|
PR EXC LESION MUCOSA&SBMCSL VESTIBULE CPLX EXC MUSC
|
Professional
|
Both
|
$1,199.00
|
|
|
Service Code
|
HCPCS 40816
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$839.30 |
| Rate for Payer: Aetna Commercial |
$393.73
|
| Rate for Payer: Aetna Medicare |
$305.58
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS MAPPO |
$293.83
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$590.81
|
| Rate for Payer: BCN Medicare Advantage |
$293.83
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cash Price |
$959.20
|
| Rate for Payer: Cofinity Commercial |
$423.12
|
| Rate for Payer: Cofinity Commercial |
$393.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.83
|
| Rate for Payer: Mclaren Medicaid |
$195.32
|
| Rate for Payer: Meridian Medicaid |
$205.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$308.52
|
| Rate for Payer: PACE SWMI |
$293.83
|
| Rate for Payer: PHP Medicare Advantage |
$293.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$839.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.30
|
| Rate for Payer: Priority Health Medicare |
$293.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$533.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.83
|
| Rate for Payer: UHC Medicare Advantage |
$302.64
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE CPLX RPR
|
Professional
|
Both
|
$666.00
|
|
|
Service Code
|
HCPCS 40814
|
| Min. Negotiated Rate |
$181.48 |
| Max. Negotiated Rate |
$684.68 |
| Rate for Payer: Aetna Commercial |
$368.70
|
| Rate for Payer: Aetna Medicare |
$286.16
|
| Rate for Payer: BCBS Complete |
$190.55
|
| Rate for Payer: BCBS MAPPO |
$275.15
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$548.78
|
| Rate for Payer: BCN Medicare Advantage |
$275.15
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cash Price |
$532.80
|
| Rate for Payer: Cofinity Commercial |
$396.22
|
| Rate for Payer: Cofinity Commercial |
$368.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.15
|
| Rate for Payer: Mclaren Medicaid |
$181.48
|
| Rate for Payer: Meridian Medicaid |
$190.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.91
|
| Rate for Payer: PACE SWMI |
$275.15
|
| Rate for Payer: PHP Medicare Advantage |
$275.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.77
|
| Rate for Payer: Priority Health Medicare |
$275.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.15
|
| Rate for Payer: UHC Medicare Advantage |
$283.40
|
|
|
PR EXC LESION MUCOSA & SBMCSL VESTIBULE SMPL RPR
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 40812
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$465.43 |
| Rate for Payer: Aetna Commercial |
$239.04
|
| Rate for Payer: Aetna Medicare |
$185.53
|
| Rate for Payer: BCBS Complete |
$122.56
|
| Rate for Payer: BCBS MAPPO |
$178.39
|
| Rate for Payer: BCBS Trust/PPO |
$465.43
|
| Rate for Payer: BCN Commercial |
$332.58
|
| Rate for Payer: BCN Medicare Advantage |
$178.39
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cofinity Commercial |
$256.88
|
| Rate for Payer: Cofinity Commercial |
$239.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.39
|
| Rate for Payer: Mclaren Medicaid |
$116.72
|
| Rate for Payer: Meridian Medicaid |
$122.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.31
|
| Rate for Payer: PACE SWMI |
$178.39
|
| Rate for Payer: PHP Medicare Advantage |
$178.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.39
|
| Rate for Payer: Priority Health Medicare |
$178.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.39
|
| Rate for Payer: UHC Medicare Advantage |
$183.74
|
|
|
PR EXC LESION PALATE UVULA W/LOCAL FLAP CLOSURE
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 42107
|
| Min. Negotiated Rate |
$207.46 |
| Max. Negotiated Rate |
$666.56 |
| Rate for Payer: Aetna Commercial |
$429.60
|
| Rate for Payer: Aetna Medicare |
$333.42
|
| Rate for Payer: BCBS Complete |
$217.83
|
| Rate for Payer: BCBS MAPPO |
$320.60
|
| Rate for Payer: BCBS Trust/PPO |
$306.41
|
| Rate for Payer: BCN Commercial |
$666.56
|
| Rate for Payer: BCN Medicare Advantage |
$320.60
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$461.66
|
| Rate for Payer: Cofinity Commercial |
$429.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.60
|
| Rate for Payer: Mclaren Medicaid |
$207.46
|
| Rate for Payer: Meridian Medicaid |
$217.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.63
|
| Rate for Payer: PACE SWMI |
$320.60
|
| Rate for Payer: PHP Medicare Advantage |
$320.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$578.57
|
| Rate for Payer: Priority Health Medicare |
$320.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$578.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.60
|
| Rate for Payer: UHC Medicare Advantage |
$330.22
|
|
|
PR EXC LESION PALATE UVULA W/O CLOSURE
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 42104
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$1,644.60 |
| Rate for Payer: Aetna Commercial |
$175.61
|
| Rate for Payer: Aetna Medicare |
$136.29
|
| Rate for Payer: BCBS Complete |
$91.24
|
| Rate for Payer: BCBS MAPPO |
$131.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.60
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: BCN Medicare Advantage |
$131.05
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$175.61
|
| Rate for Payer: Cofinity Commercial |
$188.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.05
|
| Rate for Payer: Mclaren Medicaid |
$86.90
|
| Rate for Payer: Meridian Medicaid |
$91.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.60
|
| Rate for Payer: PACE SWMI |
$131.05
|
| Rate for Payer: PHP Medicare Advantage |
$131.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.53
|
| Rate for Payer: Priority Health Medicare |
$131.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.05
|
| Rate for Payer: UHC Medicare Advantage |
$134.98
|
|
|
PR EXC LESION PALATE UVULA W/SMPL PRIM CLOSURE
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 42106
|
| Min. Negotiated Rate |
$102.88 |
| Max. Negotiated Rate |
$1,938.86 |
| Rate for Payer: Aetna Commercial |
$211.61
|
| Rate for Payer: Aetna Medicare |
$164.24
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: BCBS MAPPO |
$157.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,938.86
|
| Rate for Payer: BCN Commercial |
$374.33
|
| Rate for Payer: BCN Medicare Advantage |
$157.92
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$211.61
|
| Rate for Payer: Cofinity Commercial |
$227.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.92
|
| Rate for Payer: Mclaren Medicaid |
$102.88
|
| Rate for Payer: Meridian Medicaid |
$108.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.82
|
| Rate for Payer: PACE SWMI |
$157.92
|
| Rate for Payer: PHP Medicare Advantage |
$157.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.75
|
| Rate for Payer: Priority Health Medicare |
$157.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.92
|
| Rate for Payer: UHC Medicare Advantage |
$162.66
|
|
|
PR EXC LESION SPERMATIC CORD SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 55520
|
| Min. Negotiated Rate |
$295.64 |
| Max. Negotiated Rate |
$2,718.10 |
| Rate for Payer: Aetna Commercial |
$607.64
|
| Rate for Payer: Aetna Medicare |
$471.60
|
| Rate for Payer: BCBS Complete |
$310.42
|
| Rate for Payer: BCBS MAPPO |
$453.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,718.10
|
| Rate for Payer: BCN Commercial |
$671.93
|
| Rate for Payer: BCN Medicare Advantage |
$453.46
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cofinity Commercial |
$652.98
|
| Rate for Payer: Cofinity Commercial |
$607.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.46
|
| Rate for Payer: Mclaren Medicaid |
$295.64
|
| Rate for Payer: Meridian Medicaid |
$310.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.13
|
| Rate for Payer: PACE SWMI |
$453.46
|
| Rate for Payer: PHP Medicare Advantage |
$453.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.99
|
| Rate for Payer: Priority Health Medicare |
$453.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$742.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.46
|
| Rate for Payer: UHC Medicare Advantage |
$467.06
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$631.25 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna Commercial |
$879.75
|
| Rate for Payer: BCBS Trust/PPO |
$799.85
|
| Rate for Payer: BCN Commercial |
$799.85
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$890.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.00
|
| Rate for Payer: Healthscope Commercial |
$931.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$879.75
|
| Rate for Payer: PHP Commercial |
$879.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$631.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.80
|
| Rate for Payer: UHC Core |
$864.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.25
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
26160
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$245.81 |
| Max. Negotiated Rate |
$1,107.03 |
| Rate for Payer: Aetna Commercial |
$879.75
|
| Rate for Payer: Aetna Medicare |
$269.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$323.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$323.44
|
| Rate for Payer: BCBS Complete |
$1,107.03
|
| Rate for Payer: BCBS MAPPO |
$258.75
|
| Rate for Payer: BCBS Trust/PPO |
$804.71
|
| Rate for Payer: BCN Commercial |
$804.71
|
| Rate for Payer: BCN Medicare Advantage |
$258.75
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$890.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$828.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$258.75
|
| Rate for Payer: Healthscope Commercial |
$931.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$776.25
|
| Rate for Payer: Mclaren Medicaid |
$1,054.31
|
| Rate for Payer: Meridian Medicaid |
$1,107.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$271.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$297.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$879.75
|
| Rate for Payer: PACE Senior Care Partners |
$245.81
|
| Rate for Payer: PACE SWMI |
$258.75
|
| Rate for Payer: PHP Commercial |
$879.75
|
| Rate for Payer: PHP Medicare Advantage |
$258.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$900.45
|
| Rate for Payer: Priority Health Medicare |
$258.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$631.25
|
| Rate for Payer: Railroad Medicare Medicare |
$258.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.80
|
| Rate for Payer: UHC Core |
$864.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$258.75
|
| Rate for Payer: UHC Medicare Advantage |
$266.51
|
| Rate for Payer: VA VA |
$258.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$776.25
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$416.91
|
| Rate for Payer: Aetna Medicare |
$323.58
|
| Rate for Payer: BCBS Complete |
$217.83
|
| Rate for Payer: BCBS MAPPO |
$311.13
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$311.13
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$416.91
|
| Rate for Payer: Cofinity Commercial |
$448.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.13
|
| Rate for Payer: Mclaren Medicaid |
$207.46
|
| Rate for Payer: Meridian Medicaid |
$217.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$326.69
|
| Rate for Payer: PACE SWMI |
$311.13
|
| Rate for Payer: PHP Medicare Advantage |
$311.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$490.74
|
| Rate for Payer: Priority Health Medicare |
$311.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$490.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.13
|
| Rate for Payer: UHC Medicare Advantage |
$320.46
|
|
|
PR EXC LESION TDN SHTH/JT CAPSL HAND/FNGR
|
Professional
|
Both
|
$1,035.00
|
|
|
Service Code
|
HCPCS 26160
|
| Hospital Charge Code |
26160
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$912.85 |
| Rate for Payer: Aetna Commercial |
$416.91
|
| Rate for Payer: Aetna Medicare |
$323.58
|
| Rate for Payer: BCBS Complete |
$217.83
|
| Rate for Payer: BCBS MAPPO |
$311.13
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$912.85
|
| Rate for Payer: BCN Medicare Advantage |
$311.13
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cofinity Commercial |
$416.91
|
| Rate for Payer: Cofinity Commercial |
$448.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.13
|
| Rate for Payer: Mclaren Medicaid |
$207.46
|
| Rate for Payer: Meridian Medicaid |
$217.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$326.69
|
| Rate for Payer: PACE SWMI |
$311.13
|
| Rate for Payer: PHP Medicare Advantage |
$311.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$490.74
|
| Rate for Payer: Priority Health Medicare |
$311.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$490.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.13
|
| Rate for Payer: UHC Medicare Advantage |
$320.46
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 28090
|
| Hospital Charge Code |
28090
|
| Min. Negotiated Rate |
$199.37 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$402.42
|
| Rate for Payer: Aetna Medicare |
$312.32
|
| Rate for Payer: BCBS Complete |
$209.34
|
| Rate for Payer: BCBS MAPPO |
$300.31
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$300.31
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$402.42
|
| Rate for Payer: Cofinity Commercial |
$432.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.31
|
| Rate for Payer: Mclaren Medicaid |
$199.37
|
| Rate for Payer: Meridian Medicaid |
$209.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$315.33
|
| Rate for Payer: PACE SWMI |
$300.31
|
| Rate for Payer: PHP Medicare Advantage |
$300.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.79
|
| Rate for Payer: Priority Health Medicare |
$300.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.31
|
| Rate for Payer: UHC Medicare Advantage |
$309.32
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 28090
|
| Min. Negotiated Rate |
$199.37 |
| Max. Negotiated Rate |
$676.82 |
| Rate for Payer: Aetna Commercial |
$402.42
|
| Rate for Payer: Aetna Medicare |
$312.32
|
| Rate for Payer: BCBS Complete |
$209.34
|
| Rate for Payer: BCBS MAPPO |
$300.31
|
| Rate for Payer: BCBS Trust/PPO |
$404.15
|
| Rate for Payer: BCN Commercial |
$676.82
|
| Rate for Payer: BCN Medicare Advantage |
$300.31
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$402.42
|
| Rate for Payer: Cofinity Commercial |
$432.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.31
|
| Rate for Payer: Mclaren Medicaid |
$199.37
|
| Rate for Payer: Meridian Medicaid |
$209.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$315.33
|
| Rate for Payer: PACE SWMI |
$300.31
|
| Rate for Payer: PHP Medicare Advantage |
$300.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$469.79
|
| Rate for Payer: Priority Health Medicare |
$300.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$469.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.31
|
| Rate for Payer: UHC Medicare Advantage |
$309.32
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$1,107.03 |
| Rate for Payer: Aetna Commercial |
$738.65
|
| Rate for Payer: Aetna Medicare |
$225.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$271.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$271.56
|
| Rate for Payer: BCBS Complete |
$1,107.03
|
| Rate for Payer: BCBS MAPPO |
$217.25
|
| Rate for Payer: BCBS Trust/PPO |
$675.65
|
| Rate for Payer: BCN Commercial |
$675.65
|
| Rate for Payer: BCN Medicare Advantage |
$217.25
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$747.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$217.25
|
| Rate for Payer: Healthscope Commercial |
$782.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.75
|
| Rate for Payer: Mclaren Medicaid |
$1,054.31
|
| Rate for Payer: Meridian Medicaid |
$1,107.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$228.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.65
|
| Rate for Payer: PACE Senior Care Partners |
$206.39
|
| Rate for Payer: PACE SWMI |
$217.25
|
| Rate for Payer: PHP Commercial |
$738.65
|
| Rate for Payer: PHP Medicare Advantage |
$217.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,054.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$756.03
|
| Rate for Payer: Priority Health Medicare |
$217.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.00
|
| Rate for Payer: Railroad Medicare Medicare |
$217.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.72
|
| Rate for Payer: UHC Core |
$725.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$217.25
|
| Rate for Payer: UHC Medicare Advantage |
$223.77
|
| Rate for Payer: VA VA |
$217.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
28090
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$530.00 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Aetna Commercial |
$738.65
|
| Rate for Payer: BCBS Trust/PPO |
$671.56
|
| Rate for Payer: BCN Commercial |
$671.56
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$747.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$695.20
|
| Rate for Payer: Healthscope Commercial |
$782.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$738.65
|
| Rate for Payer: PHP Commercial |
$738.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$756.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$530.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.72
|
| Rate for Payer: UHC Core |
$725.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.75
|
|
|
PR EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA
|
Professional
|
Both
|
$813.00
|
|
|
Service Code
|
HCPCS 28092
|
| Min. Negotiated Rate |
$176.36 |
| Max. Negotiated Rate |
$612.80 |
| Rate for Payer: Aetna Commercial |
$352.71
|
| Rate for Payer: Aetna Medicare |
$273.75
|
| Rate for Payer: BCBS Complete |
$185.18
|
| Rate for Payer: BCBS MAPPO |
$263.22
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$612.80
|
| Rate for Payer: BCN Medicare Advantage |
$263.22
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cash Price |
$650.40
|
| Rate for Payer: Cofinity Commercial |
$379.04
|
| Rate for Payer: Cofinity Commercial |
$352.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.22
|
| Rate for Payer: Mclaren Medicaid |
$176.36
|
| Rate for Payer: Meridian Medicaid |
$185.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.38
|
| Rate for Payer: PACE SWMI |
$263.22
|
| Rate for Payer: PHP Medicare Advantage |
$263.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.12
|
| Rate for Payer: Priority Health Medicare |
$263.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$413.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.22
|
| Rate for Payer: UHC Medicare Advantage |
$271.12
|
|
|
PR EXC LESION TONGUE W/CLSR ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 41112
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$316.04
|
| Rate for Payer: Aetna Medicare |
$245.28
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$235.85
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: BCN Commercial |
$499.92
|
| Rate for Payer: BCN Medicare Advantage |
$235.85
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$339.62
|
| Rate for Payer: Cofinity Commercial |
$316.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.85
|
| Rate for Payer: Mclaren Medicaid |
$156.13
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$247.64
|
| Rate for Payer: PACE SWMI |
$235.85
|
| Rate for Payer: PHP Medicare Advantage |
$235.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.23
|
| Rate for Payer: Priority Health Medicare |
$235.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.85
|
| Rate for Payer: UHC Medicare Advantage |
$242.93
|
|
|
PR EXC LESION TONGUE W/CLSR POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 41113
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$345.01
|
| Rate for Payer: Aetna Medicare |
$267.77
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS MAPPO |
$257.47
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$535.59
|
| Rate for Payer: BCN Medicare Advantage |
$257.47
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$370.76
|
| Rate for Payer: Cofinity Commercial |
$345.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.47
|
| Rate for Payer: Mclaren Medicaid |
$169.34
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.34
|
| Rate for Payer: PACE SWMI |
$257.47
|
| Rate for Payer: PHP Medicare Advantage |
$257.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$467.43
|
| Rate for Payer: Priority Health Medicare |
$257.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$467.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$257.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.47
|
| Rate for Payer: UHC Medicare Advantage |
$265.19
|
|
|
PR EXC LESION TONGUE W/CLSR W/LOCAL TONGUE FLAP
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
HCPCS 41114
|
| Min. Negotiated Rate |
$398.95 |
| Max. Negotiated Rate |
$1,097.17 |
| Rate for Payer: Aetna Commercial |
$817.00
|
| Rate for Payer: Aetna Medicare |
$634.09
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS MAPPO |
$609.70
|
| Rate for Payer: BCBS Trust/PPO |
$515.09
|
| Rate for Payer: BCN Commercial |
$911.87
|
| Rate for Payer: BCN Medicare Advantage |
$609.70
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cash Price |
$905.60
|
| Rate for Payer: Cofinity Commercial |
$817.00
|
| Rate for Payer: Cofinity Commercial |
$877.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$609.70
|
| Rate for Payer: Mclaren Medicaid |
$398.95
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$640.18
|
| Rate for Payer: PACE SWMI |
$609.70
|
| Rate for Payer: PHP Medicare Advantage |
$609.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,097.17
|
| Rate for Payer: Priority Health Medicare |
$609.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,097.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$609.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$609.70
|
| Rate for Payer: UHC Medicare Advantage |
$627.99
|
|
|
PR EXC LESION/TUMOR DENTALVEOLAR STRUX W/CMPLX RPR
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 41827
|
| Min. Negotiated Rate |
$184.88 |
| Max. Negotiated Rate |
$633.33 |
| Rate for Payer: Aetna Commercial |
$373.97
|
| Rate for Payer: Aetna Medicare |
$290.24
|
| Rate for Payer: BCBS Complete |
$194.12
|
| Rate for Payer: BCBS MAPPO |
$279.08
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: BCN Commercial |
$633.33
|
| Rate for Payer: BCN Medicare Advantage |
$279.08
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$373.97
|
| Rate for Payer: Cofinity Commercial |
$401.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.08
|
| Rate for Payer: Mclaren Medicaid |
$184.88
|
| Rate for Payer: Meridian Medicaid |
$194.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$293.03
|
| Rate for Payer: PACE SWMI |
$279.08
|
| Rate for Payer: PHP Medicare Advantage |
$279.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.07
|
| Rate for Payer: Priority Health Medicare |
$279.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$505.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.08
|
| Rate for Payer: UHC Medicare Advantage |
$287.45
|
|
|
PR EXC LESION/TUMOR DENTOALVEOLAR STRUX W/O RPR
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 41825
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$339.70 |
| Rate for Payer: Aetna Commercial |
$157.14
|
| Rate for Payer: Aetna Medicare |
$121.96
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$117.27
|
| Rate for Payer: BCBS Trust/PPO |
$339.70
|
| Rate for Payer: BCN Commercial |
$324.97
|
| Rate for Payer: BCN Medicare Advantage |
$117.27
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$157.14
|
| Rate for Payer: Cofinity Commercial |
$168.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.27
|
| Rate for Payer: Mclaren Medicaid |
$78.17
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.13
|
| Rate for Payer: PACE SWMI |
$117.27
|
| Rate for Payer: PHP Medicare Advantage |
$117.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.43
|
| Rate for Payer: Priority Health Medicare |
$117.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.27
|
| Rate for Payer: UHC Medicare Advantage |
$120.79
|
|
|
PR EXC LES MUCOSA & SBMCSL VESTIBULE MOUTH W/O RPR
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 40810
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$667.79 |
| Rate for Payer: Aetna Commercial |
$159.49
|
| Rate for Payer: Aetna Medicare |
$123.78
|
| Rate for Payer: BCBS Complete |
$82.75
|
| Rate for Payer: BCBS MAPPO |
$119.02
|
| Rate for Payer: BCBS Trust/PPO |
$667.79
|
| Rate for Payer: BCN Commercial |
$320.09
|
| Rate for Payer: BCN Medicare Advantage |
$119.02
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$159.49
|
| Rate for Payer: Cofinity Commercial |
$171.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.02
|
| Rate for Payer: Mclaren Medicaid |
$78.81
|
| Rate for Payer: Meridian Medicaid |
$82.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.97
|
| Rate for Payer: PACE SWMI |
$119.02
|
| Rate for Payer: PHP Medicare Advantage |
$119.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$253.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.96
|
| Rate for Payer: Priority Health Medicare |
$119.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.02
|
| Rate for Payer: UHC Medicare Advantage |
$122.59
|
|
|
PR EXC LIP FULL THKNS RCNSTJ W/LOCAL FLAP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 40525
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,360.80 |
| Rate for Payer: Aetna Commercial |
$724.82
|
| Rate for Payer: Aetna Medicare |
$562.55
|
| Rate for Payer: BCBS Complete |
$373.04
|
| Rate for Payer: BCBS MAPPO |
$540.91
|
| Rate for Payer: BCBS Trust/PPO |
$774.49
|
| Rate for Payer: BCN Commercial |
$808.76
|
| Rate for Payer: BCN Medicare Advantage |
$540.91
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$724.82
|
| Rate for Payer: Cofinity Commercial |
$778.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.91
|
| Rate for Payer: Mclaren Medicaid |
$355.28
|
| Rate for Payer: Meridian Medicaid |
$373.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$567.96
|
| Rate for Payer: PACE SWMI |
$540.91
|
| Rate for Payer: PHP Medicare Advantage |
$540.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$973.09
|
| Rate for Payer: Priority Health Medicare |
$540.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$973.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$540.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.91
|
| Rate for Payer: UHC Medicare Advantage |
$557.14
|
|
|
PR EXC LIP TRANSVRS WEDGE EXC W/PRIM CLSR
|
Professional
|
Both
|
$712.00
|
|
|
Service Code
|
HCPCS 40510
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$719.83 |
| Rate for Payer: Aetna Commercial |
$457.05
|
| Rate for Payer: Aetna Medicare |
$354.72
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS MAPPO |
$341.08
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCN Commercial |
$719.83
|
| Rate for Payer: BCN Medicare Advantage |
$341.08
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cash Price |
$569.60
|
| Rate for Payer: Cofinity Commercial |
$491.16
|
| Rate for Payer: Cofinity Commercial |
$457.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.08
|
| Rate for Payer: Mclaren Medicaid |
$225.14
|
| Rate for Payer: Meridian Medicaid |
$236.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$358.13
|
| Rate for Payer: PACE SWMI |
$341.08
|
| Rate for Payer: PHP Medicare Advantage |
$341.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$615.02
|
| Rate for Payer: Priority Health Medicare |
$341.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$615.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$341.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$341.08
|
| Rate for Payer: UHC Medicare Advantage |
$351.31
|
|
|
PR EXC LIP V-EXC W/PRIM DIR LINR CLSR
|
Professional
|
Both
|
$1,161.00
|
|
|
Service Code
|
HCPCS 40520
|
| Min. Negotiated Rate |
$230.04 |
| Max. Negotiated Rate |
$812.70 |
| Rate for Payer: Aetna Commercial |
$469.46
|
| Rate for Payer: Aetna Medicare |
$364.35
|
| Rate for Payer: BCBS Complete |
$241.54
|
| Rate for Payer: BCBS MAPPO |
$350.34
|
| Rate for Payer: BCBS Trust/PPO |
$423.17
|
| Rate for Payer: BCN Commercial |
$744.75
|
| Rate for Payer: BCN Medicare Advantage |
$350.34
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cofinity Commercial |
$469.46
|
| Rate for Payer: Cofinity Commercial |
$504.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.34
|
| Rate for Payer: Mclaren Medicaid |
$230.04
|
| Rate for Payer: Meridian Medicaid |
$241.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.86
|
| Rate for Payer: PACE SWMI |
$350.34
|
| Rate for Payer: PHP Medicare Advantage |
$350.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.08
|
| Rate for Payer: Priority Health Medicare |
$350.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$632.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.34
|
| Rate for Payer: UHC Medicare Advantage |
$360.85
|
|
