|
PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 45392
|
| Min. Negotiated Rate |
$190.85 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$396.09
|
| Rate for Payer: Aetna Medicare |
$307.41
|
| Rate for Payer: BCBS Complete |
$200.39
|
| Rate for Payer: BCBS MAPPO |
$295.59
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$435.90
|
| Rate for Payer: BCN Medicare Advantage |
$295.59
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$425.65
|
| Rate for Payer: Cofinity Commercial |
$396.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.59
|
| Rate for Payer: Mclaren Medicaid |
$190.85
|
| Rate for Payer: Meridian Medicaid |
$200.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$310.37
|
| Rate for Payer: PACE SWMI |
$295.59
|
| Rate for Payer: PHP Medicare Advantage |
$295.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$524.47
|
| Rate for Payer: Priority Health Medicare |
$295.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$524.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.59
|
| Rate for Payer: UHC Medicare Advantage |
$304.46
|
|
|
PR COMM SVCS BY RHC/FQHC 5 MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0071
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$1,575.92 |
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,575.92
|
| Rate for Payer: BCN Commercial |
$34.21
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$31.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.44
|
|
|
PR COMPLETE REPLACEMENT PICC RS&I
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 36584
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$480.86 |
| Rate for Payer: Aetna Commercial |
$76.90
|
| Rate for Payer: Aetna Medicare |
$59.69
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$57.39
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: BCN Commercial |
$480.86
|
| Rate for Payer: BCN Medicare Advantage |
$57.39
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$82.64
|
| Rate for Payer: Cofinity Commercial |
$76.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.39
|
| Rate for Payer: Mclaren Medicaid |
$36.42
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.26
|
| Rate for Payer: PACE SWMI |
$57.39
|
| Rate for Payer: PHP Medicare Advantage |
$57.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.50
|
| Rate for Payer: Priority Health Medicare |
$57.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.39
|
| Rate for Payer: UHC Medicare Advantage |
$59.11
|
|
|
PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 93303
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$1,712.22 |
| Rate for Payer: Aetna Commercial |
$278.47
|
| Rate for Payer: Aetna Medicare |
$216.12
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$207.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,712.22
|
| Rate for Payer: BCN Commercial |
$322.04
|
| Rate for Payer: BCN Medicare Advantage |
$207.81
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$278.47
|
| Rate for Payer: Cofinity Commercial |
$299.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$218.20
|
| Rate for Payer: PACE SWMI |
$207.81
|
| Rate for Payer: PHP Medicare Advantage |
$207.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.62
|
| Rate for Payer: Priority Health Medicare |
$207.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$311.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.81
|
| Rate for Payer: UHC Medicare Advantage |
$214.04
|
|
|
PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$2,901.95 |
| Rate for Payer: Aetna Commercial |
$119.07
|
| Rate for Payer: Aetna Medicare |
$92.41
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,901.95
|
| Rate for Payer: BCN Commercial |
$140.79
|
| Rate for Payer: BCN Medicare Advantage |
$88.86
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$127.96
|
| Rate for Payer: Cofinity Commercial |
$119.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.86
|
| Rate for Payer: Mclaren Medicaid |
$57.08
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.30
|
| Rate for Payer: PACE SWMI |
$88.86
|
| Rate for Payer: PHP Medicare Advantage |
$88.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.79
|
| Rate for Payer: Priority Health Medicare |
$88.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.86
|
| Rate for Payer: UHC Medicare Advantage |
$91.53
|
|
|
PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 51727
|
| Min. Negotiated Rate |
$268.80 |
| Max. Negotiated Rate |
$3,367.38 |
| Rate for Payer: Aetna Commercial |
$464.12
|
| Rate for Payer: Aetna Medicare |
$360.21
|
| Rate for Payer: BCBS Complete |
$268.80
|
| Rate for Payer: BCBS MAPPO |
$346.36
|
| Rate for Payer: BCBS Trust/PPO |
$3,367.38
|
| Rate for Payer: BCN Commercial |
$536.08
|
| Rate for Payer: BCN Medicare Advantage |
$346.36
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$498.76
|
| Rate for Payer: Cofinity Commercial |
$464.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$363.68
|
| Rate for Payer: PACE SWMI |
$346.36
|
| Rate for Payer: PHP Medicare Advantage |
$346.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$592.77
|
| Rate for Payer: Priority Health Medicare |
$346.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$592.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.36
|
| Rate for Payer: UHC Medicare Advantage |
$356.75
|
|
|
PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES
|
Professional
|
Both
|
$647.00
|
|
|
Service Code
|
HCPCS 51728
|
| Min. Negotiated Rate |
$258.80 |
| Max. Negotiated Rate |
$2,796.82 |
| Rate for Payer: Aetna Commercial |
$462.66
|
| Rate for Payer: Aetna Medicare |
$359.08
|
| Rate for Payer: BCBS Complete |
$258.80
|
| Rate for Payer: BCBS MAPPO |
$345.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,796.82
|
| Rate for Payer: BCN Commercial |
$534.61
|
| Rate for Payer: BCN Medicare Advantage |
$345.27
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cash Price |
$517.60
|
| Rate for Payer: Cofinity Commercial |
$497.19
|
| Rate for Payer: Cofinity Commercial |
$462.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$345.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$362.53
|
| Rate for Payer: PACE SWMI |
$345.27
|
| Rate for Payer: PHP Medicare Advantage |
$345.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.16
|
| Rate for Payer: Priority Health Medicare |
$345.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$591.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$345.27
|
| Rate for Payer: UHC Medicare Advantage |
$355.63
|
|
|
PR COMPLEX IMPLANT REMOVAL, BILATERAL
|
Professional
|
Both
|
$4,220.00
|
|
|
Service Code
|
HCPCS 00564
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,688.00 |
| Max. Negotiated Rate |
$2,954.00 |
| Rate for Payer: BCBS Complete |
$1,688.00
|
| Rate for Payer: Cash Price |
$3,376.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,954.00
|
|
|
PR COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$13.65 |
| Max. Negotiated Rate |
$2,933.12 |
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Medicare |
$14.20
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,933.12
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$13.65
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.33
|
| Rate for Payer: PACE SWMI |
$13.65
|
| Rate for Payer: PHP Medicare Advantage |
$13.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.69
|
| Rate for Payer: Priority Health Medicare |
$13.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.65
|
| Rate for Payer: UHC Medicare Advantage |
$14.06
|
|
|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$2,879.24 |
| Rate for Payer: Aetna Commercial |
$491.27
|
| Rate for Payer: Aetna Medicare |
$381.28
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$366.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.24
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: BCN Medicare Advantage |
$366.62
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$491.27
|
| Rate for Payer: Cofinity Commercial |
$527.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.95
|
| Rate for Payer: PACE SWMI |
$366.62
|
| Rate for Payer: PHP Medicare Advantage |
$366.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.73
|
| Rate for Payer: Priority Health Medicare |
$366.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$625.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.62
|
| Rate for Payer: UHC Medicare Advantage |
$377.62
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,100.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$8,609.74 |
| Rate for Payer: Aetna Commercial |
$5,701.32
|
| Rate for Payer: Aetna Medicare |
$4,424.91
|
| Rate for Payer: BCBS Complete |
$2,859.59
|
| Rate for Payer: BCBS MAPPO |
$4,254.72
|
| Rate for Payer: BCBS Trust/PPO |
$736.98
|
| Rate for Payer: BCN Commercial |
$8,609.74
|
| Rate for Payer: BCN Medicare Advantage |
$4,254.72
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cofinity Commercial |
$6,126.80
|
| Rate for Payer: Cofinity Commercial |
$5,701.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,254.72
|
| Rate for Payer: Mclaren Medicaid |
$2,723.42
|
| Rate for Payer: Meridian Medicaid |
$2,859.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,467.46
|
| Rate for Payer: PACE SWMI |
$4,254.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,254.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,723.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,070.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,191.03
|
| Rate for Payer: Priority Health Medicare |
$4,254.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7,191.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,254.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,254.72
|
| Rate for Payer: UHC Medicare Advantage |
$4,382.36
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$41.46
|
| Rate for Payer: Aetna Medicare |
$32.18
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS MAPPO |
$30.94
|
| Rate for Payer: BCBS Trust/PPO |
$196.00
|
| Rate for Payer: BCN Commercial |
$53.75
|
| Rate for Payer: BCN Medicare Advantage |
$30.94
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$44.55
|
| Rate for Payer: Cofinity Commercial |
$41.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.94
|
| Rate for Payer: Mclaren Medicaid |
$20.02
|
| Rate for Payer: Meridian Medicaid |
$21.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.49
|
| Rate for Payer: PACE SWMI |
$30.94
|
| Rate for Payer: PHP Medicare Advantage |
$30.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.21
|
| Rate for Payer: Priority Health Medicare |
$30.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.94
|
| Rate for Payer: UHC Medicare Advantage |
$31.87
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 93620
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$7,115.72 |
| Rate for Payer: Aetna Commercial |
$1,103.18
|
| Rate for Payer: BCBS Complete |
$517.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.30
|
| Rate for Payer: BCN Commercial |
$7,115.72
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$905.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,145.76
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 93621
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$1,640.93 |
| Rate for Payer: Aetna Commercial |
$205.99
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,215.62
|
| Rate for Payer: BCN Commercial |
$1,640.93
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.79
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 93653
|
| Min. Negotiated Rate |
$520.15 |
| Max. Negotiated Rate |
$2,938.40 |
| Rate for Payer: Aetna Commercial |
$1,107.35
|
| Rate for Payer: Aetna Medicare |
$859.44
|
| Rate for Payer: BCBS Complete |
$546.16
|
| Rate for Payer: BCBS MAPPO |
$826.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.40
|
| Rate for Payer: BCN Commercial |
$1,207.03
|
| Rate for Payer: BCN Medicare Advantage |
$826.38
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,189.99
|
| Rate for Payer: Cofinity Commercial |
$1,107.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.38
|
| Rate for Payer: Mclaren Medicaid |
$520.15
|
| Rate for Payer: Meridian Medicaid |
$546.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$867.70
|
| Rate for Payer: PACE SWMI |
$826.38
|
| Rate for Payer: PHP Medicare Advantage |
$826.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.98
|
| Rate for Payer: Priority Health Medicare |
$826.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,167.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.38
|
| Rate for Payer: UHC Medicare Advantage |
$851.17
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
HCPCS 93654
|
| Min. Negotiated Rate |
$626.65 |
| Max. Negotiated Rate |
$3,268.06 |
| Rate for Payer: Aetna Commercial |
$1,334.77
|
| Rate for Payer: Aetna Medicare |
$1,035.94
|
| Rate for Payer: BCBS Complete |
$657.98
|
| Rate for Payer: BCBS MAPPO |
$996.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,268.06
|
| Rate for Payer: BCN Commercial |
$1,454.79
|
| Rate for Payer: BCN Medicare Advantage |
$996.10
|
| Rate for Payer: Cash Price |
$1,843.20
|
| Rate for Payer: Cash Price |
$1,843.20
|
| Rate for Payer: Cofinity Commercial |
$1,334.77
|
| Rate for Payer: Cofinity Commercial |
$1,434.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.10
|
| Rate for Payer: Mclaren Medicaid |
$626.65
|
| Rate for Payer: Meridian Medicaid |
$657.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,045.90
|
| Rate for Payer: PACE SWMI |
$996.10
|
| Rate for Payer: PHP Medicare Advantage |
$996.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,407.73
|
| Rate for Payer: Priority Health Medicare |
$996.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,407.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$996.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$996.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.98
|
|
|
PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
HCPCS 93656
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$3,385.35 |
| Rate for Payer: Aetna Commercial |
$1,255.73
|
| Rate for Payer: Aetna Medicare |
$974.59
|
| Rate for Payer: BCBS Complete |
$619.29
|
| Rate for Payer: BCBS MAPPO |
$937.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.35
|
| Rate for Payer: BCN Commercial |
$1,368.79
|
| Rate for Payer: BCN Medicare Advantage |
$937.11
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cofinity Commercial |
$1,349.44
|
| Rate for Payer: Cofinity Commercial |
$1,255.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$937.11
|
| Rate for Payer: Mclaren Medicaid |
$589.80
|
| Rate for Payer: Meridian Medicaid |
$619.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$983.97
|
| Rate for Payer: PACE SWMI |
$937.11
|
| Rate for Payer: PHP Medicare Advantage |
$937.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$589.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,324.50
|
| Rate for Payer: Priority Health Medicare |
$937.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,324.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$937.11
|
| Rate for Payer: UHC Medicare Advantage |
$965.22
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$2,061.43 |
| Rate for Payer: Aetna Commercial |
$101.42
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,061.43
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$75.69
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$101.42
|
| Rate for Payer: Cofinity Commercial |
$108.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.47
|
| Rate for Payer: PACE SWMI |
$75.69
|
| Rate for Payer: PHP Medicare Advantage |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.04
|
| Rate for Payer: Priority Health Medicare |
$75.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.69
|
| Rate for Payer: UHC Medicare Advantage |
$77.96
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$552.57 |
| Max. Negotiated Rate |
$815.40 |
| Rate for Payer: Aetna Commercial |
$770.10
|
| Rate for Payer: BCBS Trust/PPO |
$700.16
|
| Rate for Payer: BCN Commercial |
$700.16
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$779.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.80
|
| Rate for Payer: Healthscope Commercial |
$815.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.10
|
| Rate for Payer: PHP Commercial |
$770.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$797.28
|
| Rate for Payer: UHC Core |
$756.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.50
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$215.18 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: Aetna Commercial |
$770.10
|
| Rate for Payer: Aetna Medicare |
$235.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$283.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$283.12
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$226.50
|
| Rate for Payer: BCBS Trust/PPO |
$704.42
|
| Rate for Payer: BCCCP Commercial |
$322.14
|
| Rate for Payer: BCN Commercial |
$704.42
|
| Rate for Payer: BCN Medicare Advantage |
$226.50
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$779.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.50
|
| Rate for Payer: Healthscope Commercial |
$815.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$679.50
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$237.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.10
|
| Rate for Payer: PACE Senior Care Partners |
$215.18
|
| Rate for Payer: PACE SWMI |
$226.50
|
| Rate for Payer: PHP Commercial |
$770.10
|
| Rate for Payer: PHP Medicare Advantage |
$226.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$788.22
|
| Rate for Payer: Priority Health Medicare |
$226.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.57
|
| Rate for Payer: Railroad Medicare Medicare |
$226.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$797.28
|
| Rate for Payer: UHC Core |
$756.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.50
|
| Rate for Payer: UHC Medicare Advantage |
$233.30
|
| Rate for Payer: VA VA |
$226.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$679.50
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$3,117.50 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$261.20
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,117.50
|
| Rate for Payer: BCN Commercial |
$447.14
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Mclaren Medicaid |
$164.86
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.11
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.15
|
| Rate for Payer: UHC Medicare Advantage |
$258.68
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
57522
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$3,117.50 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$261.20
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,117.50
|
| Rate for Payer: BCN Commercial |
$447.14
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Mclaren Medicaid |
$164.86
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.11
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$363.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.15
|
| Rate for Payer: UHC Medicare Advantage |
$258.68
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 57520
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$1,148.52 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$303.17
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS MAPPO |
$291.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$520.93
|
| Rate for Payer: BCN Medicare Advantage |
$291.51
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cofinity Commercial |
$419.77
|
| Rate for Payer: Cofinity Commercial |
$390.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.51
|
| Rate for Payer: Mclaren Medicaid |
$191.70
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.09
|
| Rate for Payer: PACE SWMI |
$291.51
|
| Rate for Payer: PHP Medicare Advantage |
$291.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.29
|
| Rate for Payer: Priority Health Medicare |
$291.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$422.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.51
|
| Rate for Payer: UHC Medicare Advantage |
$300.26
|
|
|
PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 57291
|
| Min. Negotiated Rate |
$354.43 |
| Max. Negotiated Rate |
$1,525.20 |
| Rate for Payer: Aetna Commercial |
$729.21
|
| Rate for Payer: Aetna Medicare |
$565.96
|
| Rate for Payer: BCBS Complete |
$372.15
|
| Rate for Payer: BCBS MAPPO |
$544.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.20
|
| Rate for Payer: BCN Commercial |
$807.78
|
| Rate for Payer: BCN Medicare Advantage |
$544.19
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$783.63
|
| Rate for Payer: Cofinity Commercial |
$729.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.19
|
| Rate for Payer: Mclaren Medicaid |
$354.43
|
| Rate for Payer: Meridian Medicaid |
$372.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$571.40
|
| Rate for Payer: PACE SWMI |
$544.19
|
| Rate for Payer: PHP Medicare Advantage |
$544.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.58
|
| Rate for Payer: Priority Health Medicare |
$544.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$544.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$544.19
|
| Rate for Payer: UHC Medicare Advantage |
$560.52
|
|
|
PR CONSULTS
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 00125
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
|
