|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$501.34 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna Commercial |
$698.70
|
| Rate for Payer: BCBS Trust/PPO |
$635.24
|
| Rate for Payer: BCN Commercial |
$635.24
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.60
|
| Rate for Payer: Healthscope Commercial |
$739.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: PHP Commercial |
$698.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.36
|
| Rate for Payer: UHC Core |
$686.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.50
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$179.79
|
| Rate for Payer: Aetna Medicare |
$139.54
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$134.17
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: BCN Medicare Advantage |
$134.17
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$179.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.17
|
| Rate for Payer: Mclaren Medicaid |
$87.33
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.88
|
| Rate for Payer: PACE SWMI |
$134.17
|
| Rate for Payer: PHP Medicare Advantage |
$134.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Medicare |
$134.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.17
|
| Rate for Payer: UHC Medicare Advantage |
$138.20
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
43239
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$739.80 |
| Rate for Payer: Aetna Commercial |
$698.70
|
| Rate for Payer: Aetna Medicare |
$213.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$256.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$256.88
|
| Rate for Payer: BCBS Complete |
$624.38
|
| Rate for Payer: BCBS MAPPO |
$205.50
|
| Rate for Payer: BCBS Trust/PPO |
$639.10
|
| Rate for Payer: BCN Commercial |
$639.10
|
| Rate for Payer: BCN Medicare Advantage |
$205.50
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$706.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$657.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.50
|
| Rate for Payer: Healthscope Commercial |
$739.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$616.50
|
| Rate for Payer: Mclaren Medicaid |
$594.64
|
| Rate for Payer: Meridian Medicaid |
$624.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$215.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$698.70
|
| Rate for Payer: PACE Senior Care Partners |
$195.22
|
| Rate for Payer: PACE SWMI |
$205.50
|
| Rate for Payer: PHP Commercial |
$698.70
|
| Rate for Payer: PHP Medicare Advantage |
$205.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.14
|
| Rate for Payer: Priority Health Medicare |
$205.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$501.34
|
| Rate for Payer: Railroad Medicare Medicare |
$205.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$723.36
|
| Rate for Payer: UHC Core |
$686.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.50
|
| Rate for Payer: UHC Medicare Advantage |
$211.66
|
| Rate for Payer: VA VA |
$205.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$616.50
|
|
|
PR EGD TRANSORAL BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 43239
|
| Hospital Charge Code |
43239
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$179.79
|
| Rate for Payer: Aetna Medicare |
$139.54
|
| Rate for Payer: BCBS Complete |
$91.70
|
| Rate for Payer: BCBS MAPPO |
$134.17
|
| Rate for Payer: BCBS Trust/PPO |
$33.11
|
| Rate for Payer: BCN Commercial |
$554.16
|
| Rate for Payer: BCN Medicare Advantage |
$134.17
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$193.20
|
| Rate for Payer: Cofinity Commercial |
$179.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.17
|
| Rate for Payer: Mclaren Medicaid |
$87.33
|
| Rate for Payer: Meridian Medicaid |
$91.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.88
|
| Rate for Payer: PACE SWMI |
$134.17
|
| Rate for Payer: PHP Medicare Advantage |
$134.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.71
|
| Rate for Payer: Priority Health Medicare |
$134.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.17
|
| Rate for Payer: UHC Medicare Advantage |
$138.20
|
|
|
PR EGD TRANSORAL CONTROL BLEEDING ANY METHOD
|
Professional
|
Both
|
$1,130.00
|
|
|
Service Code
|
HCPCS 43255
|
| Min. Negotiated Rate |
$125.67 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$260.28
|
| Rate for Payer: Aetna Medicare |
$202.01
|
| Rate for Payer: BCBS Complete |
$131.95
|
| Rate for Payer: BCBS MAPPO |
$194.24
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$923.11
|
| Rate for Payer: BCN Medicare Advantage |
$194.24
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cash Price |
$904.00
|
| Rate for Payer: Cofinity Commercial |
$279.71
|
| Rate for Payer: Cofinity Commercial |
$260.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.24
|
| Rate for Payer: Mclaren Medicaid |
$125.67
|
| Rate for Payer: Meridian Medicaid |
$131.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.95
|
| Rate for Payer: PACE SWMI |
$194.24
|
| Rate for Payer: PHP Medicare Advantage |
$194.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.14
|
| Rate for Payer: Priority Health Medicare |
$194.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$345.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$194.24
|
| Rate for Payer: UHC Medicare Advantage |
$200.07
|
|
|
PR EGD TRANSORAL ENDOSCOPIC MUCOSAL RESECTION
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 43254
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$1,640.37 |
| Rate for Payer: Aetna Commercial |
$351.09
|
| Rate for Payer: Aetna Medicare |
$272.49
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS MAPPO |
$262.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,640.37
|
| Rate for Payer: BCN Commercial |
$386.55
|
| Rate for Payer: BCN Medicare Advantage |
$262.01
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$377.29
|
| Rate for Payer: Cofinity Commercial |
$351.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.01
|
| Rate for Payer: Mclaren Medicaid |
$169.34
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$275.11
|
| Rate for Payer: PACE SWMI |
$262.01
|
| Rate for Payer: PHP Medicare Advantage |
$262.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$465.09
|
| Rate for Payer: Priority Health Medicare |
$262.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$465.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.01
|
| Rate for Payer: UHC Medicare Advantage |
$269.87
|
|
|
PR EGD TRANSORAL TRANSMURAL DRAINAGE PSEUDOCYST
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 43240
|
| Min. Negotiated Rate |
$41.74 |
| Max. Negotiated Rate |
$815.50 |
| Rate for Payer: Aetna Commercial |
$509.11
|
| Rate for Payer: Aetna Medicare |
$395.13
|
| Rate for Payer: BCBS Complete |
$258.09
|
| Rate for Payer: BCBS MAPPO |
$379.93
|
| Rate for Payer: BCBS Trust/PPO |
$41.74
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$379.93
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$509.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.93
|
| Rate for Payer: Mclaren Medicaid |
$245.80
|
| Rate for Payer: Meridian Medicaid |
$258.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$398.93
|
| Rate for Payer: PACE SWMI |
$379.93
|
| Rate for Payer: PHP Medicare Advantage |
$379.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$815.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$673.82
|
| Rate for Payer: Priority Health Medicare |
$379.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$673.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.93
|
| Rate for Payer: UHC Medicare Advantage |
$391.33
|
|
|
PR EGD US GUIDED TRANSMURAL INJXN/FIDUCIAL MARKER
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
HCPCS 43253
|
| Min. Negotiated Rate |
$164.65 |
| Max. Negotiated Rate |
$1,676.30 |
| Rate for Payer: Aetna Commercial |
$341.77
|
| Rate for Payer: Aetna Medicare |
$265.25
|
| Rate for Payer: BCBS Complete |
$172.88
|
| Rate for Payer: BCBS MAPPO |
$255.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: BCN Medicare Advantage |
$255.05
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cofinity Commercial |
$367.27
|
| Rate for Payer: Cofinity Commercial |
$341.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.05
|
| Rate for Payer: Mclaren Medicaid |
$164.65
|
| Rate for Payer: Meridian Medicaid |
$172.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$267.80
|
| Rate for Payer: PACE SWMI |
$255.05
|
| Rate for Payer: PHP Medicare Advantage |
$255.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$452.74
|
| Rate for Payer: Priority Health Medicare |
$255.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$452.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.05
|
| Rate for Payer: UHC Medicare Advantage |
$262.70
|
|
|
PR EKG FOR INITIAL PREVENT EXAM
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS G0403
|
| Min. Negotiated Rate |
$13.90 |
| Max. Negotiated Rate |
$1,763.47 |
| Rate for Payer: Aetna Commercial |
$18.63
|
| Rate for Payer: Aetna Medicare |
$14.46
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$13.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,763.47
|
| Rate for Payer: BCN Commercial |
$21.02
|
| Rate for Payer: BCN Medicare Advantage |
$13.90
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$20.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.60
|
| Rate for Payer: PACE SWMI |
$13.90
|
| Rate for Payer: PHP Medicare Advantage |
$13.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.33
|
| Rate for Payer: Priority Health Medicare |
$13.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.90
|
| Rate for Payer: UHC Medicare Advantage |
$14.32
|
|
|
PR EKG INTERPRET & REPORT PREVE
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0405
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$1,397.35 |
| Rate for Payer: Aetna Commercial |
$10.69
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,397.35
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$11.49
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PHP Medicare Advantage |
$7.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.34
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.98
|
| Rate for Payer: UHC Medicare Advantage |
$8.22
|
|
|
PR EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$2,970.10 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,970.10
|
| Rate for Payer: BCN Commercial |
$9.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
|
|
PR ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$64.83
|
| Rate for Payer: Aetna Medicare |
$50.32
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.38
|
| Rate for Payer: BCBS Trust/PPO |
$205.51
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: BCN Medicare Advantage |
$48.38
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$69.67
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.38
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.80
|
| Rate for Payer: PACE SWMI |
$48.38
|
| Rate for Payer: PHP Medicare Advantage |
$48.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.58
|
| Rate for Payer: Priority Health Medicare |
$48.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.38
|
| Rate for Payer: UHC Medicare Advantage |
$49.83
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$269.43 |
| Rate for Payer: Aetna Commercial |
$56.79
|
| Rate for Payer: Aetna Medicare |
$44.08
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$42.38
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: BCN Medicare Advantage |
$42.38
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Cofinity Commercial |
$56.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.38
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.50
|
| Rate for Payer: PACE SWMI |
$42.38
|
| Rate for Payer: PHP Medicare Advantage |
$42.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.50
|
| Rate for Payer: Priority Health Medicare |
$42.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.38
|
| Rate for Payer: UHC Medicare Advantage |
$43.65
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$154.26 |
| Rate for Payer: Aetna Commercial |
$68.38
|
| Rate for Payer: Aetna Medicare |
$53.07
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$51.03
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: BCN Medicare Advantage |
$51.03
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$73.48
|
| Rate for Payer: Cofinity Commercial |
$68.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.03
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.58
|
| Rate for Payer: PACE SWMI |
$51.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.17
|
| Rate for Payer: Priority Health Medicare |
$51.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.03
|
| Rate for Payer: UHC Medicare Advantage |
$52.56
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: Aetna Medicare |
$41.62
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$40.02
|
| Rate for Payer: BCBS MAPPO |
$40.02
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: BCN Medicare Advantage |
$40.02
|
| Rate for Payer: BCN Medicare Advantage |
$40.02
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$53.63
|
| Rate for Payer: Cofinity Commercial |
$53.63
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.02
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.02
|
| Rate for Payer: PACE SWMI |
$40.02
|
| Rate for Payer: PACE SWMI |
$40.02
|
| Rate for Payer: PHP Medicare Advantage |
$40.02
|
| Rate for Payer: PHP Medicare Advantage |
$40.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health Medicare |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$40.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.02
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
|
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95970
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$18.99
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.26
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.26
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.17
|
| Rate for Payer: PACE SWMI |
$18.26
|
| Rate for Payer: PHP Medicare Advantage |
$18.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.71
|
| Rate for Payer: Priority Health Medicare |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.26
|
| Rate for Payer: UHC Medicare Advantage |
$18.81
|
|
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95971
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$475.47 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$39.78
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$475.47
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Mclaren Medicaid |
$24.50
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.25
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$140.93 |
| Rate for Payer: Aetna Commercial |
$51.04
|
| Rate for Payer: Aetna Medicare |
$39.61
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.09
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Medicare Advantage |
$38.09
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$54.85
|
| Rate for Payer: Cofinity Commercial |
$51.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.09
|
| Rate for Payer: Mclaren Medicaid |
$24.50
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.99
|
| Rate for Payer: PACE SWMI |
$38.09
|
| Rate for Payer: PHP Medicare Advantage |
$38.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Medicare |
$38.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.09
|
| Rate for Payer: UHC Medicare Advantage |
$39.23
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 95974
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: BCBS Complete |
$376.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.00
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95973
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
|
|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$367.70 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$11.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.30
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.99
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.71
|
| Rate for Payer: UHC Medicare Advantage |
$12.06
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Medicare |
$35.32
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS MAPPO |
$33.96
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: BCN Medicare Advantage |
$33.96
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$45.51
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.96
|
| Rate for Payer: Mclaren Medicaid |
$21.73
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.66
|
| Rate for Payer: PACE SWMI |
$33.96
|
| Rate for Payer: PHP Medicare Advantage |
$33.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.75
|
| Rate for Payer: Priority Health Medicare |
$33.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.96
|
| Rate for Payer: UHC Medicare Advantage |
$34.98
|
|
|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 62367
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare |
$25.29
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.32
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$24.32
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.32
|
| Rate for Payer: Mclaren Medicaid |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.54
|
| Rate for Payer: PACE SWMI |
$24.32
|
| Rate for Payer: PHP Medicare Advantage |
$24.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.34
|
| Rate for Payer: Priority Health Medicare |
$24.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.32
|
| Rate for Payer: UHC Medicare Advantage |
$25.05
|
|
|
PR ELECTROACOUS EVAL HEARING AID BINAURAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92595
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$338.64
|
| Rate for Payer: BCN Commercial |
$64.31
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.54
|
|
