|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$65.84 |
| Rate for Payer: Aetna Commercial |
$44.42
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCN Commercial |
$65.84
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$48.29 |
| Rate for Payer: Aetna Commercial |
$30.64
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCN Commercial |
$48.29
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCN Commercial |
$56.76
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$590.45 |
| Rate for Payer: Aetna Commercial |
$374.53
|
| Rate for Payer: BCBS Complete |
$250.00
|
| Rate for Payer: BCN Commercial |
$590.45
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$437.50
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$637.30 |
| Max. Negotiated Rate |
$1,643.91 |
| Rate for Payer: Aetna Commercial |
$1,305.59
|
| Rate for Payer: Aetna Medicare |
$1,013.29
|
| Rate for Payer: BCBS Complete |
$669.16
|
| Rate for Payer: BCBS MAPPO |
$974.32
|
| Rate for Payer: BCBS Trust/PPO |
$852.18
|
| Rate for Payer: BCN Commercial |
$1,643.91
|
| Rate for Payer: BCN Medicare Advantage |
$974.32
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$1,403.02
|
| Rate for Payer: Cofinity Commercial |
$1,305.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.32
|
| Rate for Payer: Mclaren Medicaid |
$637.30
|
| Rate for Payer: Meridian Medicaid |
$669.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,023.04
|
| Rate for Payer: PACE SWMI |
$974.32
|
| Rate for Payer: PHP Medicare Advantage |
$974.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.66
|
| Rate for Payer: Priority Health Medicare |
$974.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,223.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$974.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.55
|
|
|
PR FORESKN MANJ W/LSS PREPUTIAL ADS&STRETCHING
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 54450
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,562.18 |
| Rate for Payer: Aetna Commercial |
$75.07
|
| Rate for Payer: Aetna Medicare |
$58.26
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS MAPPO |
$56.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,562.18
|
| Rate for Payer: BCN Commercial |
$99.20
|
| Rate for Payer: BCN Medicare Advantage |
$56.02
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$80.67
|
| Rate for Payer: Cofinity Commercial |
$75.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.02
|
| Rate for Payer: Mclaren Medicaid |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$58.82
|
| Rate for Payer: PACE SWMI |
$56.02
|
| Rate for Payer: PHP Medicare Advantage |
$56.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.78
|
| Rate for Payer: Priority Health Medicare |
$56.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.02
|
| Rate for Payer: UHC Medicare Advantage |
$57.70
|
|
|
PR FO W/O JOINTS CF
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS L3933
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$184.38 |
| Rate for Payer: Aetna Commercial |
$116.96
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCN Commercial |
$184.38
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
|
|
PR FRAC FL FACE
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 00100
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$160.00 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: BCBS Complete |
$160.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
|
|
PR FRAC NECK
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00102
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR FRAC SCARS PER INCH
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00104
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR FRAC THGH/ABD/BACK
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 00103
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
|
|
PR FRACTURE NASAL INFERIOR TURBINATE THERAPEUTIC
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 30930
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$790.87 |
| Rate for Payer: Aetna Commercial |
$153.58
|
| Rate for Payer: Aetna Medicare |
$119.19
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$114.61
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$173.48
|
| Rate for Payer: BCN Medicare Advantage |
$114.61
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$165.04
|
| Rate for Payer: Cofinity Commercial |
$153.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.61
|
| Rate for Payer: Mclaren Medicaid |
$76.47
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.34
|
| Rate for Payer: PACE SWMI |
$114.61
|
| Rate for Payer: PHP Medicare Advantage |
$114.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.38
|
| Rate for Payer: Priority Health Medicare |
$114.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.61
|
| Rate for Payer: UHC Medicare Advantage |
$118.05
|
|
|
PR FRAC UP/LOW FACE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00101
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR FRENOPLASTY SURG REVJ FRENUM EG W/Z-PLASTY
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 41520
|
| Min. Negotiated Rate |
$162.09 |
| Max. Negotiated Rate |
$653.51 |
| Rate for Payer: Aetna Commercial |
$327.59
|
| Rate for Payer: Aetna Medicare |
$254.25
|
| Rate for Payer: BCBS Complete |
$170.19
|
| Rate for Payer: BCBS MAPPO |
$244.47
|
| Rate for Payer: BCBS Trust/PPO |
$653.51
|
| Rate for Payer: BCN Commercial |
$541.46
|
| Rate for Payer: BCN Medicare Advantage |
$244.47
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cofinity Commercial |
$352.04
|
| Rate for Payer: Cofinity Commercial |
$327.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.47
|
| Rate for Payer: Mclaren Medicaid |
$162.09
|
| Rate for Payer: Meridian Medicaid |
$170.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$256.69
|
| Rate for Payer: PACE SWMI |
$244.47
|
| Rate for Payer: PHP Medicare Advantage |
$244.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$162.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.10
|
| Rate for Payer: Priority Health Medicare |
$244.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$445.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.47
|
| Rate for Payer: UHC Medicare Advantage |
$251.80
|
|
|
PR FRENULOTOMY PENIS
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 54164
|
| Min. Negotiated Rate |
$125.03 |
| Max. Negotiated Rate |
$1,012.75 |
| Rate for Payer: Aetna Commercial |
$251.81
|
| Rate for Payer: Aetna Medicare |
$195.44
|
| Rate for Payer: BCBS Complete |
$131.28
|
| Rate for Payer: BCBS MAPPO |
$187.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.75
|
| Rate for Payer: BCN Commercial |
$280.99
|
| Rate for Payer: BCN Medicare Advantage |
$187.92
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$251.81
|
| Rate for Payer: Cofinity Commercial |
$270.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.92
|
| Rate for Payer: Mclaren Medicaid |
$125.03
|
| Rate for Payer: Meridian Medicaid |
$131.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.32
|
| Rate for Payer: PACE SWMI |
$187.92
|
| Rate for Payer: PHP Medicare Advantage |
$187.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.70
|
| Rate for Payer: Priority Health Medicare |
$187.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.92
|
| Rate for Payer: UHC Medicare Advantage |
$193.56
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 15570
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$1,331.65 |
| Rate for Payer: Aetna Commercial |
$959.00
|
| Rate for Payer: Aetna Medicare |
$744.30
|
| Rate for Payer: BCBS Complete |
$489.79
|
| Rate for Payer: BCBS MAPPO |
$715.67
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: BCN Medicare Advantage |
$715.67
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,030.56
|
| Rate for Payer: Cofinity Commercial |
$959.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$715.67
|
| Rate for Payer: Mclaren Medicaid |
$466.47
|
| Rate for Payer: Meridian Medicaid |
$489.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$751.45
|
| Rate for Payer: PACE SWMI |
$715.67
|
| Rate for Payer: PHP Medicare Advantage |
$715.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,031.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$897.30
|
| Rate for Payer: Priority Health Medicare |
$715.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$897.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$715.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$715.67
|
| Rate for Payer: UHC Medicare Advantage |
$737.14
|
|
|
PR FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 15576
|
| Min. Negotiated Rate |
$413.65 |
| Max. Negotiated Rate |
$4,106.40 |
| Rate for Payer: Aetna Commercial |
$844.66
|
| Rate for Payer: Aetna Medicare |
$655.55
|
| Rate for Payer: BCBS Complete |
$434.33
|
| Rate for Payer: BCBS MAPPO |
$630.34
|
| Rate for Payer: BCBS Trust/PPO |
$4,106.40
|
| Rate for Payer: BCN Commercial |
$1,142.53
|
| Rate for Payer: BCN Medicare Advantage |
$630.34
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$907.69
|
| Rate for Payer: Cofinity Commercial |
$844.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.34
|
| Rate for Payer: Mclaren Medicaid |
$413.65
|
| Rate for Payer: Meridian Medicaid |
$434.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.86
|
| Rate for Payer: PACE SWMI |
$630.34
|
| Rate for Payer: PHP Medicare Advantage |
$630.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,113.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.30
|
| Rate for Payer: Priority Health Medicare |
$630.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$793.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$630.34
|
| Rate for Payer: UHC Medicare Advantage |
$649.25
|
|
|
PR FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS
|
Professional
|
Both
|
$1,535.00
|
|
|
Service Code
|
HCPCS 15572
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,341.25 |
| Rate for Payer: Aetna Commercial |
$963.61
|
| Rate for Payer: Aetna Medicare |
$747.87
|
| Rate for Payer: BCBS Complete |
$495.39
|
| Rate for Payer: BCBS MAPPO |
$719.11
|
| Rate for Payer: BCBS Trust/PPO |
$6,341.25
|
| Rate for Payer: BCN Commercial |
$1,290.60
|
| Rate for Payer: BCN Medicare Advantage |
$719.11
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Cash Price |
$1,228.00
|
| Rate for Payer: Cofinity Commercial |
$963.61
|
| Rate for Payer: Cofinity Commercial |
$1,035.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.11
|
| Rate for Payer: Mclaren Medicaid |
$471.80
|
| Rate for Payer: Meridian Medicaid |
$495.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$755.07
|
| Rate for Payer: PACE SWMI |
$719.11
|
| Rate for Payer: PHP Medicare Advantage |
$719.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$903.87
|
| Rate for Payer: Priority Health Medicare |
$719.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$903.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$719.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.11
|
| Rate for Payer: UHC Medicare Advantage |
$740.68
|
|
|
PR FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 15574
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$962.00
|
| Rate for Payer: Aetna Medicare |
$746.63
|
| Rate for Payer: BCBS Complete |
$497.18
|
| Rate for Payer: BCBS MAPPO |
$717.91
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,283.75
|
| Rate for Payer: BCN Medicare Advantage |
$717.91
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Commercial |
$962.00
|
| Rate for Payer: Cofinity Commercial |
$1,033.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.91
|
| Rate for Payer: Mclaren Medicaid |
$473.50
|
| Rate for Payer: Meridian Medicaid |
$497.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$753.81
|
| Rate for Payer: PACE SWMI |
$717.91
|
| Rate for Payer: PHP Medicare Advantage |
$717.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$901.00
|
| Rate for Payer: Priority Health Medicare |
$717.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$901.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.91
|
| Rate for Payer: UHC Medicare Advantage |
$739.45
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$836.78 |
| Max. Negotiated Rate |
$1,234.80 |
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,060.28
|
| Rate for Payer: BCN Commercial |
$1,060.28
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,193.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$836.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.36
|
| Rate for Payer: UHC Core |
$1,145.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
PR FTH/GF FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,372.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$1,256.10 |
| Rate for Payer: Aetna Commercial |
$1,166.20
|
| Rate for Payer: Aetna Medicare |
$356.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$428.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$428.75
|
| Rate for Payer: BCBS Complete |
$1,256.10
|
| Rate for Payer: BCBS MAPPO |
$343.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.73
|
| Rate for Payer: BCN Commercial |
$1,066.73
|
| Rate for Payer: BCN Medicare Advantage |
$343.00
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,179.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,097.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.00
|
| Rate for Payer: Healthscope Commercial |
$1,234.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,029.00
|
| Rate for Payer: Mclaren Medicaid |
$1,196.28
|
| Rate for Payer: Meridian Medicaid |
$1,256.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$360.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$394.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,166.20
|
| Rate for Payer: PACE Senior Care Partners |
$325.85
|
| Rate for Payer: PACE SWMI |
$343.00
|
| Rate for Payer: PHP Commercial |
$1,166.20
|
| Rate for Payer: PHP Medicare Advantage |
$343.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,193.64
|
| Rate for Payer: Priority Health Medicare |
$343.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$836.78
|
| Rate for Payer: Railroad Medicare Medicare |
$343.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.36
|
| Rate for Payer: UHC Core |
$1,145.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$343.00
|
| Rate for Payer: UHC Medicare Advantage |
$353.29
|
| Rate for Payer: VA VA |
$343.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,029.00
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$1,458.22 |
| Rate for Payer: Aetna Commercial |
$1,095.83
|
| Rate for Payer: Aetna Medicare |
$850.49
|
| Rate for Payer: BCBS Complete |
$566.96
|
| Rate for Payer: BCBS MAPPO |
$817.78
|
| Rate for Payer: BCBS Trust/PPO |
$35.25
|
| Rate for Payer: BCN Commercial |
$1,458.22
|
| Rate for Payer: BCN Medicare Advantage |
$817.78
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,177.60
|
| Rate for Payer: Cofinity Commercial |
$1,095.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$817.78
|
| Rate for Payer: Mclaren Medicaid |
$539.96
|
| Rate for Payer: Meridian Medicaid |
$566.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$858.67
|
| Rate for Payer: PACE SWMI |
$817.78
|
| Rate for Payer: PHP Medicare Advantage |
$817.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,032.12
|
| Rate for Payer: Priority Health Medicare |
$817.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,032.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$817.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$817.78
|
| Rate for Payer: UHC Medicare Advantage |
$842.31
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<
|
Professional
|
Both
|
$1,656.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$390.64 |
| Max. Negotiated Rate |
$12,622.63 |
| Rate for Payer: Aetna Commercial |
$791.56
|
| Rate for Payer: Aetna Medicare |
$614.35
|
| Rate for Payer: BCBS Complete |
$410.17
|
| Rate for Payer: BCBS MAPPO |
$590.72
|
| Rate for Payer: BCBS Trust/PPO |
$12,622.63
|
| Rate for Payer: BCN Commercial |
$1,125.42
|
| Rate for Payer: BCN Medicare Advantage |
$590.72
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cofinity Commercial |
$850.64
|
| Rate for Payer: Cofinity Commercial |
$791.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.72
|
| Rate for Payer: Mclaren Medicaid |
$390.64
|
| Rate for Payer: Meridian Medicaid |
$410.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$620.26
|
| Rate for Payer: PACE SWMI |
$590.72
|
| Rate for Payer: PHP Medicare Advantage |
$590.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,159.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.62
|
| Rate for Payer: Priority Health Medicare |
$590.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$590.72
|
| Rate for Payer: UHC Medicare Advantage |
$608.44
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,227.56 |
| Rate for Payer: Aetna Commercial |
$878.05
|
| Rate for Payer: Aetna Medicare |
$681.47
|
| Rate for Payer: BCBS Complete |
$452.90
|
| Rate for Payer: BCBS MAPPO |
$655.26
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$655.26
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$878.05
|
| Rate for Payer: Cofinity Commercial |
$943.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.26
|
| Rate for Payer: Mclaren Medicaid |
$431.33
|
| Rate for Payer: Meridian Medicaid |
$452.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$688.02
|
| Rate for Payer: PACE SWMI |
$655.26
|
| Rate for Payer: PHP Medicare Advantage |
$655.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$823.72
|
| Rate for Payer: Priority Health Medicare |
$655.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$823.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$655.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$655.26
|
| Rate for Payer: UHC Medicare Advantage |
$674.92
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<
|
Professional
|
Both
|
$1,372.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$509.50 |
| Max. Negotiated Rate |
$1,357.55 |
| Rate for Payer: Aetna Commercial |
$1,030.75
|
| Rate for Payer: Aetna Medicare |
$799.99
|
| Rate for Payer: BCBS Complete |
$534.98
|
| Rate for Payer: BCBS MAPPO |
$769.22
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$1,357.55
|
| Rate for Payer: BCN Medicare Advantage |
$769.22
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cash Price |
$1,097.60
|
| Rate for Payer: Cofinity Commercial |
$1,107.68
|
| Rate for Payer: Cofinity Commercial |
$1,030.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$769.22
|
| Rate for Payer: Mclaren Medicaid |
$509.50
|
| Rate for Payer: Meridian Medicaid |
$534.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$807.68
|
| Rate for Payer: PACE SWMI |
$769.22
|
| Rate for Payer: PHP Medicare Advantage |
$769.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$960.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$972.10
|
| Rate for Payer: Priority Health Medicare |
$769.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$972.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$769.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$769.22
|
| Rate for Payer: UHC Medicare Advantage |
$792.30
|
|
