|
PR CORPORA CAVERNOSA-CORPUS SPONGIOSUM SHUNT UNI/BI
|
Professional
|
Both
|
$1,874.00
|
|
|
Service Code
|
HCPCS 54430
|
| Min. Negotiated Rate |
$410.66 |
| Max. Negotiated Rate |
$3,265.16 |
| Rate for Payer: Aetna Commercial |
$819.30
|
| Rate for Payer: Aetna Medicare |
$635.88
|
| Rate for Payer: BCBS Complete |
$431.19
|
| Rate for Payer: BCBS MAPPO |
$611.42
|
| Rate for Payer: BCBS Trust/PPO |
$3,265.16
|
| Rate for Payer: BCN Commercial |
$922.62
|
| Rate for Payer: BCN Medicare Advantage |
$611.42
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cash Price |
$1,499.20
|
| Rate for Payer: Cofinity Commercial |
$880.44
|
| Rate for Payer: Cofinity Commercial |
$819.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$611.42
|
| Rate for Payer: Mclaren Medicaid |
$410.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$641.99
|
| Rate for Payer: Meridian Medicaid |
$431.19
|
| Rate for Payer: Nomi Health Commercial |
$733.70
|
| Rate for Payer: PACE SWMI |
$611.42
|
| Rate for Payer: PHP Medicare Advantage |
$611.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,218.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,019.39
|
| Rate for Payer: Priority Health Medicare |
$617.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,019.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$611.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$611.42
|
| Rate for Payer: UHC Exchange |
$611.42
|
| Rate for Payer: UHC Medicare Advantage |
$611.42
|
| Rate for Payer: UHCCP Medicaid |
$410.66
|
|
|
PR CORPORA CAVERNOSA-GLANS PENIS FSTLJ PRIAPISM
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 54435
|
| Min. Negotiated Rate |
$267.53 |
| Max. Negotiated Rate |
$1,738.11 |
| Rate for Payer: Aetna Commercial |
$531.54
|
| Rate for Payer: Aetna Medicare |
$412.54
|
| Rate for Payer: BCBS Complete |
$280.91
|
| Rate for Payer: BCBS MAPPO |
$396.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.11
|
| Rate for Payer: BCN Commercial |
$600.09
|
| Rate for Payer: BCN Medicare Advantage |
$396.67
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cofinity Commercial |
$571.20
|
| Rate for Payer: Cofinity Commercial |
$531.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.67
|
| Rate for Payer: Mclaren Medicaid |
$267.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.50
|
| Rate for Payer: Meridian Medicaid |
$280.91
|
| Rate for Payer: Nomi Health Commercial |
$476.00
|
| Rate for Payer: PACE SWMI |
$396.67
|
| Rate for Payer: PHP Medicare Advantage |
$396.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.45
|
| Rate for Payer: Priority Health HMO/PPO |
$664.16
|
| Rate for Payer: Priority Health Medicare |
$400.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$664.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.67
|
| Rate for Payer: UHC Exchange |
$396.67
|
| Rate for Payer: UHC Medicare Advantage |
$396.67
|
| Rate for Payer: UHCCP Medicaid |
$267.53
|
|
|
PR CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT UNI/BI
|
Professional
|
Both
|
$1,348.00
|
|
|
Service Code
|
HCPCS 54420
|
| Min. Negotiated Rate |
$450.50 |
| Max. Negotiated Rate |
$2,612.13 |
| Rate for Payer: Aetna Commercial |
$899.97
|
| Rate for Payer: Aetna Medicare |
$698.48
|
| Rate for Payer: BCBS Complete |
$473.02
|
| Rate for Payer: BCBS MAPPO |
$671.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,612.13
|
| Rate for Payer: BCN Commercial |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$671.62
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cash Price |
$1,078.40
|
| Rate for Payer: Cofinity Commercial |
$967.13
|
| Rate for Payer: Cofinity Commercial |
$899.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.62
|
| Rate for Payer: Mclaren Medicaid |
$450.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$705.20
|
| Rate for Payer: Meridian Medicaid |
$473.02
|
| Rate for Payer: Nomi Health Commercial |
$805.94
|
| Rate for Payer: PACE SWMI |
$671.62
|
| Rate for Payer: PHP Medicare Advantage |
$671.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$450.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$876.20
|
| Rate for Payer: Priority Health HMO/PPO |
$1,119.52
|
| Rate for Payer: Priority Health Medicare |
$678.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,119.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$671.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$671.62
|
| Rate for Payer: UHC Exchange |
$671.62
|
| Rate for Payer: UHC Medicare Advantage |
$671.62
|
| Rate for Payer: UHCCP Medicaid |
$450.50
|
|
|
PR CORRECT BUNION,SIMPLE
|
Professional
|
Both
|
$1,384.00
|
|
|
Service Code
|
HCPCS 28290
|
| Min. Negotiated Rate |
$553.60 |
| Max. Negotiated Rate |
$899.60 |
| Rate for Payer: Aetna Medicare |
$692.00
|
| Rate for Payer: BCBS Complete |
$553.60
|
| Rate for Payer: Cash Price |
$1,107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.60
|
|
|
PR CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 28286
|
| Min. Negotiated Rate |
$192.13 |
| Max. Negotiated Rate |
$2,002.26 |
| Rate for Payer: Aetna Commercial |
$378.72
|
| Rate for Payer: Aetna Medicare |
$293.94
|
| Rate for Payer: BCBS Complete |
$201.74
|
| Rate for Payer: BCBS MAPPO |
$282.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,002.26
|
| Rate for Payer: BCN Commercial |
$639.19
|
| Rate for Payer: BCN Medicare Advantage |
$282.63
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$406.99
|
| Rate for Payer: Cofinity Commercial |
$378.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.63
|
| Rate for Payer: Mclaren Medicaid |
$192.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$296.76
|
| Rate for Payer: Meridian Medicaid |
$201.74
|
| Rate for Payer: Nomi Health Commercial |
$339.16
|
| Rate for Payer: PACE SWMI |
$282.63
|
| Rate for Payer: PHP Medicare Advantage |
$282.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO |
$458.99
|
| Rate for Payer: Priority Health Medicare |
$285.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$458.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$282.63
|
| Rate for Payer: UHC Exchange |
$282.63
|
| Rate for Payer: UHC Medicare Advantage |
$282.63
|
| Rate for Payer: UHCCP Medicaid |
$192.13
|
|
|
PR CORRECTION HAMMERTOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28285
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Aetna Commercial |
$497.60
|
| Rate for Payer: Aetna Medicare |
$386.19
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS MAPPO |
$371.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.65
|
| Rate for Payer: BCN Commercial |
$860.92
|
| Rate for Payer: BCN Medicare Advantage |
$371.34
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$534.73
|
| Rate for Payer: Cofinity Commercial |
$497.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.34
|
| Rate for Payer: Mclaren Medicaid |
$253.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.91
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Nomi Health Commercial |
$445.61
|
| Rate for Payer: PACE SWMI |
$371.34
|
| Rate for Payer: PHP Medicare Advantage |
$371.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health HMO/PPO |
$596.89
|
| Rate for Payer: Priority Health Medicare |
$375.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.34
|
| Rate for Payer: UHC Exchange |
$371.34
|
| Rate for Payer: UHC Medicare Advantage |
$371.34
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
|
|
PR CORRECTION INVERTED NIPPLES
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 19355
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$1,109.79 |
| Rate for Payer: Aetna Commercial |
$792.14
|
| Rate for Payer: Aetna Medicare |
$614.80
|
| Rate for Payer: BCBS Complete |
$420.01
|
| Rate for Payer: BCBS MAPPO |
$591.15
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$1,109.79
|
| Rate for Payer: BCN Medicare Advantage |
$591.15
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$851.26
|
| Rate for Payer: Cofinity Commercial |
$792.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.15
|
| Rate for Payer: Mclaren Medicaid |
$400.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$620.71
|
| Rate for Payer: Meridian Medicaid |
$420.01
|
| Rate for Payer: Nomi Health Commercial |
$709.38
|
| Rate for Payer: PACE SWMI |
$591.15
|
| Rate for Payer: PHP Medicare Advantage |
$591.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health HMO/PPO |
$839.36
|
| Rate for Payer: Priority Health Medicare |
$597.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$839.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.15
|
| Rate for Payer: UHC Exchange |
$591.15
|
| Rate for Payer: UHC Medicare Advantage |
$591.15
|
| Rate for Payer: UHCCP Medicaid |
$400.01
|
|
|
PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 67820
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$668.83 |
| Rate for Payer: Aetna Commercial |
$27.52
|
| Rate for Payer: Aetna Medicare |
$21.36
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$20.54
|
| Rate for Payer: BCBS Trust/PPO |
$668.83
|
| Rate for Payer: BCN Commercial |
$22.39
|
| Rate for Payer: BCN Medicare Advantage |
$20.54
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$29.58
|
| Rate for Payer: Cofinity Commercial |
$27.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.54
|
| Rate for Payer: Mclaren Medicaid |
$14.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.57
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Nomi Health Commercial |
$24.65
|
| Rate for Payer: PACE SWMI |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$20.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO |
$38.60
|
| Rate for Payer: Priority Health Medicare |
$20.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.54
|
| Rate for Payer: UHC Exchange |
$20.54
|
| Rate for Payer: UHC Medicare Advantage |
$20.54
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT
|
Professional
|
Both
|
$2,241.00
|
|
|
Service Code
|
HCPCS 28296
|
| Min. Negotiated Rate |
$334.62 |
| Max. Negotiated Rate |
$1,456.65 |
| Rate for Payer: Aetna Commercial |
$661.13
|
| Rate for Payer: Aetna Medicare |
$513.12
|
| Rate for Payer: BCBS Complete |
$351.35
|
| Rate for Payer: BCBS MAPPO |
$493.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,186.56
|
| Rate for Payer: BCN Commercial |
$1,288.16
|
| Rate for Payer: BCN Medicare Advantage |
$493.38
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cash Price |
$1,792.80
|
| Rate for Payer: Cofinity Commercial |
$710.47
|
| Rate for Payer: Cofinity Commercial |
$661.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.38
|
| Rate for Payer: Mclaren Medicaid |
$334.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$518.05
|
| Rate for Payer: Meridian Medicaid |
$351.35
|
| Rate for Payer: Nomi Health Commercial |
$592.06
|
| Rate for Payer: PACE SWMI |
$493.38
|
| Rate for Payer: PHP Medicare Advantage |
$493.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,456.65
|
| Rate for Payer: Priority Health HMO/PPO |
$790.25
|
| Rate for Payer: Priority Health Medicare |
$498.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$790.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.38
|
| Rate for Payer: UHC Exchange |
$493.38
|
| Rate for Payer: UHC Medicare Advantage |
$493.38
|
| Rate for Payer: UHCCP Medicaid |
$334.62
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$767.94
|
| Rate for Payer: Aetna Medicare |
$596.01
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS MAPPO |
$573.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: BCN Medicare Advantage |
$573.09
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$825.25
|
| Rate for Payer: Cofinity Commercial |
$767.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.09
|
| Rate for Payer: Mclaren Medicaid |
$388.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.74
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Nomi Health Commercial |
$687.71
|
| Rate for Payer: PACE SWMI |
$573.09
|
| Rate for Payer: PHP Medicare Advantage |
$573.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO |
$925.62
|
| Rate for Payer: Priority Health Medicare |
$578.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$925.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.09
|
| Rate for Payer: UHC Exchange |
$573.09
|
| Rate for Payer: UHC Medicare Advantage |
$573.09
|
| Rate for Payer: UHCCP Medicaid |
$388.30
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
OP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$469.78 |
| Max. Negotiated Rate |
$9,570.97 |
| Rate for Payer: Aetna Commercial |
$1,681.30
|
| Rate for Payer: Aetna Medicare |
$514.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$618.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$618.12
|
| Rate for Payer: BCBS Complete |
$9,570.97
|
| Rate for Payer: BCBS MAPPO |
$494.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,626.11
|
| Rate for Payer: BCN Commercial |
$1,537.90
|
| Rate for Payer: BCN Medicare Advantage |
$494.50
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,701.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.50
|
| Rate for Payer: Healthscope Commercial |
$1,780.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.50
|
| Rate for Payer: Mclaren Medicaid |
$9,114.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.22
|
| Rate for Payer: Meridian Medicaid |
$9,570.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$568.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: PACE Senior Care Partners |
$469.78
|
| Rate for Payer: PACE SWMI |
$494.50
|
| Rate for Payer: PHP Commercial |
$1,681.30
|
| Rate for Payer: PHP Medicare Advantage |
$494.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,114.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.86
|
| Rate for Payer: Priority Health Medicare |
$499.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,325.26
|
| Rate for Payer: Railroad Medicare Medicare |
$494.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.64
|
| Rate for Payer: UHC Core |
$1,651.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.50
|
| Rate for Payer: UHC Exchange |
$494.50
|
| Rate for Payer: UHC Medicare Advantage |
$494.50
|
| Rate for Payer: UHCCP Medicaid |
$9,114.61
|
| Rate for Payer: VA VA |
$494.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.50
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 28297
|
| Min. Negotiated Rate |
$388.30 |
| Max. Negotiated Rate |
$1,499.26 |
| Rate for Payer: Aetna Commercial |
$767.94
|
| Rate for Payer: Aetna Medicare |
$596.01
|
| Rate for Payer: BCBS Complete |
$407.72
|
| Rate for Payer: BCBS MAPPO |
$573.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,304.37
|
| Rate for Payer: BCN Commercial |
$1,499.26
|
| Rate for Payer: BCN Medicare Advantage |
$573.09
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$825.25
|
| Rate for Payer: Cofinity Commercial |
$767.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.09
|
| Rate for Payer: Mclaren Medicaid |
$388.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.74
|
| Rate for Payer: Meridian Medicaid |
$407.72
|
| Rate for Payer: Nomi Health Commercial |
$687.71
|
| Rate for Payer: PACE SWMI |
$573.09
|
| Rate for Payer: PHP Medicare Advantage |
$573.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO |
$925.62
|
| Rate for Payer: Priority Health Medicare |
$578.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$925.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.09
|
| Rate for Payer: UHC Exchange |
$573.09
|
| Rate for Payer: UHC Medicare Advantage |
$573.09
|
| Rate for Payer: UHCCP Medicaid |
$388.30
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS
|
Facility
|
IP
|
$1,978.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
28297
|
| Min. Negotiated Rate |
$1,285.70 |
| Max. Negotiated Rate |
$1,780.20 |
| Rate for Payer: Aetna Commercial |
$1,681.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,614.64
|
| Rate for Payer: BCN Commercial |
$1,528.60
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$1,701.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,582.40
|
| Rate for Payer: Healthscope Commercial |
$1,780.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,483.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,681.30
|
| Rate for Payer: Nomi Health Commercial |
$1,621.96
|
| Rate for Payer: PHP Commercial |
$1,681.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.70
|
| Rate for Payer: Priority Health HMO/PPO |
$1,720.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,325.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,740.64
|
| Rate for Payer: UHC Core |
$1,651.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,483.50
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 28295
|
| Min. Negotiated Rate |
$388.73 |
| Max. Negotiated Rate |
$1,564.75 |
| Rate for Payer: Aetna Commercial |
$767.10
|
| Rate for Payer: Aetna Medicare |
$595.36
|
| Rate for Payer: BCBS Complete |
$408.17
|
| Rate for Payer: BCBS MAPPO |
$572.46
|
| Rate for Payer: BCBS Trust/PPO |
$982.11
|
| Rate for Payer: BCN Commercial |
$1,564.75
|
| Rate for Payer: BCN Medicare Advantage |
$572.46
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cofinity Commercial |
$824.34
|
| Rate for Payer: Cofinity Commercial |
$767.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.46
|
| Rate for Payer: Mclaren Medicaid |
$388.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.08
|
| Rate for Payer: Meridian Medicaid |
$408.17
|
| Rate for Payer: Nomi Health Commercial |
$686.95
|
| Rate for Payer: PACE SWMI |
$572.46
|
| Rate for Payer: PHP Medicare Advantage |
$572.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,068.60
|
| Rate for Payer: Priority Health HMO/PPO |
$927.65
|
| Rate for Payer: Priority Health Medicare |
$578.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$927.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$572.46
|
| Rate for Payer: UHC Exchange |
$572.46
|
| Rate for Payer: UHC Medicare Advantage |
$572.46
|
| Rate for Payer: UHCCP Medicaid |
$388.73
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT
|
Professional
|
Both
|
$1,911.00
|
|
|
Service Code
|
HCPCS 28298
|
| Min. Negotiated Rate |
$329.09 |
| Max. Negotiated Rate |
$1,491.48 |
| Rate for Payer: Aetna Commercial |
$650.18
|
| Rate for Payer: Aetna Medicare |
$504.62
|
| Rate for Payer: BCBS Complete |
$345.54
|
| Rate for Payer: BCBS MAPPO |
$485.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,491.48
|
| Rate for Payer: BCN Commercial |
$1,212.90
|
| Rate for Payer: BCN Medicare Advantage |
$485.21
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cash Price |
$1,528.80
|
| Rate for Payer: Cofinity Commercial |
$698.70
|
| Rate for Payer: Cofinity Commercial |
$650.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$485.21
|
| Rate for Payer: Mclaren Medicaid |
$329.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$509.47
|
| Rate for Payer: Meridian Medicaid |
$345.54
|
| Rate for Payer: Nomi Health Commercial |
$582.25
|
| Rate for Payer: PACE SWMI |
$485.21
|
| Rate for Payer: PHP Medicare Advantage |
$485.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$329.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,242.15
|
| Rate for Payer: Priority Health HMO/PPO |
$782.63
|
| Rate for Payer: Priority Health Medicare |
$490.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$782.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$485.21
|
| Rate for Payer: UHC Exchange |
$485.21
|
| Rate for Payer: UHC Medicare Advantage |
$485.21
|
| Rate for Payer: UHCCP Medicaid |
$329.09
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 28292
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$1,544.75 |
| Rate for Payer: Aetna Commercial |
$623.76
|
| Rate for Payer: Aetna Medicare |
$484.11
|
| Rate for Payer: BCBS Complete |
$332.35
|
| Rate for Payer: BCBS MAPPO |
$465.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,544.75
|
| Rate for Payer: BCN Commercial |
$1,011.07
|
| Rate for Payer: BCN Medicare Advantage |
$465.49
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$670.31
|
| Rate for Payer: Cofinity Commercial |
$623.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.49
|
| Rate for Payer: Mclaren Medicaid |
$316.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.76
|
| Rate for Payer: Meridian Medicaid |
$332.35
|
| Rate for Payer: Nomi Health Commercial |
$558.59
|
| Rate for Payer: PACE SWMI |
$465.49
|
| Rate for Payer: PHP Medicare Advantage |
$465.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health HMO/PPO |
$749.04
|
| Rate for Payer: Priority Health Medicare |
$470.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$749.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$465.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.49
|
| Rate for Payer: UHC Exchange |
$465.49
|
| Rate for Payer: UHC Medicare Advantage |
$465.49
|
| Rate for Payer: UHCCP Medicaid |
$316.52
|
|
|
PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 28299
|
| Min. Negotiated Rate |
$387.02 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Commercial |
$765.23
|
| Rate for Payer: Aetna Medicare |
$593.91
|
| Rate for Payer: BCBS Complete |
$406.37
|
| Rate for Payer: BCBS MAPPO |
$571.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$1,468.47
|
| Rate for Payer: BCN Medicare Advantage |
$571.07
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cofinity Commercial |
$822.34
|
| Rate for Payer: Cofinity Commercial |
$765.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.07
|
| Rate for Payer: Mclaren Medicaid |
$387.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.62
|
| Rate for Payer: Meridian Medicaid |
$406.37
|
| Rate for Payer: Nomi Health Commercial |
$685.28
|
| Rate for Payer: PACE SWMI |
$571.07
|
| Rate for Payer: PHP Medicare Advantage |
$571.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$387.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
| Rate for Payer: Priority Health HMO/PPO |
$916.46
|
| Rate for Payer: Priority Health Medicare |
$576.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$916.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$571.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.07
|
| Rate for Payer: UHC Exchange |
$571.07
|
| Rate for Payer: UHC Medicare Advantage |
$571.07
|
| Rate for Payer: UHCCP Medicaid |
$387.02
|
|
|
PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 67912
|
| Min. Negotiated Rate |
$307.79 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$602.73
|
| Rate for Payer: Aetna Medicare |
$467.79
|
| Rate for Payer: BCBS Complete |
$323.18
|
| Rate for Payer: BCBS MAPPO |
$449.80
|
| Rate for Payer: BCN Commercial |
$1,323.34
|
| Rate for Payer: BCN Medicare Advantage |
$449.80
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$647.71
|
| Rate for Payer: Cofinity Commercial |
$602.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.80
|
| Rate for Payer: Mclaren Medicaid |
$307.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.29
|
| Rate for Payer: Meridian Medicaid |
$323.18
|
| Rate for Payer: Nomi Health Commercial |
$539.76
|
| Rate for Payer: PACE SWMI |
$449.80
|
| Rate for Payer: PHP Medicare Advantage |
$449.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$307.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health HMO/PPO |
$845.78
|
| Rate for Payer: Priority Health Medicare |
$454.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$845.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.80
|
| Rate for Payer: UHC Exchange |
$449.80
|
| Rate for Payer: UHC Medicare Advantage |
$449.80
|
| Rate for Payer: UHCCP Medicaid |
$307.79
|
|
|
PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 44055
|
| Min. Negotiated Rate |
$957.44 |
| Max. Negotiated Rate |
$2,659.62 |
| Rate for Payer: Aetna Commercial |
$1,945.34
|
| Rate for Payer: Aetna Medicare |
$1,509.82
|
| Rate for Payer: BCBS Complete |
$1,005.31
|
| Rate for Payer: BCBS MAPPO |
$1,451.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$2,163.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.75
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$2,090.52
|
| Rate for Payer: Cofinity Commercial |
$1,945.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.75
|
| Rate for Payer: Mclaren Medicaid |
$957.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,524.34
|
| Rate for Payer: Meridian Medicaid |
$1,005.31
|
| Rate for Payer: Nomi Health Commercial |
$1,742.10
|
| Rate for Payer: PACE SWMI |
$1,451.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$957.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO |
$2,659.62
|
| Rate for Payer: Priority Health Medicare |
$1,466.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,659.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,451.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,451.75
|
| Rate for Payer: UHC Exchange |
$1,451.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,451.75
|
| Rate for Payer: UHCCP Medicaid |
$957.44
|
|
|
PR COSMETIC CORRECTION OF INVERTED NIPPLES
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 00557
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Medicare |
$765.00
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
|
|
PR COSMETIC SCLEROTHERAPY
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00181
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,256.00
|
|
|
Service Code
|
HCPCS 63064
|
| Min. Negotiated Rate |
$631.85 |
| Max. Negotiated Rate |
$4,066.40 |
| Rate for Payer: Aetna Commercial |
$2,323.77
|
| Rate for Payer: Aetna Medicare |
$1,803.53
|
| Rate for Payer: BCBS Complete |
$1,201.89
|
| Rate for Payer: BCBS MAPPO |
$1,734.16
|
| Rate for Payer: BCBS Trust/PPO |
$631.85
|
| Rate for Payer: BCN Commercial |
$2,887.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,734.16
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cash Price |
$5,004.80
|
| Rate for Payer: Cofinity Commercial |
$2,497.19
|
| Rate for Payer: Cofinity Commercial |
$2,323.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,734.16
|
| Rate for Payer: Mclaren Medicaid |
$1,144.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,820.87
|
| Rate for Payer: Meridian Medicaid |
$1,201.89
|
| Rate for Payer: Nomi Health Commercial |
$2,080.99
|
| Rate for Payer: PACE SWMI |
$1,734.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,734.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,144.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,066.40
|
| Rate for Payer: Priority Health HMO/PPO |
$3,065.95
|
| Rate for Payer: Priority Health Medicare |
$1,751.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,065.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,734.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,734.16
|
| Rate for Payer: UHC Exchange |
$1,734.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,734.16
|
| Rate for Payer: UHCCP Medicaid |
$1,144.66
|
|
|
PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
HCPCS 63066
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$1,394.25 |
| Rate for Payer: Aetna Commercial |
$272.73
|
| Rate for Payer: Aetna Medicare |
$211.67
|
| Rate for Payer: BCBS Complete |
$138.66
|
| Rate for Payer: BCBS MAPPO |
$203.53
|
| Rate for Payer: BCBS Trust/PPO |
$766.04
|
| Rate for Payer: BCN Commercial |
$330.92
|
| Rate for Payer: BCN Medicare Advantage |
$203.53
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cofinity Commercial |
$293.08
|
| Rate for Payer: Cofinity Commercial |
$272.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.53
|
| Rate for Payer: Mclaren Medicaid |
$132.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.71
|
| Rate for Payer: Meridian Medicaid |
$138.66
|
| Rate for Payer: Nomi Health Commercial |
$244.24
|
| Rate for Payer: PACE SWMI |
$203.53
|
| Rate for Payer: PHP Medicare Advantage |
$203.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.25
|
| Rate for Payer: Priority Health HMO/PPO |
$350.89
|
| Rate for Payer: Priority Health Medicare |
$205.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$350.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.53
|
| Rate for Payer: UHC Exchange |
$203.53
|
| Rate for Payer: UHC Medicare Advantage |
$203.53
|
| Rate for Payer: UHCCP Medicaid |
$132.06
|
|
