|
PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 28545
|
| Min. Negotiated Rate |
$263.93 |
| Max. Negotiated Rate |
$461.50 |
| Rate for Payer: Aetna Commercial |
$353.67
|
| Rate for Payer: Aetna Medicare |
$274.49
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: BCBS MAPPO |
$263.93
|
| Rate for Payer: BCN Medicare Advantage |
$263.93
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Cofinity Commercial |
$380.06
|
| Rate for Payer: Cofinity Commercial |
$353.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$277.13
|
| Rate for Payer: Nomi Health Commercial |
$316.72
|
| Rate for Payer: PACE SWMI |
$263.93
|
| Rate for Payer: PHP Medicare Advantage |
$263.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.50
|
| Rate for Payer: Priority Health Medicare |
$266.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.93
|
| Rate for Payer: UHC Exchange |
$263.93
|
| Rate for Payer: UHC Medicare Advantage |
$263.93
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION
|
Professional
|
Both
|
$843.00
|
|
|
Service Code
|
HCPCS 27530
|
| Min. Negotiated Rate |
$281.96 |
| Max. Negotiated Rate |
$547.95 |
| Rate for Payer: Aetna Commercial |
$377.83
|
| Rate for Payer: Aetna Medicare |
$293.24
|
| Rate for Payer: BCBS Complete |
$337.20
|
| Rate for Payer: BCBS MAPPO |
$281.96
|
| Rate for Payer: BCN Medicare Advantage |
$281.96
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cofinity Commercial |
$406.02
|
| Rate for Payer: Cofinity Commercial |
$377.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.06
|
| Rate for Payer: Nomi Health Commercial |
$338.35
|
| Rate for Payer: PACE SWMI |
$281.96
|
| Rate for Payer: PHP Medicare Advantage |
$281.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.95
|
| Rate for Payer: Priority Health Medicare |
$284.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$281.96
|
| Rate for Payer: UHC Exchange |
$281.96
|
| Rate for Payer: UHC Medicare Advantage |
$281.96
|
|
|
PR CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 27532
|
| Min. Negotiated Rate |
$454.40 |
| Max. Negotiated Rate |
$811.77 |
| Rate for Payer: Aetna Commercial |
$755.40
|
| Rate for Payer: Aetna Medicare |
$586.28
|
| Rate for Payer: BCBS Complete |
$454.40
|
| Rate for Payer: BCBS MAPPO |
$563.73
|
| Rate for Payer: BCN Medicare Advantage |
$563.73
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cofinity Commercial |
$811.77
|
| Rate for Payer: Cofinity Commercial |
$755.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.92
|
| Rate for Payer: Nomi Health Commercial |
$676.48
|
| Rate for Payer: PACE SWMI |
$563.73
|
| Rate for Payer: PHP Medicare Advantage |
$563.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$738.40
|
| Rate for Payer: Priority Health Medicare |
$569.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$563.73
|
| Rate for Payer: UHC Exchange |
$563.73
|
| Rate for Payer: UHC Medicare Advantage |
$563.73
|
|
|
PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ
|
Professional
|
Both
|
$1,793.00
|
|
|
Service Code
|
HCPCS 27752
|
| Min. Negotiated Rate |
$476.72 |
| Max. Negotiated Rate |
$1,165.45 |
| Rate for Payer: Aetna Commercial |
$638.80
|
| Rate for Payer: Aetna Medicare |
$495.79
|
| Rate for Payer: BCBS Complete |
$717.20
|
| Rate for Payer: BCBS MAPPO |
$476.72
|
| Rate for Payer: BCN Medicare Advantage |
$476.72
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cash Price |
$1,434.40
|
| Rate for Payer: Cofinity Commercial |
$686.48
|
| Rate for Payer: Cofinity Commercial |
$638.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$476.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$500.56
|
| Rate for Payer: Nomi Health Commercial |
$572.06
|
| Rate for Payer: PACE SWMI |
$476.72
|
| Rate for Payer: PHP Medicare Advantage |
$476.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,165.45
|
| Rate for Payer: Priority Health Medicare |
$481.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$476.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$476.72
|
| Rate for Payer: UHC Exchange |
$476.72
|
| Rate for Payer: UHC Medicare Advantage |
$476.72
|
|
|
PR CLTX TIBIAL SHAFT FX W/O MANIPULATION
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 27750
|
| Min. Negotiated Rate |
$315.19 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$422.35
|
| Rate for Payer: Aetna Medicare |
$327.80
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$315.19
|
| Rate for Payer: BCN Medicare Advantage |
$315.19
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$453.87
|
| Rate for Payer: Cofinity Commercial |
$422.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.95
|
| Rate for Payer: Nomi Health Commercial |
$378.23
|
| Rate for Payer: PACE SWMI |
$315.19
|
| Rate for Payer: PHP Medicare Advantage |
$315.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$318.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.19
|
| Rate for Payer: UHC Exchange |
$315.19
|
| Rate for Payer: UHC Medicare Advantage |
$315.19
|
|
|
PR CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MNPJ
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 25680
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$743.72 |
| Rate for Payer: Aetna Commercial |
$692.07
|
| Rate for Payer: Aetna Medicare |
$537.13
|
| Rate for Payer: BCBS Complete |
$357.60
|
| Rate for Payer: BCBS MAPPO |
$516.47
|
| Rate for Payer: BCN Medicare Advantage |
$516.47
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cofinity Commercial |
$743.72
|
| Rate for Payer: Cofinity Commercial |
$692.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.29
|
| Rate for Payer: Nomi Health Commercial |
$619.76
|
| Rate for Payer: PACE SWMI |
$516.47
|
| Rate for Payer: PHP Medicare Advantage |
$516.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.10
|
| Rate for Payer: Priority Health Medicare |
$521.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.47
|
| Rate for Payer: UHC Exchange |
$516.47
|
| Rate for Payer: UHC Medicare Advantage |
$516.47
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION
|
Professional
|
Both
|
$1,696.00
|
|
|
Service Code
|
HCPCS 27818
|
| Min. Negotiated Rate |
$431.01 |
| Max. Negotiated Rate |
$1,102.40 |
| Rate for Payer: Aetna Commercial |
$577.55
|
| Rate for Payer: Aetna Medicare |
$448.25
|
| Rate for Payer: BCBS Complete |
$678.40
|
| Rate for Payer: BCBS MAPPO |
$431.01
|
| Rate for Payer: BCN Medicare Advantage |
$431.01
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Cofinity Commercial |
$620.65
|
| Rate for Payer: Cofinity Commercial |
$577.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.56
|
| Rate for Payer: Nomi Health Commercial |
$517.21
|
| Rate for Payer: PACE SWMI |
$431.01
|
| Rate for Payer: PHP Medicare Advantage |
$431.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.40
|
| Rate for Payer: Priority Health Medicare |
$435.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$431.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.01
|
| Rate for Payer: UHC Exchange |
$431.01
|
| Rate for Payer: UHC Medicare Advantage |
$431.01
|
|
|
PR CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 27816
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$414.68 |
| Rate for Payer: Aetna Commercial |
$385.88
|
| Rate for Payer: Aetna Medicare |
$299.49
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: BCBS MAPPO |
$287.97
|
| Rate for Payer: BCN Medicare Advantage |
$287.97
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$414.68
|
| Rate for Payer: Cofinity Commercial |
$385.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$302.37
|
| Rate for Payer: Nomi Health Commercial |
$345.56
|
| Rate for Payer: PACE SWMI |
$287.97
|
| Rate for Payer: PHP Medicare Advantage |
$287.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
| Rate for Payer: Priority Health Medicare |
$290.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.97
|
| Rate for Payer: UHC Exchange |
$287.97
|
| Rate for Payer: UHC Medicare Advantage |
$287.97
|
|
|
PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING
|
Professional
|
Both
|
$895.00
|
|
|
Service Code
|
HCPCS 22310
|
| Min. Negotiated Rate |
$286.97 |
| Max. Negotiated Rate |
$581.75 |
| Rate for Payer: Aetna Commercial |
$384.54
|
| Rate for Payer: Aetna Medicare |
$298.45
|
| Rate for Payer: BCBS Complete |
$358.00
|
| Rate for Payer: BCBS MAPPO |
$286.97
|
| Rate for Payer: BCN Medicare Advantage |
$286.97
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cash Price |
$716.00
|
| Rate for Payer: Cofinity Commercial |
$413.24
|
| Rate for Payer: Cofinity Commercial |
$384.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.32
|
| Rate for Payer: Nomi Health Commercial |
$344.36
|
| Rate for Payer: PACE SWMI |
$286.97
|
| Rate for Payer: PHP Medicare Advantage |
$286.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.75
|
| Rate for Payer: Priority Health Medicare |
$289.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.97
|
| Rate for Payer: UHC Exchange |
$286.97
|
| Rate for Payer: UHC Medicare Advantage |
$286.97
|
|
|
PR CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ
|
Professional
|
Both
|
$1,302.00
|
|
|
Service Code
|
HCPCS 22315
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,091.55 |
| Rate for Payer: Aetna Commercial |
$1,015.75
|
| Rate for Payer: Aetna Medicare |
$788.34
|
| Rate for Payer: BCBS Complete |
$520.80
|
| Rate for Payer: BCBS MAPPO |
$758.02
|
| Rate for Payer: BCN Medicare Advantage |
$758.02
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cofinity Commercial |
$1,091.55
|
| Rate for Payer: Cofinity Commercial |
$1,015.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.92
|
| Rate for Payer: Nomi Health Commercial |
$909.62
|
| Rate for Payer: PACE SWMI |
$758.02
|
| Rate for Payer: PHP Medicare Advantage |
$758.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.30
|
| Rate for Payer: Priority Health Medicare |
$765.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$758.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.02
|
| Rate for Payer: UHC Exchange |
$758.02
|
| Rate for Payer: UHC Medicare Advantage |
$758.02
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO
|
Professional
|
Both
|
$2,029.00
|
|
|
Service Code
|
HCPCS 57260
|
| Min. Negotiated Rate |
$746.92 |
| Max. Negotiated Rate |
$1,318.85 |
| Rate for Payer: Aetna Commercial |
$1,000.87
|
| Rate for Payer: Aetna Medicare |
$776.80
|
| Rate for Payer: BCBS Complete |
$811.60
|
| Rate for Payer: BCBS MAPPO |
$746.92
|
| Rate for Payer: BCN Medicare Advantage |
$746.92
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cofinity Commercial |
$1,075.56
|
| Rate for Payer: Cofinity Commercial |
$1,000.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$784.27
|
| Rate for Payer: Nomi Health Commercial |
$896.30
|
| Rate for Payer: PACE SWMI |
$746.92
|
| Rate for Payer: PHP Medicare Advantage |
$746.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,318.85
|
| Rate for Payer: Priority Health Medicare |
$754.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$746.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.92
|
| Rate for Payer: UHC Exchange |
$746.92
|
| Rate for Payer: UHC Medicare Advantage |
$746.92
|
|
|
PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR
|
Professional
|
Both
|
$2,612.00
|
|
|
Service Code
|
HCPCS 57265
|
| Min. Negotiated Rate |
$836.04 |
| Max. Negotiated Rate |
$1,697.80 |
| Rate for Payer: Aetna Commercial |
$1,120.29
|
| Rate for Payer: Aetna Medicare |
$869.48
|
| Rate for Payer: BCBS Complete |
$1,044.80
|
| Rate for Payer: BCBS MAPPO |
$836.04
|
| Rate for Payer: BCN Medicare Advantage |
$836.04
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cash Price |
$2,089.60
|
| Rate for Payer: Cofinity Commercial |
$1,203.90
|
| Rate for Payer: Cofinity Commercial |
$1,120.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$836.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.84
|
| Rate for Payer: Nomi Health Commercial |
$1,003.25
|
| Rate for Payer: PACE SWMI |
$836.04
|
| Rate for Payer: PHP Medicare Advantage |
$836.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,697.80
|
| Rate for Payer: Priority Health Medicare |
$844.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$836.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$836.04
|
| Rate for Payer: UHC Exchange |
$836.04
|
| Rate for Payer: UHC Medicare Advantage |
$836.04
|
|
|
PR CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 36598
|
| Min. Negotiated Rate |
$33.29 |
| Max. Negotiated Rate |
$256.75 |
| Rate for Payer: Aetna Commercial |
$44.61
|
| Rate for Payer: Aetna Medicare |
$34.62
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$33.29
|
| Rate for Payer: BCN Medicare Advantage |
$33.29
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Cofinity Commercial |
$44.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.95
|
| Rate for Payer: Nomi Health Commercial |
$39.95
|
| Rate for Payer: PACE SWMI |
$33.29
|
| Rate for Payer: PHP Medicare Advantage |
$33.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$33.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.29
|
| Rate for Payer: UHC Exchange |
$33.29
|
| Rate for Payer: UHC Medicare Advantage |
$33.29
|
|
|
PR COCCYGECTOMY PRIMARY
|
Professional
|
Both
|
$1,951.00
|
|
|
Service Code
|
HCPCS 27080
|
| Min. Negotiated Rate |
$492.76 |
| Max. Negotiated Rate |
$1,268.15 |
| Rate for Payer: Aetna Commercial |
$660.30
|
| Rate for Payer: Aetna Medicare |
$512.47
|
| Rate for Payer: BCBS Complete |
$780.40
|
| Rate for Payer: BCBS MAPPO |
$492.76
|
| Rate for Payer: BCN Medicare Advantage |
$492.76
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cash Price |
$1,560.80
|
| Rate for Payer: Cofinity Commercial |
$709.57
|
| Rate for Payer: Cofinity Commercial |
$660.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$492.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.40
|
| Rate for Payer: Nomi Health Commercial |
$591.31
|
| Rate for Payer: PACE SWMI |
$492.76
|
| Rate for Payer: PHP Medicare Advantage |
$492.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,268.15
|
| Rate for Payer: Priority Health Medicare |
$497.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$492.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$492.76
|
| Rate for Payer: UHC Exchange |
$492.76
|
| Rate for Payer: UHC Medicare Advantage |
$492.76
|
|
|
PR COCHLEAR DEVICE IMPLANTATION W/WO MASTOIDECTOMY
|
Professional
|
Both
|
$4,226.00
|
|
|
Service Code
|
HCPCS 69930
|
| Min. Negotiated Rate |
$1,144.86 |
| Max. Negotiated Rate |
$2,746.90 |
| Rate for Payer: Aetna Commercial |
$1,534.11
|
| Rate for Payer: Aetna Medicare |
$1,190.65
|
| Rate for Payer: BCBS Complete |
$1,690.40
|
| Rate for Payer: BCBS MAPPO |
$1,144.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.86
|
| Rate for Payer: Cash Price |
$3,380.80
|
| Rate for Payer: Cash Price |
$3,380.80
|
| Rate for Payer: Cofinity Commercial |
$1,648.60
|
| Rate for Payer: Cofinity Commercial |
$1,534.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,202.10
|
| Rate for Payer: Nomi Health Commercial |
$1,373.83
|
| Rate for Payer: PACE SWMI |
$1,144.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,746.90
|
| Rate for Payer: Priority Health Medicare |
$1,156.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,144.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.86
|
| Rate for Payer: UHC Exchange |
$1,144.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.86
|
|
|
PR COCHLEAR DEVICE/SOFT BAND FITTING FEE
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 00593
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Medicare |
$255.00
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
|
|
PR COCM BY RHC/FQHC 60 MIN MO
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS G0512
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$230.10 |
| Rate for Payer: Aetna Medicare |
$177.00
|
| Rate for Payer: BCBS Complete |
$141.60
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.10
|
|
|
PR CO DIFFUSING CAPACITY
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 94729
|
| Min. Negotiated Rate |
$50.22 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Commercial |
$67.29
|
| Rate for Payer: Aetna Commercial |
$67.29
|
| Rate for Payer: Aetna Medicare |
$52.23
|
| Rate for Payer: Aetna Medicare |
$52.23
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$50.22
|
| Rate for Payer: BCBS MAPPO |
$50.22
|
| Rate for Payer: BCN Medicare Advantage |
$50.22
|
| Rate for Payer: BCN Medicare Advantage |
$50.22
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$72.32
|
| Rate for Payer: Cofinity Commercial |
$67.29
|
| Rate for Payer: Cofinity Commercial |
$67.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.73
|
| Rate for Payer: Nomi Health Commercial |
$60.26
|
| Rate for Payer: Nomi Health Commercial |
$60.26
|
| Rate for Payer: PACE SWMI |
$50.22
|
| Rate for Payer: PACE SWMI |
$50.22
|
| Rate for Payer: PHP Medicare Advantage |
$50.22
|
| Rate for Payer: PHP Medicare Advantage |
$50.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$50.72
|
| Rate for Payer: Priority Health Medicare |
$50.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.22
|
| Rate for Payer: UHC Exchange |
$50.22
|
| Rate for Payer: UHC Exchange |
$50.22
|
| Rate for Payer: UHC Medicare Advantage |
$50.22
|
| Rate for Payer: UHC Medicare Advantage |
$50.22
|
|
|
PR COLCT TOT ABDL W/O PRCTECT W/CONTINENT ILEOST
|
Professional
|
Both
|
$3,840.00
|
|
|
Service Code
|
HCPCS 44151
|
| Min. Negotiated Rate |
$1,536.00 |
| Max. Negotiated Rate |
$2,989.79 |
| Rate for Payer: Aetna Commercial |
$2,782.16
|
| Rate for Payer: Aetna Medicare |
$2,159.29
|
| Rate for Payer: BCBS Complete |
$1,536.00
|
| Rate for Payer: BCBS MAPPO |
$2,076.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,076.24
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cash Price |
$3,072.00
|
| Rate for Payer: Cofinity Commercial |
$2,989.79
|
| Rate for Payer: Cofinity Commercial |
$2,782.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,076.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,180.05
|
| Rate for Payer: Nomi Health Commercial |
$2,491.49
|
| Rate for Payer: PACE SWMI |
$2,076.24
|
| Rate for Payer: PHP Medicare Advantage |
$2,076.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,496.00
|
| Rate for Payer: Priority Health Medicare |
$2,097.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,076.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,076.24
|
| Rate for Payer: UHC Exchange |
$2,076.24
|
| Rate for Payer: UHC Medicare Advantage |
$2,076.24
|
|
|
PR COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$4,611.00
|
|
|
Service Code
|
HCPCS 44150
|
| Min. Negotiated Rate |
$1,780.09 |
| Max. Negotiated Rate |
$2,997.15 |
| Rate for Payer: Aetna Commercial |
$2,385.32
|
| Rate for Payer: Aetna Medicare |
$1,851.29
|
| Rate for Payer: BCBS Complete |
$1,844.40
|
| Rate for Payer: BCBS MAPPO |
$1,780.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,780.09
|
| Rate for Payer: Cash Price |
$3,688.80
|
| Rate for Payer: Cash Price |
$3,688.80
|
| Rate for Payer: Cofinity Commercial |
$2,563.33
|
| Rate for Payer: Cofinity Commercial |
$2,385.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,780.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,869.09
|
| Rate for Payer: Nomi Health Commercial |
$2,136.11
|
| Rate for Payer: PACE SWMI |
$1,780.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,780.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,997.15
|
| Rate for Payer: Priority Health Medicare |
$1,797.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,780.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,780.09
|
| Rate for Payer: UHC Exchange |
$1,780.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,780.09
|
|
|
PR COLCT TTL ABD W/PRCTECT ILEOANAL ANAST & RSVR
|
Professional
|
Both
|
$4,699.00
|
|
|
Service Code
|
HCPCS 44158
|
| Min. Negotiated Rate |
$1,879.60 |
| Max. Negotiated Rate |
$3,118.08 |
| Rate for Payer: Aetna Commercial |
$2,901.54
|
| Rate for Payer: Aetna Medicare |
$2,251.94
|
| Rate for Payer: BCBS Complete |
$1,879.60
|
| Rate for Payer: BCBS MAPPO |
$2,165.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,165.33
|
| Rate for Payer: Cash Price |
$3,759.20
|
| Rate for Payer: Cash Price |
$3,759.20
|
| Rate for Payer: Cofinity Commercial |
$3,118.08
|
| Rate for Payer: Cofinity Commercial |
$2,901.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,165.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,273.60
|
| Rate for Payer: Nomi Health Commercial |
$2,598.40
|
| Rate for Payer: PACE SWMI |
$2,165.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,165.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,054.35
|
| Rate for Payer: Priority Health Medicare |
$2,186.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,165.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,165.33
|
| Rate for Payer: UHC Exchange |
$2,165.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,165.33
|
|
|
PR COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$3,874.00
|
|
|
Service Code
|
HCPCS 44140
|
| Min. Negotiated Rate |
$1,299.60 |
| Max. Negotiated Rate |
$2,518.10 |
| Rate for Payer: Aetna Commercial |
$1,741.46
|
| Rate for Payer: Aetna Medicare |
$1,351.58
|
| Rate for Payer: BCBS Complete |
$1,549.60
|
| Rate for Payer: BCBS MAPPO |
$1,299.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.60
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cofinity Commercial |
$1,871.42
|
| Rate for Payer: Cofinity Commercial |
$1,741.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,364.58
|
| Rate for Payer: Nomi Health Commercial |
$1,559.52
|
| Rate for Payer: PACE SWMI |
$1,299.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.10
|
| Rate for Payer: Priority Health Medicare |
$1,312.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,299.60
|
| Rate for Payer: UHC Exchange |
$1,299.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,299.60
|
|
|
PR COLECTOMY PARTIAL W/ANASTOMOSIS
|
Facility
|
IP
|
$3,874.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
44140
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$2,518.10 |
| Max. Negotiated Rate |
$3,486.60 |
| Rate for Payer: Aetna Commercial |
$3,292.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,162.35
|
| Rate for Payer: BCN Commercial |
$2,993.83
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cofinity Commercial |
$3,331.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,099.20
|
| Rate for Payer: Healthscope Commercial |
$3,486.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,905.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,292.90
|
| Rate for Payer: Nomi Health Commercial |
$3,176.68
|
| Rate for Payer: PHP Commercial |
$3,292.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.10
|
| Rate for Payer: Priority Health HMO/PPO |
$3,370.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,595.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,409.12
|
| Rate for Payer: UHC Core |
$3,234.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,905.50
|
|
|
PR COLECTOMY PARTIAL W/ANASTOMOSIS
|
Facility
|
OP
|
$3,874.00
|
|
|
Service Code
|
CPT 44140
|
| Hospital Charge Code |
44140
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$920.08 |
| Max. Negotiated Rate |
$3,486.60 |
| Rate for Payer: Aetna Commercial |
$3,292.90
|
| Rate for Payer: Aetna Medicare |
$1,007.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,210.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,210.62
|
| Rate for Payer: BCBS Complete |
$1,549.60
|
| Rate for Payer: BCBS MAPPO |
$968.50
|
| Rate for Payer: BCBS Trust/PPO |
$3,184.82
|
| Rate for Payer: BCN Commercial |
$3,012.03
|
| Rate for Payer: BCN Medicare Advantage |
$968.50
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cofinity Commercial |
$3,331.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,099.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.50
|
| Rate for Payer: Healthscope Commercial |
$3,486.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,905.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,113.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,292.90
|
| Rate for Payer: Nomi Health Commercial |
$3,176.68
|
| Rate for Payer: PACE Senior Care Partners |
$920.08
|
| Rate for Payer: PACE SWMI |
$968.50
|
| Rate for Payer: PHP Commercial |
$3,292.90
|
| Rate for Payer: PHP Medicare Advantage |
$968.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.10
|
| Rate for Payer: Priority Health HMO/PPO |
$3,370.38
|
| Rate for Payer: Priority Health Medicare |
$978.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,595.58
|
| Rate for Payer: Railroad Medicare Medicare |
$968.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,409.12
|
| Rate for Payer: UHC Core |
$3,234.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.50
|
| Rate for Payer: UHC Exchange |
$968.50
|
| Rate for Payer: UHC Medicare Advantage |
$968.50
|
| Rate for Payer: VA VA |
$968.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,905.50
|
|
|
PR COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$3,874.00
|
|
|
Service Code
|
HCPCS 44140
|
| Hospital Charge Code |
44140
|
| Min. Negotiated Rate |
$1,299.60 |
| Max. Negotiated Rate |
$2,518.10 |
| Rate for Payer: Aetna Commercial |
$1,741.46
|
| Rate for Payer: Aetna Medicare |
$1,351.58
|
| Rate for Payer: BCBS Complete |
$1,549.60
|
| Rate for Payer: BCBS MAPPO |
$1,299.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.60
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cofinity Commercial |
$1,871.42
|
| Rate for Payer: Cofinity Commercial |
$1,741.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,364.58
|
| Rate for Payer: Nomi Health Commercial |
$1,559.52
|
| Rate for Payer: PACE SWMI |
$1,299.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,518.10
|
| Rate for Payer: Priority Health Medicare |
$1,312.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,299.60
|
| Rate for Payer: UHC Exchange |
$1,299.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,299.60
|
|
