|
PR LATISSE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 00267
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$125.30 |
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.30
|
|
|
PR LAVAGE CANNULATION MAXILLARY SINUS
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 31000
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$694.71 |
| Rate for Payer: Aetna Commercial |
$143.54
|
| Rate for Payer: Aetna Medicare |
$111.40
|
| Rate for Payer: BCBS Complete |
$74.93
|
| Rate for Payer: BCBS MAPPO |
$107.12
|
| Rate for Payer: BCBS Trust/PPO |
$694.71
|
| Rate for Payer: BCN Commercial |
$274.15
|
| Rate for Payer: BCN Medicare Advantage |
$107.12
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$143.54
|
| Rate for Payer: Cofinity Commercial |
$154.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.12
|
| Rate for Payer: Mclaren Medicaid |
$71.36
|
| Rate for Payer: Meridian Medicaid |
$74.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.48
|
| Rate for Payer: PACE SWMI |
$107.12
|
| Rate for Payer: PHP Medicare Advantage |
$107.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.74
|
| Rate for Payer: Priority Health Medicare |
$107.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.12
|
| Rate for Payer: UHC Medicare Advantage |
$110.33
|
|
|
PR LAVAGE CANNULATION SPHENOID SINUS
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 31002
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$689.96 |
| Rate for Payer: Aetna Commercial |
$248.68
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$185.58
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$185.58
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$267.24
|
| Rate for Payer: Cofinity Commercial |
$248.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.58
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$194.86
|
| Rate for Payer: PACE SWMI |
$185.58
|
| Rate for Payer: PHP Medicare Advantage |
$185.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.64
|
| Rate for Payer: Priority Health Medicare |
$185.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.58
|
| Rate for Payer: UHC Medicare Advantage |
$191.15
|
|
|
PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 93462
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$548.90 |
| Rate for Payer: Aetna Commercial |
$273.98
|
| Rate for Payer: Aetna Medicare |
$212.64
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$204.46
|
| Rate for Payer: BCBS Trust/PPO |
$548.90
|
| Rate for Payer: BCN Commercial |
$298.58
|
| Rate for Payer: BCN Medicare Advantage |
$204.46
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cash Price |
$346.40
|
| Rate for Payer: Cofinity Commercial |
$294.42
|
| Rate for Payer: Cofinity Commercial |
$273.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.46
|
| Rate for Payer: Mclaren Medicaid |
$129.08
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.68
|
| Rate for Payer: PACE SWMI |
$204.46
|
| Rate for Payer: PHP Medicare Advantage |
$204.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.92
|
| Rate for Payer: Priority Health Medicare |
$204.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$288.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.46
|
| Rate for Payer: UHC Medicare Advantage |
$210.59
|
|
|
PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 26476
|
| Min. Negotiated Rate |
$418.12 |
| Max. Negotiated Rate |
$1,727.54 |
| Rate for Payer: Aetna Commercial |
$842.18
|
| Rate for Payer: Aetna Medicare |
$653.63
|
| Rate for Payer: BCBS Complete |
$439.03
|
| Rate for Payer: BCBS MAPPO |
$628.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,727.54
|
| Rate for Payer: BCN Commercial |
$959.76
|
| Rate for Payer: BCN Medicare Advantage |
$628.49
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$842.18
|
| Rate for Payer: Cofinity Commercial |
$905.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$628.49
|
| Rate for Payer: Mclaren Medicaid |
$418.12
|
| Rate for Payer: Meridian Medicaid |
$439.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$659.91
|
| Rate for Payer: PACE SWMI |
$628.49
|
| Rate for Payer: PHP Medicare Advantage |
$628.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$418.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$925.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,002.91
|
| Rate for Payer: Priority Health Medicare |
$628.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,002.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$628.49
|
| Rate for Payer: UHC Medicare Advantage |
$647.34
|
|
|
PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 26478
|
| Min. Negotiated Rate |
$426.64 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$869.79
|
| Rate for Payer: Aetna Medicare |
$675.06
|
| Rate for Payer: BCBS Complete |
$447.97
|
| Rate for Payer: BCBS MAPPO |
$649.10
|
| Rate for Payer: BCBS Trust/PPO |
$878.03
|
| Rate for Payer: BCN Commercial |
$989.08
|
| Rate for Payer: BCN Medicare Advantage |
$649.10
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cofinity Commercial |
$934.70
|
| Rate for Payer: Cofinity Commercial |
$869.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$649.10
|
| Rate for Payer: Mclaren Medicaid |
$426.64
|
| Rate for Payer: Meridian Medicaid |
$447.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$681.56
|
| Rate for Payer: PACE SWMI |
$649.10
|
| Rate for Payer: PHP Medicare Advantage |
$649.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.56
|
| Rate for Payer: Priority Health Medicare |
$649.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$649.10
|
| Rate for Payer: UHC Medicare Advantage |
$668.57
|
|
|
PR LESION <15
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00074
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
PR LESION FL FACE/NECK
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00075
|
|
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 LESION REMOVAL COLONOSCOPY
|
Professional
|
Both
|
$1,553.00
|
|
|
Service Code
|
HCPCS G6024
|
| Min. Negotiated Rate |
$621.20 |
| Max. Negotiated Rate |
$1,087.10 |
| Rate for Payer: BCBS Complete |
$621.20
|
| Rate for Payer: Cash Price |
$1,242.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.10
|
|
|
PR LESION SINGLE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 00073
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$2,222.66 |
| Rate for Payer: Aetna Commercial |
$2,068.31
|
| Rate for Payer: Aetna Medicare |
$1,605.26
|
| Rate for Payer: BCBS Complete |
$432.40
|
| Rate for Payer: BCBS MAPPO |
$1,543.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,111.82
|
| Rate for Payer: BCN Commercial |
$1,126.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,543.52
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cofinity Commercial |
$2,222.66
|
| Rate for Payer: Cofinity Commercial |
$2,068.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,543.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,620.69
|
| Rate for Payer: PACE SWMI |
$1,543.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,543.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health Medicare |
$1,543.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,543.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,543.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,589.82
|
|
|
PR LEUPROLIDE ACETATE INJECITON
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS J9218
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$25.90 |
| Rate for Payer: Aetna Commercial |
$13.48
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$10.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCN Commercial |
$7.60
|
| Rate for Payer: BCN Medicare Advantage |
$10.06
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$13.48
|
| Rate for Payer: Cofinity Commercial |
$14.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.56
|
| Rate for Payer: PACE SWMI |
$10.06
|
| Rate for Payer: PHP Medicare Advantage |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Medicare |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.06
|
| Rate for Payer: UHC Medicare Advantage |
$10.36
|
|
|
PR LEUPROLIDE ACETATE SUSPNSION
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS J9217
|
| Min. Negotiated Rate |
$165.86 |
| Max. Negotiated Rate |
$316.40 |
| Rate for Payer: Aetna Commercial |
$222.26
|
| Rate for Payer: Aetna Medicare |
$172.50
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$165.86
|
| Rate for Payer: BCBS Trust/PPO |
$191.56
|
| Rate for Payer: BCN Commercial |
$182.32
|
| Rate for Payer: BCN Medicare Advantage |
$165.86
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$222.26
|
| Rate for Payer: Cofinity Commercial |
$238.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.16
|
| Rate for Payer: PACE SWMI |
$165.86
|
| Rate for Payer: PHP Medicare Advantage |
$165.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.40
|
| Rate for Payer: Priority Health Medicare |
$165.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.86
|
| Rate for Payer: UHC Medicare Advantage |
$170.84
|
|
|
PR LEVALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J7614
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.05
|
| Rate for Payer: Aetna Medicare |
$0.04
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.04
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.04
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.05
|
| Rate for Payer: Cofinity Commercial |
$0.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.04
|
| Rate for Payer: PACE SWMI |
$0.04
|
| Rate for Payer: PHP Medicare Advantage |
$0.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.04
|
| Rate for Payer: UHC Medicare Advantage |
$0.04
|
|
|
PR LEVONORGESTREL IMPLANT SYS
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS J7306
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$2,147.54 |
| Rate for Payer: Aetna Commercial |
$406.00
|
| Rate for Payer: BCBS Complete |
$220.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,147.54
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.00
|
|
|
PR LEVONORGESTREL IU CONTRACEPT
|
Professional
|
Both
|
$823.00
|
|
|
Service Code
|
HCPCS J7302
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$576.10 |
| Rate for Payer: BCBS Complete |
$329.20
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.10
|
|
|
PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 93452
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$1,383.09 |
| Rate for Payer: Aetna Commercial |
$1,141.40
|
| Rate for Payer: Aetna Medicare |
$885.86
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$851.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,383.09
|
| Rate for Payer: BCN Commercial |
$1,319.43
|
| Rate for Payer: BCN Medicare Advantage |
$851.79
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$1,141.40
|
| Rate for Payer: Cofinity Commercial |
$1,226.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$851.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$894.38
|
| Rate for Payer: PACE SWMI |
$851.79
|
| Rate for Payer: PHP Medicare Advantage |
$851.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,276.74
|
| Rate for Payer: Priority Health Medicare |
$851.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,276.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$851.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$851.79
|
| Rate for Payer: UHC Medicare Advantage |
$877.34
|
|
|
PR LIDOCAINE INJECTION
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J2001
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR
|
Professional
|
Both
|
$2,440.00
|
|
|
Service Code
|
HCPCS 27427
|
| Min. Negotiated Rate |
$459.02 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$939.26
|
| Rate for Payer: Aetna Medicare |
$728.98
|
| Rate for Payer: BCBS Complete |
$481.97
|
| Rate for Payer: BCBS MAPPO |
$700.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,194.49
|
| Rate for Payer: BCN Commercial |
$1,046.26
|
| Rate for Payer: BCN Medicare Advantage |
$700.94
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cash Price |
$1,952.00
|
| Rate for Payer: Cofinity Commercial |
$939.26
|
| Rate for Payer: Cofinity Commercial |
$1,009.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$700.94
|
| Rate for Payer: Mclaren Medicaid |
$459.02
|
| Rate for Payer: Meridian Medicaid |
$481.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$735.99
|
| Rate for Payer: PACE SWMI |
$700.94
|
| Rate for Payer: PHP Medicare Advantage |
$700.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,093.29
|
| Rate for Payer: Priority Health Medicare |
$700.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,093.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$700.94
|
| Rate for Payer: UHC Medicare Advantage |
$721.97
|
|
|
PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 27428
|
| Min. Negotiated Rate |
$720.79 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: Aetna Commercial |
$1,473.88
|
| Rate for Payer: Aetna Medicare |
$1,143.91
|
| Rate for Payer: BCBS Complete |
$756.83
|
| Rate for Payer: BCBS MAPPO |
$1,099.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.07
|
| Rate for Payer: BCN Commercial |
$1,639.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.91
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cofinity Commercial |
$1,473.88
|
| Rate for Payer: Cofinity Commercial |
$1,583.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.91
|
| Rate for Payer: Mclaren Medicaid |
$720.79
|
| Rate for Payer: Meridian Medicaid |
$756.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,154.91
|
| Rate for Payer: PACE SWMI |
$1,099.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,712.73
|
| Rate for Payer: Priority Health Medicare |
$1,099.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,712.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.91
|
| Rate for Payer: UHC Medicare Advantage |
$1,132.91
|
|
|
PR LIGATION ARTERIES ETHMOIDAL
|
Professional
|
Both
|
$1,018.00
|
|
|
Service Code
|
HCPCS 30915
|
| Min. Negotiated Rate |
$388.94 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$793.79
|
| Rate for Payer: Aetna Medicare |
$616.08
|
| Rate for Payer: BCBS Complete |
$408.39
|
| Rate for Payer: BCBS MAPPO |
$592.38
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$892.81
|
| Rate for Payer: BCN Medicare Advantage |
$592.38
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cash Price |
$814.40
|
| Rate for Payer: Cofinity Commercial |
$853.03
|
| Rate for Payer: Cofinity Commercial |
$793.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.38
|
| Rate for Payer: Mclaren Medicaid |
$388.94
|
| Rate for Payer: Meridian Medicaid |
$408.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$622.00
|
| Rate for Payer: PACE SWMI |
$592.38
|
| Rate for Payer: PHP Medicare Advantage |
$592.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$712.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$845.98
|
| Rate for Payer: Priority Health Medicare |
$592.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$845.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$592.38
|
| Rate for Payer: UHC Medicare Advantage |
$610.15
|
|
|
PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 30920
|
| Min. Negotiated Rate |
$561.04 |
| Max. Negotiated Rate |
$2,317.12 |
| Rate for Payer: Aetna Commercial |
$1,149.87
|
| Rate for Payer: Aetna Medicare |
$892.43
|
| Rate for Payer: BCBS Complete |
$589.09
|
| Rate for Payer: BCBS MAPPO |
$858.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.12
|
| Rate for Payer: BCN Commercial |
$1,291.09
|
| Rate for Payer: BCN Medicare Advantage |
$858.11
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cofinity Commercial |
$1,235.68
|
| Rate for Payer: Cofinity Commercial |
$1,149.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.11
|
| Rate for Payer: Mclaren Medicaid |
$561.04
|
| Rate for Payer: Meridian Medicaid |
$589.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$901.02
|
| Rate for Payer: PACE SWMI |
$858.11
|
| Rate for Payer: PHP Medicare Advantage |
$858.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,223.37
|
| Rate for Payer: Priority Health Medicare |
$858.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,223.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.11
|
| Rate for Payer: UHC Medicare Advantage |
$883.85
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$209.48 |
| Max. Negotiated Rate |
$1,116.73 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: Aetna Medicare |
$229.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$275.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$275.62
|
| Rate for Payer: BCBS Complete |
$1,116.73
|
| Rate for Payer: BCBS MAPPO |
$220.50
|
| Rate for Payer: BCBS Trust/PPO |
$685.76
|
| Rate for Payer: BCN Commercial |
$685.76
|
| Rate for Payer: BCN Medicare Advantage |
$220.50
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Mclaren Medicaid |
$1,063.55
|
| Rate for Payer: Meridian Medicaid |
$1,116.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$231.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.70
|
| Rate for Payer: PACE Senior Care Partners |
$209.48
|
| Rate for Payer: PACE SWMI |
$220.50
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: PHP Medicare Advantage |
$220.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,063.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.34
|
| Rate for Payer: Priority Health Medicare |
$220.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.93
|
| Rate for Payer: Railroad Medicare Medicare |
$220.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.16
|
| Rate for Payer: UHC Core |
$736.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.50
|
| Rate for Payer: UHC Medicare Advantage |
$227.12
|
| Rate for Payer: VA VA |
$220.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$537.93 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Aetna Commercial |
$749.70
|
| Rate for Payer: BCBS Trust/PPO |
$681.61
|
| Rate for Payer: BCN Commercial |
$681.61
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$758.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$705.60
|
| Rate for Payer: Healthscope Commercial |
$793.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$661.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$749.70
|
| Rate for Payer: PHP Commercial |
$749.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$537.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$776.16
|
| Rate for Payer: UHC Core |
$736.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$661.50
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Professional
|
Both
|
$882.00
|
|
|
Service Code
|
HCPCS 37609
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$911.85 |
| Rate for Payer: Aetna Commercial |
$269.54
|
| Rate for Payer: Aetna Medicare |
$209.20
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$201.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.85
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: BCN Medicare Advantage |
$201.15
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cofinity Commercial |
$269.54
|
| Rate for Payer: Cofinity Commercial |
$289.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$201.15
|
| Rate for Payer: Mclaren Medicaid |
$130.14
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$211.21
|
| Rate for Payer: PACE SWMI |
$201.15
|
| Rate for Payer: PHP Medicare Advantage |
$201.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$617.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$324.49
|
| Rate for Payer: Priority Health Medicare |
$201.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$324.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$201.15
|
| Rate for Payer: UHC Medicare Advantage |
$207.18
|
|
