|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,404.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$129.43 |
| Max. Negotiated Rate |
$1,128.03 |
| Rate for Payer: Aetna Commercial |
$963.86
|
| Rate for Payer: Aetna Medicare |
$748.07
|
| Rate for Payer: BCBS Complete |
$496.72
|
| Rate for Payer: BCBS MAPPO |
$719.30
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$1,079.48
|
| Rate for Payer: BCN Medicare Advantage |
$719.30
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cash Price |
$1,123.20
|
| Rate for Payer: Cofinity Commercial |
$963.86
|
| Rate for Payer: Cofinity Commercial |
$1,035.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.30
|
| Rate for Payer: Mclaren Medicaid |
$473.07
|
| Rate for Payer: Meridian Medicaid |
$496.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$755.26
|
| Rate for Payer: PACE SWMI |
$719.30
|
| Rate for Payer: PHP Medicare Advantage |
$719.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,128.03
|
| Rate for Payer: Priority Health Medicare |
$719.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,128.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.30
|
| Rate for Payer: UHC Medicare Advantage |
$740.88
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,313.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$1,619.10 |
| Rate for Payer: Aetna Commercial |
$941.50
|
| Rate for Payer: Aetna Medicare |
$730.71
|
| Rate for Payer: BCBS Complete |
$485.32
|
| Rate for Payer: BCBS MAPPO |
$702.61
|
| Rate for Payer: BCBS Trust/PPO |
$69.19
|
| Rate for Payer: BCN Commercial |
$1,054.56
|
| Rate for Payer: BCN Medicare Advantage |
$702.61
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cash Price |
$1,850.40
|
| Rate for Payer: Cofinity Commercial |
$1,011.76
|
| Rate for Payer: Cofinity Commercial |
$941.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.61
|
| Rate for Payer: Mclaren Medicaid |
$462.21
|
| Rate for Payer: Meridian Medicaid |
$485.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$737.74
|
| Rate for Payer: PACE SWMI |
$702.61
|
| Rate for Payer: PHP Medicare Advantage |
$702.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,619.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,101.99
|
| Rate for Payer: Priority Health Medicare |
$702.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,101.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$702.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.61
|
| Rate for Payer: UHC Medicare Advantage |
$723.69
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,633.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$3,943.10 |
| Rate for Payer: Aetna Commercial |
$1,815.41
|
| Rate for Payer: Aetna Medicare |
$1,408.97
|
| Rate for Payer: BCBS Complete |
$917.86
|
| Rate for Payer: BCBS MAPPO |
$1,354.78
|
| Rate for Payer: BCBS Trust/PPO |
$170.11
|
| Rate for Payer: BCN Commercial |
$2,197.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,354.78
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,950.88
|
| Rate for Payer: Cofinity Commercial |
$1,815.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,354.78
|
| Rate for Payer: Mclaren Medicaid |
$874.15
|
| Rate for Payer: Meridian Medicaid |
$917.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,422.52
|
| Rate for Payer: PACE SWMI |
$1,354.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,354.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$874.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,312.45
|
| Rate for Payer: Priority Health Medicare |
$1,354.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,312.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,354.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,354.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,395.42
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,890.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$153.79 |
| Max. Negotiated Rate |
$1,323.00 |
| Rate for Payer: Aetna Commercial |
$324.19
|
| Rate for Payer: Aetna Medicare |
$251.61
|
| Rate for Payer: BCBS Complete |
$161.48
|
| Rate for Payer: BCBS MAPPO |
$241.93
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$389.03
|
| Rate for Payer: BCN Medicare Advantage |
$241.93
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cofinity Commercial |
$348.38
|
| Rate for Payer: Cofinity Commercial |
$324.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.93
|
| Rate for Payer: Mclaren Medicaid |
$153.79
|
| Rate for Payer: Meridian Medicaid |
$161.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$254.03
|
| Rate for Payer: PACE SWMI |
$241.93
|
| Rate for Payer: PHP Medicare Advantage |
$241.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,323.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.37
|
| Rate for Payer: Priority Health Medicare |
$241.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$409.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.93
|
| Rate for Payer: UHC Medicare Advantage |
$249.19
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,580.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$3,906.00 |
| Rate for Payer: Aetna Commercial |
$2,045.82
|
| Rate for Payer: Aetna Medicare |
$1,587.80
|
| Rate for Payer: BCBS Complete |
$982.04
|
| Rate for Payer: BCBS MAPPO |
$1,526.73
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$2,469.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,526.73
|
| Rate for Payer: Cash Price |
$4,464.00
|
| Rate for Payer: Cash Price |
$4,464.00
|
| Rate for Payer: Cofinity Commercial |
$2,198.49
|
| Rate for Payer: Cofinity Commercial |
$2,045.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,526.73
|
| Rate for Payer: Mclaren Medicaid |
$935.28
|
| Rate for Payer: Meridian Medicaid |
$982.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,603.07
|
| Rate for Payer: PACE SWMI |
$1,526.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,526.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$935.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,906.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,598.39
|
| Rate for Payer: Priority Health Medicare |
$1,526.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,598.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,526.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,526.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,572.53
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: BCBS Trust/PPO |
$111.47
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$284.23 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: Aetna Medicare |
$98.06
|
| Rate for Payer: BCBS Complete |
$65.08
|
| Rate for Payer: BCBS MAPPO |
$94.29
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$139.76
|
| Rate for Payer: BCN Medicare Advantage |
$94.29
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$126.35
|
| Rate for Payer: Cofinity Commercial |
$135.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.29
|
| Rate for Payer: Mclaren Medicaid |
$61.98
|
| Rate for Payer: Meridian Medicaid |
$65.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.00
|
| Rate for Payer: PACE SWMI |
$94.29
|
| Rate for Payer: PHP Medicare Advantage |
$94.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.16
|
| Rate for Payer: Priority Health Medicare |
$94.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.29
|
| Rate for Payer: UHC Medicare Advantage |
$97.12
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$239.68 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$1,136.49 |
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna Medicare |
$536.41
|
| Rate for Payer: BCBS Complete |
$353.59
|
| Rate for Payer: BCBS MAPPO |
$515.78
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: BCN Medicare Advantage |
$515.78
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$742.72
|
| Rate for Payer: Cofinity Commercial |
$691.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.78
|
| Rate for Payer: Mclaren Medicaid |
$336.75
|
| Rate for Payer: Meridian Medicaid |
$353.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$541.57
|
| Rate for Payer: PACE SWMI |
$515.78
|
| Rate for Payer: PHP Medicare Advantage |
$515.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.49
|
| Rate for Payer: Priority Health Medicare |
$515.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,136.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$515.78
|
| Rate for Payer: UHC Medicare Advantage |
$531.25
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$561.11 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$782.00
|
| Rate for Payer: BCBS Trust/PPO |
$710.98
|
| Rate for Payer: BCN Commercial |
$710.98
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$791.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Healthscope Commercial |
$828.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$782.00
|
| Rate for Payer: PHP Commercial |
$782.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.60
|
| Rate for Payer: UHC Core |
$768.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.00
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$218.50 |
| Max. Negotiated Rate |
$3,974.31 |
| Rate for Payer: Aetna Commercial |
$782.00
|
| Rate for Payer: Aetna Medicare |
$239.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.50
|
| Rate for Payer: BCBS Complete |
$3,974.31
|
| Rate for Payer: BCBS MAPPO |
$230.00
|
| Rate for Payer: BCBS Trust/PPO |
$715.30
|
| Rate for Payer: BCN Commercial |
$715.30
|
| Rate for Payer: BCN Medicare Advantage |
$230.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$791.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.00
|
| Rate for Payer: Healthscope Commercial |
$828.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.00
|
| Rate for Payer: Mclaren Medicaid |
$3,785.06
|
| Rate for Payer: Meridian Medicaid |
$3,974.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$241.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$782.00
|
| Rate for Payer: PACE Senior Care Partners |
$218.50
|
| Rate for Payer: PACE SWMI |
$230.00
|
| Rate for Payer: PHP Commercial |
$782.00
|
| Rate for Payer: PHP Medicare Advantage |
$230.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,785.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$800.40
|
| Rate for Payer: Priority Health Medicare |
$230.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$561.11
|
| Rate for Payer: Railroad Medicare Medicare |
$230.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$809.60
|
| Rate for Payer: UHC Core |
$768.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.00
|
| Rate for Payer: UHC Medicare Advantage |
$236.90
|
| Rate for Payer: VA VA |
$230.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.00
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$1,136.49 |
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna Medicare |
$536.41
|
| Rate for Payer: BCBS Complete |
$353.59
|
| Rate for Payer: BCBS MAPPO |
$515.78
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: BCN Medicare Advantage |
$515.78
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$691.15
|
| Rate for Payer: Cofinity Commercial |
$742.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.78
|
| Rate for Payer: Mclaren Medicaid |
$336.75
|
| Rate for Payer: Meridian Medicaid |
$353.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$541.57
|
| Rate for Payer: PACE SWMI |
$515.78
|
| Rate for Payer: PHP Medicare Advantage |
$515.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.49
|
| Rate for Payer: Priority Health Medicare |
$515.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,136.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$515.78
|
| Rate for Payer: UHC Medicare Advantage |
$531.25
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$1,080.37 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.37
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$1,890.26 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna Medicare |
$22.08
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.26
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$30.57
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.20
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.23
|
| Rate for Payer: UHC Medicare Advantage |
$21.87
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$1,499.32 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.32
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.37
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$1,672.30 |
| Rate for Payer: Aetna Commercial |
$1,049.30
|
| Rate for Payer: Aetna Medicare |
$814.38
|
| Rate for Payer: BCBS Complete |
$534.74
|
| Rate for Payer: BCBS MAPPO |
$783.06
|
| Rate for Payer: BCBS Trust/PPO |
$85.32
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$783.06
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$1,127.61
|
| Rate for Payer: Cofinity Commercial |
$1,049.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$783.06
|
| Rate for Payer: Mclaren Medicaid |
$509.28
|
| Rate for Payer: Meridian Medicaid |
$534.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$822.21
|
| Rate for Payer: PACE SWMI |
$783.06
|
| Rate for Payer: PHP Medicare Advantage |
$783.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,672.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,396.43
|
| Rate for Payer: Priority Health Medicare |
$783.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,396.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$783.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$783.06
|
| Rate for Payer: UHC Medicare Advantage |
$806.55
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,105.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,546.50 |
| Rate for Payer: Aetna Commercial |
$1,944.66
|
| Rate for Payer: Aetna Medicare |
$1,509.29
|
| Rate for Payer: BCBS Complete |
$972.88
|
| Rate for Payer: BCBS MAPPO |
$1,451.24
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$2,116.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.24
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cofinity Commercial |
$2,089.79
|
| Rate for Payer: Cofinity Commercial |
$1,944.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.24
|
| Rate for Payer: Mclaren Medicaid |
$926.55
|
| Rate for Payer: Meridian Medicaid |
$972.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,523.80
|
| Rate for Payer: PACE SWMI |
$1,451.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,173.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,546.50
|
| Rate for Payer: Priority Health Medicare |
$1,451.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,546.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,451.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,494.78
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,150.00
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$686.71 |
| Max. Negotiated Rate |
$2,905.00 |
| Rate for Payer: Aetna Commercial |
$1,431.46
|
| Rate for Payer: Aetna Medicare |
$1,110.98
|
| Rate for Payer: BCBS Complete |
$721.05
|
| Rate for Payer: BCBS MAPPO |
$1,068.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,485.05
|
| Rate for Payer: BCN Commercial |
$1,564.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,068.25
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Cofinity Commercial |
$1,431.46
|
| Rate for Payer: Cofinity Commercial |
$1,538.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,068.25
|
| Rate for Payer: Mclaren Medicaid |
$686.71
|
| Rate for Payer: Meridian Medicaid |
$721.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,121.66
|
| Rate for Payer: PACE SWMI |
$1,068.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,068.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$686.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,905.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,702.80
|
| Rate for Payer: Priority Health Medicare |
$1,068.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,702.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,068.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,068.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,100.30
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$3,050.93 |
| Rate for Payer: Aetna Commercial |
$539.04
|
| Rate for Payer: Aetna Medicare |
$418.36
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS MAPPO |
$402.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,050.93
|
| Rate for Payer: BCN Commercial |
$856.16
|
| Rate for Payer: BCN Medicare Advantage |
$402.27
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$579.27
|
| Rate for Payer: Cofinity Commercial |
$539.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.27
|
| Rate for Payer: Mclaren Medicaid |
$266.25
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$422.38
|
| Rate for Payer: PACE SWMI |
$402.27
|
| Rate for Payer: PHP Medicare Advantage |
$402.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.58
|
| Rate for Payer: Priority Health Medicare |
$402.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$627.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.27
|
| Rate for Payer: UHC Medicare Advantage |
$414.34
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$804.78 |
| Rate for Payer: Aetna Commercial |
$710.09
|
| Rate for Payer: Aetna Medicare |
$551.12
|
| Rate for Payer: BCBS Complete |
$354.49
|
| Rate for Payer: BCBS MAPPO |
$529.92
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: BCN Medicare Advantage |
$529.92
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cofinity Commercial |
$763.08
|
| Rate for Payer: Cofinity Commercial |
$710.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.92
|
| Rate for Payer: Mclaren Medicaid |
$337.61
|
| Rate for Payer: Meridian Medicaid |
$354.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$556.42
|
| Rate for Payer: PACE SWMI |
$529.92
|
| Rate for Payer: PHP Medicare Advantage |
$529.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$804.78
|
| Rate for Payer: Priority Health Medicare |
$529.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$804.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$529.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.92
|
| Rate for Payer: UHC Medicare Advantage |
$545.82
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$367.79
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.06
|
| Rate for Payer: BCN Commercial |
$516.04
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Mclaren Medicaid |
$226.42
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.25
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.64
|
| Rate for Payer: UHC Medicare Advantage |
$364.25
|
|
