|
PR CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26525
|
| Min. Negotiated Rate |
$634.25 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$849.89
|
| Rate for Payer: Aetna Medicare |
$659.62
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$634.25
|
| Rate for Payer: BCN Medicare Advantage |
$634.25
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$913.32
|
| Rate for Payer: Cofinity Commercial |
$849.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$634.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.96
|
| Rate for Payer: Nomi Health Commercial |
$761.10
|
| Rate for Payer: PACE SWMI |
$634.25
|
| Rate for Payer: PHP Medicare Advantage |
$634.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$640.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$634.25
|
| Rate for Payer: UHC Exchange |
$634.25
|
| Rate for Payer: UHC Medicare Advantage |
$634.25
|
|
|
PR CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 26520
|
| Min. Negotiated Rate |
$629.66 |
| Max. Negotiated Rate |
$1,030.90 |
| Rate for Payer: Aetna Commercial |
$843.74
|
| Rate for Payer: Aetna Medicare |
$654.85
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$629.66
|
| Rate for Payer: BCN Medicare Advantage |
$629.66
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$906.71
|
| Rate for Payer: Cofinity Commercial |
$843.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.14
|
| Rate for Payer: Nomi Health Commercial |
$755.59
|
| Rate for Payer: PACE SWMI |
$629.66
|
| Rate for Payer: PHP Medicare Advantage |
$629.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$635.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$629.66
|
| Rate for Payer: UHC Exchange |
$629.66
|
| Rate for Payer: UHC Medicare Advantage |
$629.66
|
|
|
PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 28270
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$521.30 |
| Rate for Payer: Aetna Commercial |
$429.04
|
| Rate for Payer: Aetna Medicare |
$332.99
|
| Rate for Payer: BCBS Complete |
$320.80
|
| Rate for Payer: BCBS MAPPO |
$320.18
|
| Rate for Payer: BCN Medicare Advantage |
$320.18
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cofinity Commercial |
$461.06
|
| Rate for Payer: Cofinity Commercial |
$429.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.19
|
| Rate for Payer: Nomi Health Commercial |
$384.22
|
| Rate for Payer: PACE SWMI |
$320.18
|
| Rate for Payer: PHP Medicare Advantage |
$320.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.30
|
| Rate for Payer: Priority Health Medicare |
$323.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.18
|
| Rate for Payer: UHC Exchange |
$320.18
|
| Rate for Payer: UHC Medicare Advantage |
$320.18
|
|
|
PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT
|
Professional
|
Both
|
$2,003.00
|
|
|
Service Code
|
HCPCS 26516
|
| Min. Negotiated Rate |
$698.15 |
| Max. Negotiated Rate |
$1,301.95 |
| Rate for Payer: Aetna Commercial |
$935.52
|
| Rate for Payer: Aetna Medicare |
$726.08
|
| Rate for Payer: BCBS Complete |
$801.20
|
| Rate for Payer: BCBS MAPPO |
$698.15
|
| Rate for Payer: BCN Medicare Advantage |
$698.15
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cofinity Commercial |
$935.52
|
| Rate for Payer: Cofinity Commercial |
$1,005.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.06
|
| Rate for Payer: Nomi Health Commercial |
$837.78
|
| Rate for Payer: PACE SWMI |
$698.15
|
| Rate for Payer: PHP Medicare Advantage |
$698.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,301.95
|
| Rate for Payer: Priority Health Medicare |
$705.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$698.15
|
| Rate for Payer: UHC Exchange |
$698.15
|
| Rate for Payer: UHC Medicare Advantage |
$698.15
|
|
|
PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON
|
Professional
|
Both
|
$2,867.00
|
|
|
Service Code
|
HCPCS 23450
|
| Min. Negotiated Rate |
$912.93 |
| Max. Negotiated Rate |
$1,863.55 |
| Rate for Payer: Aetna Commercial |
$1,223.33
|
| Rate for Payer: Aetna Medicare |
$949.45
|
| Rate for Payer: BCBS Complete |
$1,146.80
|
| Rate for Payer: BCBS MAPPO |
$912.93
|
| Rate for Payer: BCN Medicare Advantage |
$912.93
|
| Rate for Payer: Cash Price |
$2,293.60
|
| Rate for Payer: Cash Price |
$2,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,314.62
|
| Rate for Payer: Cofinity Commercial |
$1,223.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$912.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$958.58
|
| Rate for Payer: Nomi Health Commercial |
$1,095.52
|
| Rate for Payer: PACE SWMI |
$912.93
|
| Rate for Payer: PHP Medicare Advantage |
$912.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,863.55
|
| Rate for Payer: Priority Health Medicare |
$922.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$912.93
|
| Rate for Payer: UHC Exchange |
$912.93
|
| Rate for Payer: UHC Medicare Advantage |
$912.93
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 23462
|
| Min. Negotiated Rate |
$1,029.48 |
| Max. Negotiated Rate |
$2,219.10 |
| Rate for Payer: Aetna Commercial |
$1,379.50
|
| Rate for Payer: Aetna Medicare |
$1,070.66
|
| Rate for Payer: BCBS Complete |
$1,365.60
|
| Rate for Payer: BCBS MAPPO |
$1,029.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.48
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,482.45
|
| Rate for Payer: Cofinity Commercial |
$1,379.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,080.95
|
| Rate for Payer: Nomi Health Commercial |
$1,235.38
|
| Rate for Payer: PACE SWMI |
$1,029.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health Medicare |
$1,039.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.48
|
| Rate for Payer: UHC Exchange |
$1,029.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,029.48
|
|
|
PR CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 23460
|
| Min. Negotiated Rate |
$1,051.24 |
| Max. Negotiated Rate |
$1,815.45 |
| Rate for Payer: Aetna Commercial |
$1,408.66
|
| Rate for Payer: Aetna Medicare |
$1,093.29
|
| Rate for Payer: BCBS Complete |
$1,117.20
|
| Rate for Payer: BCBS MAPPO |
$1,051.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,051.24
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$1,513.79
|
| Rate for Payer: Cofinity Commercial |
$1,408.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,051.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,103.80
|
| Rate for Payer: Nomi Health Commercial |
$1,261.49
|
| Rate for Payer: PACE SWMI |
$1,051.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,051.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health Medicare |
$1,061.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,051.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,051.24
|
| Rate for Payer: UHC Exchange |
$1,051.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,051.24
|
|
|
PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR
|
Professional
|
Both
|
$3,203.00
|
|
|
Service Code
|
HCPCS 23455
|
| Min. Negotiated Rate |
$937.19 |
| Max. Negotiated Rate |
$2,081.95 |
| Rate for Payer: Aetna Commercial |
$1,255.83
|
| Rate for Payer: Aetna Medicare |
$974.68
|
| Rate for Payer: BCBS Complete |
$1,281.20
|
| Rate for Payer: BCBS MAPPO |
$937.19
|
| Rate for Payer: BCN Medicare Advantage |
$937.19
|
| Rate for Payer: Cash Price |
$2,562.40
|
| Rate for Payer: Cash Price |
$2,562.40
|
| Rate for Payer: Cofinity Commercial |
$1,349.55
|
| Rate for Payer: Cofinity Commercial |
$1,255.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$937.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$984.05
|
| Rate for Payer: Nomi Health Commercial |
$1,124.63
|
| Rate for Payer: PACE SWMI |
$937.19
|
| Rate for Payer: PHP Medicare Advantage |
$937.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,081.95
|
| Rate for Payer: Priority Health Medicare |
$946.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$937.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$937.19
|
| Rate for Payer: UHC Exchange |
$937.19
|
| Rate for Payer: UHC Medicare Advantage |
$937.19
|
|
|
PR CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 23465
|
| Min. Negotiated Rate |
$1,077.85 |
| Max. Negotiated Rate |
$2,275.00 |
| Rate for Payer: Aetna Commercial |
$1,444.32
|
| Rate for Payer: Aetna Medicare |
$1,120.96
|
| Rate for Payer: BCBS Complete |
$1,400.00
|
| Rate for Payer: BCBS MAPPO |
$1,077.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.85
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$1,552.10
|
| Rate for Payer: Cofinity Commercial |
$1,444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.74
|
| Rate for Payer: Nomi Health Commercial |
$1,293.42
|
| Rate for Payer: PACE SWMI |
$1,077.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health Medicare |
$1,088.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.85
|
| Rate for Payer: UHC Exchange |
$1,077.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.85
|
|
|
PR CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 23466
|
| Min. Negotiated Rate |
$803.20 |
| Max. Negotiated Rate |
$1,551.23 |
| Rate for Payer: Aetna Commercial |
$1,443.50
|
| Rate for Payer: Aetna Medicare |
$1,120.33
|
| Rate for Payer: BCBS Complete |
$803.20
|
| Rate for Payer: BCBS MAPPO |
$1,077.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.24
|
| Rate for Payer: Cash Price |
$1,606.40
|
| Rate for Payer: Cash Price |
$1,606.40
|
| Rate for Payer: Cofinity Commercial |
$1,551.23
|
| Rate for Payer: Cofinity Commercial |
$1,443.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,131.10
|
| Rate for Payer: Nomi Health Commercial |
$1,292.69
|
| Rate for Payer: PACE SWMI |
$1,077.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,305.20
|
| Rate for Payer: Priority Health Medicare |
$1,088.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,077.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.24
|
| Rate for Payer: UHC Exchange |
$1,077.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.24
|
|
|
PR CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX
|
Professional
|
Both
|
$1,556.00
|
|
|
Service Code
|
HCPCS 28260
|
| Min. Negotiated Rate |
$515.71 |
| Max. Negotiated Rate |
$1,011.40 |
| Rate for Payer: Aetna Commercial |
$691.05
|
| Rate for Payer: Aetna Medicare |
$536.34
|
| Rate for Payer: BCBS Complete |
$622.40
|
| Rate for Payer: BCBS MAPPO |
$515.71
|
| Rate for Payer: BCN Medicare Advantage |
$515.71
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cash Price |
$1,244.80
|
| Rate for Payer: Cofinity Commercial |
$742.62
|
| Rate for Payer: Cofinity Commercial |
$691.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$541.50
|
| Rate for Payer: Nomi Health Commercial |
$618.85
|
| Rate for Payer: PACE SWMI |
$515.71
|
| Rate for Payer: PHP Medicare Advantage |
$515.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,011.40
|
| Rate for Payer: Priority Health Medicare |
$520.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$515.71
|
| Rate for Payer: UHC Exchange |
$515.71
|
| Rate for Payer: UHC Medicare Advantage |
$515.71
|
|
|
PR CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE
|
Professional
|
Both
|
$2,715.00
|
|
|
Service Code
|
HCPCS 27435
|
| Min. Negotiated Rate |
$779.12 |
| Max. Negotiated Rate |
$1,764.75 |
| Rate for Payer: Aetna Commercial |
$1,044.02
|
| Rate for Payer: Aetna Medicare |
$810.28
|
| Rate for Payer: BCBS Complete |
$1,086.00
|
| Rate for Payer: BCBS MAPPO |
$779.12
|
| Rate for Payer: BCN Medicare Advantage |
$779.12
|
| Rate for Payer: Cash Price |
$2,172.00
|
| Rate for Payer: Cash Price |
$2,172.00
|
| Rate for Payer: Cofinity Commercial |
$1,121.93
|
| Rate for Payer: Cofinity Commercial |
$1,044.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$818.08
|
| Rate for Payer: Nomi Health Commercial |
$934.94
|
| Rate for Payer: PACE SWMI |
$779.12
|
| Rate for Payer: PHP Medicare Advantage |
$779.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.75
|
| Rate for Payer: Priority Health Medicare |
$786.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$779.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$779.12
|
| Rate for Payer: UHC Exchange |
$779.12
|
| Rate for Payer: UHC Medicare Advantage |
$779.12
|
|
|
PR CAPSULOTOMY WRIST
|
Professional
|
Both
|
$1,640.00
|
|
|
Service Code
|
HCPCS 25085
|
| Min. Negotiated Rate |
$435.03 |
| Max. Negotiated Rate |
$1,066.00 |
| Rate for Payer: Aetna Commercial |
$582.94
|
| Rate for Payer: Aetna Medicare |
$452.43
|
| Rate for Payer: BCBS Complete |
$656.00
|
| Rate for Payer: BCBS MAPPO |
$435.03
|
| Rate for Payer: BCN Medicare Advantage |
$435.03
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cash Price |
$1,312.00
|
| Rate for Payer: Cofinity Commercial |
$626.44
|
| Rate for Payer: Cofinity Commercial |
$582.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.78
|
| Rate for Payer: Nomi Health Commercial |
$522.04
|
| Rate for Payer: PACE SWMI |
$435.03
|
| Rate for Payer: PHP Medicare Advantage |
$435.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,066.00
|
| Rate for Payer: Priority Health Medicare |
$439.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.03
|
| Rate for Payer: UHC Exchange |
$435.03
|
| Rate for Payer: UHC Medicare Advantage |
$435.03
|
|
|
PR CARDIOPULMONARY EXERCISE TESTING
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 94621
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$204.97 |
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna Medicare |
$148.03
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS MAPPO |
$142.34
|
| Rate for Payer: BCN Medicare Advantage |
$142.34
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$204.97
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.46
|
| Rate for Payer: Nomi Health Commercial |
$170.81
|
| Rate for Payer: PACE SWMI |
$142.34
|
| Rate for Payer: PHP Medicare Advantage |
$142.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health Medicare |
$143.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.34
|
| Rate for Payer: UHC Exchange |
$142.34
|
| Rate for Payer: UHC Medicare Advantage |
$142.34
|
|
|
PR CARDIOPULMONARY RESUSCITATION
|
Professional
|
Both
|
$559.00
|
|
|
Service Code
|
HCPCS 92950
|
| Min. Negotiated Rate |
$174.91 |
| Max. Negotiated Rate |
$363.35 |
| Rate for Payer: Aetna Commercial |
$234.38
|
| Rate for Payer: Aetna Medicare |
$181.91
|
| Rate for Payer: BCBS Complete |
$223.60
|
| Rate for Payer: BCBS MAPPO |
$174.91
|
| Rate for Payer: BCN Medicare Advantage |
$174.91
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cofinity Commercial |
$251.87
|
| Rate for Payer: Cofinity Commercial |
$234.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.66
|
| Rate for Payer: Nomi Health Commercial |
$209.89
|
| Rate for Payer: PACE SWMI |
$174.91
|
| Rate for Payer: PHP Medicare Advantage |
$174.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health Medicare |
$176.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.91
|
| Rate for Payer: UHC Exchange |
$174.91
|
| Rate for Payer: UHC Medicare Advantage |
$174.91
|
|
|
PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP
|
Professional
|
Both
|
$6,846.00
|
|
|
Service Code
|
HCPCS 33315
|
| Min. Negotiated Rate |
$1,831.72 |
| Max. Negotiated Rate |
$4,449.90 |
| Rate for Payer: Aetna Commercial |
$2,454.50
|
| Rate for Payer: Aetna Medicare |
$1,904.99
|
| Rate for Payer: BCBS Complete |
$2,738.40
|
| Rate for Payer: BCBS MAPPO |
$1,831.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,831.72
|
| Rate for Payer: Cash Price |
$5,476.80
|
| Rate for Payer: Cash Price |
$5,476.80
|
| Rate for Payer: Cofinity Commercial |
$2,637.68
|
| Rate for Payer: Cofinity Commercial |
$2,454.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,831.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,923.31
|
| Rate for Payer: Nomi Health Commercial |
$2,198.06
|
| Rate for Payer: PACE SWMI |
$1,831.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,831.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,449.90
|
| Rate for Payer: Priority Health Medicare |
$1,850.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,831.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,831.72
|
| Rate for Payer: UHC Exchange |
$1,831.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,831.72
|
|
|
PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP
|
Professional
|
Both
|
$4,619.00
|
|
|
Service Code
|
HCPCS 33310
|
| Min. Negotiated Rate |
$1,119.02 |
| Max. Negotiated Rate |
$3,002.35 |
| Rate for Payer: Aetna Commercial |
$1,499.49
|
| Rate for Payer: Aetna Medicare |
$1,163.78
|
| Rate for Payer: BCBS Complete |
$1,847.60
|
| Rate for Payer: BCBS MAPPO |
$1,119.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.02
|
| Rate for Payer: Cash Price |
$3,695.20
|
| Rate for Payer: Cash Price |
$3,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,611.39
|
| Rate for Payer: Cofinity Commercial |
$1,499.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,174.97
|
| Rate for Payer: Nomi Health Commercial |
$1,342.82
|
| Rate for Payer: PACE SWMI |
$1,119.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,002.35
|
| Rate for Payer: Priority Health Medicare |
$1,130.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,119.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,119.02
|
| Rate for Payer: UHC Exchange |
$1,119.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,119.02
|
|
|
PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 93660
|
| Min. Negotiated Rate |
$151.10 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$202.47
|
| Rate for Payer: Aetna Medicare |
$157.14
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$151.10
|
| Rate for Payer: BCN Medicare Advantage |
$151.10
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$217.58
|
| Rate for Payer: Cofinity Commercial |
$202.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.66
|
| Rate for Payer: Nomi Health Commercial |
$181.32
|
| Rate for Payer: PACE SWMI |
$151.10
|
| Rate for Payer: PHP Medicare Advantage |
$151.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$152.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.10
|
| Rate for Payer: UHC Exchange |
$151.10
|
| Rate for Payer: UHC Medicare Advantage |
$151.10
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92960
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$136.28
|
| Rate for Payer: Aetna Medicare |
$105.77
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: BCBS MAPPO |
$101.70
|
| Rate for Payer: BCN Medicare Advantage |
$101.70
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$146.45
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.78
|
| Rate for Payer: Nomi Health Commercial |
$122.04
|
| Rate for Payer: PACE SWMI |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$101.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health Medicare |
$102.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.70
|
| Rate for Payer: UHC Exchange |
$101.70
|
| Rate for Payer: UHC Medicare Advantage |
$101.70
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92960
|
| Hospital Charge Code |
92960
|
| Min. Negotiated Rate |
$101.70 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$136.28
|
| Rate for Payer: Aetna Medicare |
$105.77
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: BCBS MAPPO |
$101.70
|
| Rate for Payer: BCN Medicare Advantage |
$101.70
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$146.45
|
| Rate for Payer: Cofinity Commercial |
$136.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.78
|
| Rate for Payer: Nomi Health Commercial |
$122.04
|
| Rate for Payer: PACE SWMI |
$101.70
|
| Rate for Payer: PHP Medicare Advantage |
$101.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health Medicare |
$102.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.70
|
| Rate for Payer: UHC Exchange |
$101.70
|
| Rate for Payer: UHC Medicare Advantage |
$101.70
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$118.99 |
| Max. Negotiated Rate |
$496.81 |
| Rate for Payer: Aetna Commercial |
$425.85
|
| Rate for Payer: Aetna Medicare |
$130.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.56
|
| Rate for Payer: BCBS Complete |
$496.81
|
| Rate for Payer: BCBS MAPPO |
$125.25
|
| Rate for Payer: BCBS Trust/PPO |
$411.87
|
| Rate for Payer: BCN Commercial |
$389.53
|
| Rate for Payer: BCN Medicare Advantage |
$125.25
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$430.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.25
|
| Rate for Payer: Healthscope Commercial |
$450.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.75
|
| Rate for Payer: Mclaren Medicaid |
$473.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.51
|
| Rate for Payer: Meridian Medicaid |
$496.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.85
|
| Rate for Payer: Nomi Health Commercial |
$410.82
|
| Rate for Payer: PACE Senior Care Partners |
$118.99
|
| Rate for Payer: PACE SWMI |
$125.25
|
| Rate for Payer: PHP Commercial |
$425.85
|
| Rate for Payer: PHP Medicare Advantage |
$125.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO |
$435.87
|
| Rate for Payer: Priority Health Medicare |
$126.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.67
|
| Rate for Payer: Railroad Medicare Medicare |
$125.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.88
|
| Rate for Payer: UHC Core |
$418.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.25
|
| Rate for Payer: UHC Exchange |
$125.25
|
| Rate for Payer: UHC Medicare Advantage |
$125.25
|
| Rate for Payer: UHCCP Medicaid |
$473.12
|
| Rate for Payer: VA VA |
$125.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.75
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
92960
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$325.65 |
| Max. Negotiated Rate |
$450.90 |
| Rate for Payer: Aetna Commercial |
$425.85
|
| Rate for Payer: BCBS Trust/PPO |
$408.97
|
| Rate for Payer: BCN Commercial |
$387.17
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$430.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$400.80
|
| Rate for Payer: Healthscope Commercial |
$450.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$375.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.85
|
| Rate for Payer: Nomi Health Commercial |
$410.82
|
| Rate for Payer: PHP Commercial |
$425.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO |
$435.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.88
|
| Rate for Payer: UHC Core |
$418.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$375.75
|
|
|
PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 92961
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$333.40 |
| Rate for Payer: Aetna Commercial |
$310.25
|
| Rate for Payer: Aetna Medicare |
$240.79
|
| Rate for Payer: BCBS Complete |
$200.80
|
| Rate for Payer: BCBS MAPPO |
$231.53
|
| Rate for Payer: BCN Medicare Advantage |
$231.53
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$333.40
|
| Rate for Payer: Cofinity Commercial |
$310.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.11
|
| Rate for Payer: Nomi Health Commercial |
$277.84
|
| Rate for Payer: PACE SWMI |
$231.53
|
| Rate for Payer: PHP Medicare Advantage |
$231.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health Medicare |
$233.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.53
|
| Rate for Payer: UHC Exchange |
$231.53
|
| Rate for Payer: UHC Medicare Advantage |
$231.53
|
|
|
PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 96161
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.76
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$2.65
|
| Rate for Payer: BCN Medicare Advantage |
$2.65
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$3.82
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.78
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: PACE SWMI |
$2.65
|
| Rate for Payer: PHP Medicare Advantage |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.65
|
| Rate for Payer: UHC Exchange |
$2.65
|
| Rate for Payer: UHC Medicare Advantage |
$2.65
|
|
|
PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 99484
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Commercial |
$54.70
|
| Rate for Payer: Aetna Medicare |
$42.45
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$40.82
|
| Rate for Payer: BCN Medicare Advantage |
$40.82
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$58.78
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.86
|
| Rate for Payer: Nomi Health Commercial |
$48.98
|
| Rate for Payer: PACE SWMI |
$40.82
|
| Rate for Payer: PHP Medicare Advantage |
$40.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$41.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.82
|
| Rate for Payer: UHC Exchange |
$40.82
|
| Rate for Payer: UHC Medicare Advantage |
$40.82
|
|
