commercial |
$884.17
|
| Rate for Payer: Healthscope Commercial |
$764.69
|
| Rate for Payer: Mclaren Medicaid |
$325.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.83
|
| Rate for Payer: Meridian Medicaid |
$341.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87,646.00
|
| Rate for Payer: Nomi Health Commercial |
$573.52
|
| Rate for Payer: PACE SWMI |
$477.93
|
| Rate for Payer: PHP Medicare Advantage |
$477.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.41
|
| Rate for Payer: Priority Health Medicare |
$477.93
|
| Rate for Payer: Priority Health Narrow Network |
$770.41
|
| Rate for Payer: Priority Health SBD |
$770.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$599.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.93
|
| Rate for Payer: UHC Exchange |
$599.36
|
| Rate for Payer: UHC Medicare Advantage |
$477.93
|
| Rate for Payer: UHCCP Medicaid |
$325.68
|
|
|
PR CARPECTOMY ALL BONES PROXIMAL ROW
|
Professional
|
Both
|
$2,289.00
|
|
|
Service Code
|
HCPCS 25215
|
| Min. Negotiated Rate |
$407.47 |
| Max. Negotiated Rate |
$110,129.00 |
| Rate for Payer: Aetna Commercial |
$804.16
|
| Rate for Payer: Aetna Medicare |
$624.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.17
|
| Rate for Payer: BCBS Complete |
$427.84
|
| Rate for Payer: BCBS MAPPO |
$600.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,436.98
|
| Rate for Payer: BCN Commercial |
$916.27
|
| Rate for Payer: BCN Medicare Advantage |
$600.12
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cash Price |
$1,831.20
|
| Rate for Payer: Cofinity Commercial |
$864.17
|
| Rate for Payer: Cofinity Commercial |
$804.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$600.12
|
| Rate for Payer: Healthscope Commercial |
$960.19
|
| Rate for Payer: Healthscope Commercial |
$1,110.22
|
| Rate for Payer: Mclaren Medicaid |
$407.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$630.13
|
| Rate for Payer: Meridian Medicaid |
$427.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,129.00
|
| Rate for Payer: Nomi Health Commercial |
$720.14
|
| Rate for Payer: PACE SWMI |
$600.12
|
| Rate for Payer: PHP Medicare Advantage |
$600.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,487.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$963.27
|
| Rate for Payer: Priority Health Medicare |
$600.12
|
| Rate for Payer: Priority Health Narrow Network |
$963.27
|
| Rate for Payer: Priority Health SBD |
$963.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$600.12
|
| Rate for Payer: UHC Exchange |
$853.87
|
| Rate for Payer: UHC Medicare Advantage |
$600.12
|
| Rate for Payer: UHCCP Medicaid |
$407.47
|
|
|
PR CARTILAGE GRAFT COSTOCHONDRAL
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
HCPCS 20910
|
| Min. Negotiated Rate |
$312.90 |
| Max. Negotiated Rate |
$83,869.00 |
| Rate for Payer: Aetna Commercial |
$614.46
|
| Rate for Payer: Aetna Medicare |
$476.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.31
|
| Rate for Payer: BCBS Complete |
$328.54
|
| Rate for Payer: BCBS MAPPO |
$458.55
|
| Rate for Payer: BCBS Trust/PPO |
$8,557.53
|
| Rate for Payer: BCN Commercial |
$701.25
|
| Rate for Payer: BCN Medicare Advantage |
$458.55
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cofinity Commercial |
$660.31
|
| Rate for Payer: Cofinity Commercial |
$614.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$458.55
|
| Rate for Payer: Healthscope Commercial |
$848.32
|
| Rate for Payer: Healthscope Commercial |
$733.68
|
| Rate for Payer: Mclaren Medicaid |
$312.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$481.48
|
| Rate for Payer: Meridian Medicaid |
$328.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83,869.00
|
| Rate for Payer: Nomi Health Commercial |
$550.26
|
| Rate for Payer: PACE SWMI |
$458.55
|
| Rate for Payer: PHP Medicare Advantage |
$458.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$610.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.39
|
| Rate for Payer: Priority Health Medicare |
$458.55
|
| Rate for Payer: Priority Health Narrow Network |
$740.39
|
| Rate for Payer: Priority Health SBD |
$740.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$458.55
|
| Rate for Payer: UHC Exchange |
$561.92
|
| Rate for Payer: UHC Medicare Advantage |
$458.55
|
| Rate for Payer: UHCCP Medicaid |
$312.90
|
|
|
PR CARTILAGE GRAFT NASAL SEPTUM
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20912
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$85,000.00 |
| Rate for Payer: Aetna Commercial |
$615.57
|
| Rate for Payer: Aetna Medicare |
$477.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.51
|
| Rate for Payer: BCBS Complete |
$327.87
|
| Rate for Payer: BCBS MAPPO |
$459.38
|
| Rate for Payer: BCBS Trust/PPO |
$86.88
|
| Rate for Payer: BCN Commercial |
$707.61
|
| Rate for Payer: BCN Medicare Advantage |
$459.38
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$661.51
|
| Rate for Payer: Cofinity Commercial |
$615.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.38
|
| Rate for Payer: Healthscope Commercial |
$849.85
|
| Rate for Payer: Healthscope Commercial |
$735.01
|
| Rate for Payer: Mclaren Medicaid |
$312.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.35
|
| Rate for Payer: Meridian Medicaid |
$327.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85,000.00
|
| Rate for Payer: Nomi Health Commercial |
$551.26
|
| Rate for Payer: PACE SWMI |
$459.38
|
| Rate for Payer: PHP Medicare Advantage |
$459.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$686.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$743.95
|
| Rate for Payer: Priority Health Medicare |
$459.38
|
| Rate for Payer: Priority Health Narrow Network |
$743.95
|
| Rate for Payer: Priority Health SBD |
$743.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.38
|
| Rate for Payer: UHC Exchange |
$554.50
|
| Rate for Payer: UHC Medicare Advantage |
$459.38
|
| Rate for Payer: UHCCP Medicaid |
$312.26
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$55.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.08
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Healthscope Commercial |
$99.03
|
| Rate for Payer: Healthscope Commercial |
$85.65
|
| Rate for Payer: Mclaren Medicaid |
$36.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,114.00
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.83
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: Priority Health Narrow Network |
$100.83
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Exchange |
$123.33
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$258.30 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health SBD |
$258.30
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
G0104
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$2,807.55 |
| Rate for Payer: Aetna Commercial |
$348.50
|
| Rate for Payer: Aetna Medicare |
$929.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,116.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,116.60
|
| Rate for Payer: BCBS Complete |
$502.74
|
| Rate for Payer: BCBS MAPPO |
$893.28
|
| Rate for Payer: BCBS Trust/PPO |
$450.59
|
| Rate for Payer: BCN Commercial |
$450.59
|
| Rate for Payer: BCN Medicare Advantage |
$893.28
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$352.60
|
| Rate for Payer: Cofinity Commercial |
$287.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$893.28
|
| Rate for Payer: Healthscope Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$478.80
|
| Rate for Payer: Mclaren Medicare |
$893.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$937.94
|
| Rate for Payer: Meridian Medicaid |
$502.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,027.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.50
|
| Rate for Payer: Nomi Health Commercial |
$1,875.89
|
| Rate for Payer: PACE Medicare |
$848.62
|
| Rate for Payer: PACE SWMI |
$893.28
|
| Rate for Payer: PHP Commercial |
$348.50
|
| Rate for Payer: PHP Medicare Advantage |
$893.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,807.55
|
| Rate for Payer: Priority Health Medicare |
$893.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,246.04
|
| Rate for Payer: Priority Health SBD |
$258.30
|
| Rate for Payer: Railroad Medicare Medicare |
$893.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.28
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$893.28
|
| Rate for Payer: UHC Exchange |
$303.40
|
| Rate for Payer: UHC Medicare Advantage |
$893.28
|
| Rate for Payer: UHCCP Medicaid |
$502.92
|
| Rate for Payer: VA VA |
$893.28
|
|
|
PR CA SCREEN;FLEXI SIGMOIDSCOPE
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS G0104
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Aetna Commercial |
$71.73
|
| Rate for Payer: Aetna Medicare |
$55.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.08
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$53.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,681.05
|
| Rate for Payer: BCN Commercial |
$273.17
|
| Rate for Payer: BCN Medicare Advantage |
$53.53
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$71.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.53
|
| Rate for Payer: Healthscope Commercial |
$99.03
|
| Rate for Payer: Healthscope Commercial |
$85.65
|
| Rate for Payer: Mclaren Medicaid |
$36.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.21
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,114.00
|
| Rate for Payer: Nomi Health Commercial |
$64.24
|
| Rate for Payer: PACE SWMI |
$53.53
|
| Rate for Payer: PHP Medicare Advantage |
$53.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.83
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: Priority Health Narrow Network |
$100.83
|
| Rate for Payer: Priority Health SBD |
$100.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.53
|
| Rate for Payer: UHC Exchange |
$123.33
|
| Rate for Payer: UHC Medicare Advantage |
$53.53
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
|
|
PR CA SCREEN;PELVIC/BREAST EXAM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS G0101
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$4,059.00 |
| Rate for Payer: Aetna Commercial |
$34.40
|
| Rate for Payer: Aetna Medicare |
$26.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.96
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS MAPPO |
$25.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,696.90
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$25.67
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$36.96
|
| Rate for Payer: Cofinity Commercial |
$34.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.67
|
| Rate for Payer: Healthscope Commercial |
$47.49
|
| Rate for Payer: Healthscope Commercial |
$41.07
|
| Rate for Payer: Mclaren Medicaid |
$17.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.95
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,059.00
|
| Rate for Payer: Nomi Health Commercial |
$30.80
|
| Rate for Payer: PACE SWMI |
$25.67
|
| Rate for Payer: PHP Medicare Advantage |
$25.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.80
|
| Rate for Payer: Priority Health Medicare |
$25.67
|
| Rate for Payer: Priority Health Narrow Network |
$36.80
|
| Rate for Payer: Priority Health SBD |
$36.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.67
|
| Rate for Payer: UHC Exchange |
$38.79
|
| Rate for Payer: UHC Medicare Advantage |
$25.67
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
|
|
PR CAST SUP GAUNTLET FIBERGLASS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS Q4014
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$3,158.00 |
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCN Commercial |
$26.15
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,158.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
|
|
PR CAST SUP LNG ARM SPLINT FBRG
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4018
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$1,725.00 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$14.28
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,725.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR CAST SUP LNG ARM SPLINT PLST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS Q4017
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$1,082.00 |
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCN Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,082.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
|
|
PR CAST SUP LNG ARM SPLNT PED F
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS Q4020
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$866.00 |
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCN Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$866.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
|
|
PR CAST SUP LNG LEG CYLINDER FB
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS Q4034
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$7,969.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCN Commercial |
$65.98
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,969.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
|
|
PR CAST SUP LNGLEG CYLNDR PED F
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS Q4036
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$3,987.00 |
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCN Commercial |
$33.01
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,987.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR CAST SUP LNG LEG PED FBRGLS
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS Q4032
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$4,522.00 |
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCN Commercial |
$37.44
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,522.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
|
|
PR CAST SUP LNG LEG SPLNT FBRGL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS Q4042
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$4,058.00 |
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$33.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,058.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR CAST SUP LNG LEG SPLNT PED F
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS Q4044
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$2,032.00 |
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCN Commercial |
$16.82
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,032.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
PR CAST SUP LONG ARM ADULT FBRG
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS Q4006
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCN Commercial |
$28.75
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,472.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
|
|
PR CAST SUP LONG ARM PED FBRGLS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q4008
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$1,735.00 |
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,735.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR CAST SUP LONG LEG FIBERGLASS
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS Q4030
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$9,044.00 |
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCN Commercial |
$74.88
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,044.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
|
|
PR CAST SUPPLIES UNLISTED
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS Q4050
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
