|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$217.47 |
| Max. Negotiated Rate |
$2,659.46 |
| Rate for Payer: Aetna Commercial |
$437.51
|
| Rate for Payer: Aetna Medicare |
$339.56
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$326.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.46
|
| Rate for Payer: BCN Commercial |
$490.63
|
| Rate for Payer: BCN Medicare Advantage |
$326.50
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$470.16
|
| Rate for Payer: Cofinity Commercial |
$437.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.50
|
| Rate for Payer: Mclaren Medicaid |
$217.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.82
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: Nomi Health Commercial |
$391.80
|
| Rate for Payer: PACE SWMI |
$326.50
|
| Rate for Payer: PHP Medicare Advantage |
$326.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health HMO/PPO |
$539.52
|
| Rate for Payer: Priority Health Medicare |
$329.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.50
|
| Rate for Payer: UHC Exchange |
$326.50
|
| Rate for Payer: UHC Medicare Advantage |
$326.50
|
| Rate for Payer: UHCCP Medicaid |
$217.47
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$2,160.75 |
| Rate for Payer: Aetna Commercial |
$360.38
|
| Rate for Payer: Aetna Medicare |
$279.70
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS MAPPO |
$268.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.75
|
| Rate for Payer: BCN Commercial |
$405.60
|
| Rate for Payer: BCN Medicare Advantage |
$268.94
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cofinity Commercial |
$387.27
|
| Rate for Payer: Cofinity Commercial |
$360.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.94
|
| Rate for Payer: Mclaren Medicaid |
$179.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.39
|
| Rate for Payer: Meridian Medicaid |
$188.32
|
| Rate for Payer: Nomi Health Commercial |
$322.73
|
| Rate for Payer: PACE SWMI |
$268.94
|
| Rate for Payer: PHP Medicare Advantage |
$268.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.05
|
| Rate for Payer: Priority Health HMO/PPO |
$446.32
|
| Rate for Payer: Priority Health Medicare |
$271.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.94
|
| Rate for Payer: UHC Exchange |
$268.94
|
| Rate for Payer: UHC Medicare Advantage |
$268.94
|
| Rate for Payer: UHCCP Medicaid |
$179.35
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$195.32 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: Aetna Commercial |
$392.73
|
| Rate for Payer: Aetna Medicare |
$304.80
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS MAPPO |
$293.08
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$440.30
|
| Rate for Payer: BCN Medicare Advantage |
$293.08
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$422.04
|
| Rate for Payer: Cofinity Commercial |
$392.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.08
|
| Rate for Payer: Mclaren Medicaid |
$195.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.73
|
| Rate for Payer: Meridian Medicaid |
$205.09
|
| Rate for Payer: Nomi Health Commercial |
$351.70
|
| Rate for Payer: PACE SWMI |
$293.08
|
| Rate for Payer: PHP Medicare Advantage |
$293.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health HMO/PPO |
$485.73
|
| Rate for Payer: Priority Health Medicare |
$296.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$485.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.08
|
| Rate for Payer: UHC Exchange |
$293.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.08
|
| Rate for Payer: UHCCP Medicaid |
$195.32
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$247.08 |
| Max. Negotiated Rate |
$7,607.52 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$7,607.52
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$370.96
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.96
|
| Rate for Payer: Mclaren Medicaid |
$247.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Meridian Medicaid |
$259.43
|
| Rate for Payer: Nomi Health Commercial |
$445.15
|
| Rate for Payer: PACE SWMI |
$370.96
|
| Rate for Payer: PHP Medicare Advantage |
$370.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health HMO/PPO |
$614.62
|
| Rate for Payer: Priority Health Medicare |
$374.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Exchange |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
| Rate for Payer: UHCCP Medicaid |
$247.08
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$223.86 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$450.36
|
| Rate for Payer: Aetna Medicare |
$349.53
|
| Rate for Payer: BCBS Complete |
$235.05
|
| Rate for Payer: BCBS MAPPO |
$336.09
|
| Rate for Payer: BCBS Trust/PPO |
$677.97
|
| Rate for Payer: BCN Commercial |
$504.80
|
| Rate for Payer: BCN Medicare Advantage |
$336.09
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$483.97
|
| Rate for Payer: Cofinity Commercial |
$450.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.09
|
| Rate for Payer: Mclaren Medicaid |
$223.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.89
|
| Rate for Payer: Meridian Medicaid |
$235.05
|
| Rate for Payer: Nomi Health Commercial |
$403.31
|
| Rate for Payer: PACE SWMI |
$336.09
|
| Rate for Payer: PHP Medicare Advantage |
$336.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health HMO/PPO |
$555.50
|
| Rate for Payer: Priority Health Medicare |
$339.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$555.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.09
|
| Rate for Payer: UHC Exchange |
$336.09
|
| Rate for Payer: UHC Medicare Advantage |
$336.09
|
| Rate for Payer: UHCCP Medicaid |
$223.86
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$191.49 |
| Max. Negotiated Rate |
$475.62 |
| Rate for Payer: Aetna Commercial |
$385.22
|
| Rate for Payer: Aetna Medicare |
$298.98
|
| Rate for Payer: BCBS Complete |
$201.06
|
| Rate for Payer: BCBS MAPPO |
$287.48
|
| Rate for Payer: BCBS Trust/PPO |
$393.43
|
| Rate for Payer: BCN Commercial |
$431.01
|
| Rate for Payer: BCN Medicare Advantage |
$287.48
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$413.97
|
| Rate for Payer: Cofinity Commercial |
$385.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.48
|
| Rate for Payer: Mclaren Medicaid |
$191.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.85
|
| Rate for Payer: Meridian Medicaid |
$201.06
|
| Rate for Payer: Nomi Health Commercial |
$344.98
|
| Rate for Payer: PACE SWMI |
$287.48
|
| Rate for Payer: PHP Medicare Advantage |
$287.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO |
$475.62
|
| Rate for Payer: Priority Health Medicare |
$290.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$475.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.48
|
| Rate for Payer: UHC Exchange |
$287.48
|
| Rate for Payer: UHC Medicare Advantage |
$287.48
|
| Rate for Payer: UHCCP Medicaid |
$191.49
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$281.37 |
| Max. Negotiated Rate |
$2,753.98 |
| Rate for Payer: Aetna Commercial |
$566.42
|
| Rate for Payer: Aetna Medicare |
$439.61
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS MAPPO |
$422.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.98
|
| Rate for Payer: BCN Commercial |
$635.28
|
| Rate for Payer: BCN Medicare Advantage |
$422.70
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$608.69
|
| Rate for Payer: Cofinity Commercial |
$566.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.70
|
| Rate for Payer: Mclaren Medicaid |
$281.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.84
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| Rate for Payer: Nomi Health Commercial |
$507.24
|
| Rate for Payer: PACE SWMI |
$422.70
|
| Rate for Payer: PHP Medicare Advantage |
$422.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO |
$699.84
|
| Rate for Payer: Priority Health Medicare |
$426.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$699.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.70
|
| Rate for Payer: UHC Exchange |
$422.70
|
| Rate for Payer: UHC Medicare Advantage |
$422.70
|
| Rate for Payer: UHCCP Medicaid |
$281.37
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$3,736.67 |
| Rate for Payer: Aetna Commercial |
$469.23
|
| Rate for Payer: Aetna Medicare |
$364.18
|
| Rate for Payer: BCBS Complete |
$244.90
|
| Rate for Payer: BCBS MAPPO |
$350.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,736.67
|
| Rate for Payer: BCN Commercial |
$525.33
|
| Rate for Payer: BCN Medicare Advantage |
$350.17
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cofinity Commercial |
$504.24
|
| Rate for Payer: Cofinity Commercial |
$469.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.17
|
| Rate for Payer: Mclaren Medicaid |
$233.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.68
|
| Rate for Payer: Meridian Medicaid |
$244.90
|
| Rate for Payer: Nomi Health Commercial |
$420.20
|
| Rate for Payer: PACE SWMI |
$350.17
|
| Rate for Payer: PHP Medicare Advantage |
$350.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.35
|
| Rate for Payer: Priority Health HMO/PPO |
$580.00
|
| Rate for Payer: Priority Health Medicare |
$353.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$580.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.17
|
| Rate for Payer: UHC Exchange |
$350.17
|
| Rate for Payer: UHC Medicare Advantage |
$350.17
|
| Rate for Payer: UHCCP Medicaid |
$233.24
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,127.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$248.78 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$500.54
|
| Rate for Payer: Aetna Medicare |
$388.48
|
| Rate for Payer: BCBS Complete |
$261.22
|
| Rate for Payer: BCBS MAPPO |
$373.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: BCN Commercial |
$561.49
|
| Rate for Payer: BCN Medicare Advantage |
$373.54
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cofinity Commercial |
$537.90
|
| Rate for Payer: Cofinity Commercial |
$500.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.54
|
| Rate for Payer: Mclaren Medicaid |
$248.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.22
|
| Rate for Payer: Meridian Medicaid |
$261.22
|
| Rate for Payer: Nomi Health Commercial |
$448.25
|
| Rate for Payer: PACE SWMI |
$373.54
|
| Rate for Payer: PHP Medicare Advantage |
$373.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.55
|
| Rate for Payer: Priority Health HMO/PPO |
$618.88
|
| Rate for Payer: Priority Health Medicare |
$377.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$618.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$373.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.54
|
| Rate for Payer: UHC Exchange |
$373.54
|
| Rate for Payer: UHC Medicare Advantage |
$373.54
|
| Rate for Payer: UHCCP Medicaid |
$248.78
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,411.96 |
| Rate for Payer: Aetna Commercial |
$997.00
|
| Rate for Payer: Aetna Medicare |
$773.79
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS MAPPO |
$744.03
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$1,172.83
|
| Rate for Payer: BCN Medicare Advantage |
$744.03
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$997.00
|
| Rate for Payer: Cofinity Commercial |
$1,071.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.03
|
| Rate for Payer: Mclaren Medicaid |
$512.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.23
|
| Rate for Payer: Meridian Medicaid |
$537.65
|
| Rate for Payer: Nomi Health Commercial |
$892.84
|
| Rate for Payer: PACE SWMI |
$744.03
|
| Rate for Payer: PHP Medicare Advantage |
$744.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO |
$1,411.96
|
| Rate for Payer: Priority Health Medicare |
$751.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,411.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.03
|
| Rate for Payer: UHC Exchange |
$744.03
|
| Rate for Payer: UHC Medicare Advantage |
$744.03
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO |
$133.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$133.50
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$67.93 |
| Rate for Payer: Aetna Commercial |
$34.36
|
| Rate for Payer: Aetna Medicare |
$26.67
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$25.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$36.92
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.64
|
| Rate for Payer: Mclaren Medicaid |
$17.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.92
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Nomi Health Commercial |
$30.77
|
| Rate for Payer: PACE SWMI |
$25.64
|
| Rate for Payer: PHP Medicare Advantage |
$25.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health HMO/PPO |
$37.03
|
| Rate for Payer: Priority Health Medicare |
$25.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.64
|
| Rate for Payer: UHC Exchange |
$25.64
|
| Rate for Payer: UHC Medicare Advantage |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$14.64
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$32.20
|
| Rate for Payer: BCN Medicare Advantage |
$14.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.08
|
| Rate for Payer: Mclaren Medicaid |
$9.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.78
|
| Rate for Payer: Meridian Medicaid |
$9.84
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: PACE SWMI |
$14.08
|
| Rate for Payer: PHP Medicare Advantage |
$14.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.87
|
| Rate for Payer: Priority Health Medicare |
$14.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.08
|
| Rate for Payer: UHC Exchange |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$14.08
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$955.37 |
| Rate for Payer: Aetna Commercial |
$533.78
|
| Rate for Payer: Aetna Medicare |
$414.27
|
| Rate for Payer: BCBS Complete |
$278.89
|
| Rate for Payer: BCBS MAPPO |
$398.34
|
| Rate for Payer: BCBS Trust/PPO |
$25.40
|
| Rate for Payer: BCN Commercial |
$955.37
|
| Rate for Payer: BCN Medicare Advantage |
$398.34
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$573.61
|
| Rate for Payer: Cofinity Commercial |
$533.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.34
|
| Rate for Payer: Mclaren Medicaid |
$265.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.26
|
| Rate for Payer: Meridian Medicaid |
$278.89
|
| Rate for Payer: Nomi Health Commercial |
$478.01
|
| Rate for Payer: PACE SWMI |
$398.34
|
| Rate for Payer: PHP Medicare Advantage |
$398.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO |
$559.89
|
| Rate for Payer: Priority Health Medicare |
$402.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$559.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.34
|
| Rate for Payer: UHC Exchange |
$398.34
|
| Rate for Payer: UHC Medicare Advantage |
$398.34
|
| Rate for Payer: UHCCP Medicaid |
$265.61
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$360.18 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$732.78
|
| Rate for Payer: Aetna Medicare |
$568.72
|
| Rate for Payer: BCBS Complete |
$378.19
|
| Rate for Payer: BCBS MAPPO |
$546.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: BCN Medicare Advantage |
$546.85
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$787.46
|
| Rate for Payer: Cofinity Commercial |
$732.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.85
|
| Rate for Payer: Mclaren Medicaid |
$360.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.19
|
| Rate for Payer: Meridian Medicaid |
$378.19
|
| Rate for Payer: Nomi Health Commercial |
$656.22
|
| Rate for Payer: PACE SWMI |
$546.85
|
| Rate for Payer: PHP Medicare Advantage |
$546.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$360.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health HMO/PPO |
$760.35
|
| Rate for Payer: Priority Health Medicare |
$552.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$760.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.85
|
| Rate for Payer: UHC Exchange |
$546.85
|
| Rate for Payer: UHC Medicare Advantage |
$546.85
|
| Rate for Payer: UHCCP Medicaid |
$360.18
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Mclaren Medicaid |
$490.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,036.23
|
| Rate for Payer: Priority Health Medicare |
$755.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Exchange |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$490.33 |
| Max. Negotiated Rate |
$2,189.70 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: BCBS Complete |
$514.85
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,189.70
|
| Rate for Payer: BCN Commercial |
$1,118.58
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Mclaren Medicaid |
$490.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Meridian Medicaid |
$514.85
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,036.23
|
| Rate for Payer: Priority Health Medicare |
$755.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,036.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Exchange |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UHCCP Medicaid |
$490.33
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$337.96 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna Medicare |
$369.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$444.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$444.69
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$355.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.85
|
| Rate for Payer: BCN Commercial |
$1,106.38
|
| Rate for Payer: BCN Medicare Advantage |
$355.75
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.75
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$409.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: PACE Senior Care Partners |
$337.96
|
| Rate for Payer: PACE SWMI |
$355.75
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: PHP Medicare Advantage |
$355.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,238.01
|
| Rate for Payer: Priority Health Medicare |
$359.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$953.41
|
| Rate for Payer: Railroad Medicare Medicare |
$355.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.24
|
| Rate for Payer: UHC Core |
$1,188.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.75
|
| Rate for Payer: UHC Exchange |
$355.75
|
| Rate for Payer: UHC Medicare Advantage |
$355.75
|
| Rate for Payer: VA VA |
$355.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$924.95 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,161.59
|
| Rate for Payer: BCN Commercial |
$1,099.69
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: Nomi Health Commercial |
$1,166.86
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,238.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$953.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,252.24
|
| Rate for Payer: UHC Core |
$1,188.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$2,187.45 |
| Rate for Payer: Aetna Commercial |
$907.61
|
| Rate for Payer: Aetna Medicare |
$704.41
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$677.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,187.45
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$677.32
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$907.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.32
|
| Rate for Payer: Mclaren Medicaid |
$445.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.19
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Nomi Health Commercial |
$812.78
|
| Rate for Payer: PACE SWMI |
$677.32
|
| Rate for Payer: PHP Medicare Advantage |
$677.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health HMO/PPO |
$937.35
|
| Rate for Payer: Priority Health Medicare |
$684.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$937.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$677.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.32
|
| Rate for Payer: UHC Exchange |
$677.32
|
| Rate for Payer: UHC Medicare Advantage |
$677.32
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$664.60 |
| Rate for Payer: Aetna Commercial |
$353.49
|
| Rate for Payer: Aetna Medicare |
$274.35
|
| Rate for Payer: BCBS Complete |
$186.30
|
| Rate for Payer: BCBS MAPPO |
$263.80
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: BCN Medicare Advantage |
$263.80
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$379.87
|
| Rate for Payer: Cofinity Commercial |
$353.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.80
|
| Rate for Payer: Mclaren Medicaid |
$177.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.99
|
| Rate for Payer: Meridian Medicaid |
$186.30
|
| Rate for Payer: Nomi Health Commercial |
$316.56
|
| Rate for Payer: PACE SWMI |
$263.80
|
| Rate for Payer: PHP Medicare Advantage |
$263.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$177.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health HMO/PPO |
$372.95
|
| Rate for Payer: Priority Health Medicare |
$266.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$372.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.80
|
| Rate for Payer: UHC Exchange |
$263.80
|
| Rate for Payer: UHC Medicare Advantage |
$263.80
|
| Rate for Payer: UHCCP Medicaid |
$177.43
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$729.59 |
| Rate for Payer: Aetna Commercial |
$384.27
|
| Rate for Payer: Aetna Medicare |
$298.24
|
| Rate for Payer: BCBS Complete |
$200.61
|
| Rate for Payer: BCBS MAPPO |
$286.77
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$729.59
|
| Rate for Payer: BCN Medicare Advantage |
$286.77
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$412.95
|
| Rate for Payer: Cofinity Commercial |
$384.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.77
|
| Rate for Payer: Mclaren Medicaid |
$191.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.11
|
| Rate for Payer: Meridian Medicaid |
$200.61
|
| Rate for Payer: Nomi Health Commercial |
$344.12
|
| Rate for Payer: PACE SWMI |
$286.77
|
| Rate for Payer: PHP Medicare Advantage |
$286.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health HMO/PPO |
$400.94
|
| Rate for Payer: Priority Health Medicare |
$289.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$400.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.77
|
| Rate for Payer: UHC Exchange |
$286.77
|
| Rate for Payer: UHC Medicare Advantage |
$286.77
|
| Rate for Payer: UHCCP Medicaid |
$191.06
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$652.85 |
| Max. Negotiated Rate |
$4,478.93 |
| Rate for Payer: Aetna Commercial |
$1,302.31
|
| Rate for Payer: Aetna Medicare |
$1,010.74
|
| Rate for Payer: BCBS Complete |
$685.49
|
| Rate for Payer: BCBS MAPPO |
$971.87
|
| Rate for Payer: BCBS Trust/PPO |
$4,478.93
|
| Rate for Payer: BCN Commercial |
$1,477.76
|
| Rate for Payer: BCN Medicare Advantage |
$971.87
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,399.49
|
| Rate for Payer: Cofinity Commercial |
$1,302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$971.87
|
| Rate for Payer: Mclaren Medicaid |
$652.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,020.46
|
| Rate for Payer: Meridian Medicaid |
$685.49
|
| Rate for Payer: Nomi Health Commercial |
$1,166.24
|
| Rate for Payer: PACE SWMI |
$971.87
|
| Rate for Payer: PHP Medicare Advantage |
$971.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,547.96
|
| Rate for Payer: Priority Health Medicare |
$981.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,547.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$971.87
|
| Rate for Payer: UHC Exchange |
$971.87
|
| Rate for Payer: UHC Medicare Advantage |
$971.87
|
| Rate for Payer: UHCCP Medicaid |
$652.85
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$431.54 |
| Max. Negotiated Rate |
$1,135.85 |
| Rate for Payer: Aetna Commercial |
$853.62
|
| Rate for Payer: Aetna Medicare |
$662.51
|
| Rate for Payer: BCBS Complete |
$453.12
|
| Rate for Payer: BCBS MAPPO |
$637.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,135.85
|
| Rate for Payer: BCN Commercial |
$970.03
|
| Rate for Payer: BCN Medicare Advantage |
$637.03
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$917.32
|
| Rate for Payer: Cofinity Commercial |
$853.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.03
|
| Rate for Payer: Mclaren Medicaid |
$431.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.88
|
| Rate for Payer: Meridian Medicaid |
$453.12
|
| Rate for Payer: Nomi Health Commercial |
$764.44
|
| Rate for Payer: PACE SWMI |
$637.03
|
| Rate for Payer: PHP Medicare Advantage |
$637.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,020.26
|
| Rate for Payer: Priority Health Medicare |
$643.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,020.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.03
|
| Rate for Payer: UHC Exchange |
$637.03
|
| Rate for Payer: UHC Medicare Advantage |
$637.03
|
| Rate for Payer: UHCCP Medicaid |
$431.54
|
|
|
PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT
|
Professional
|
Both
|
$2,181.00
|
|
|
Service Code
|
HCPCS 25025
|
| Min. Negotiated Rate |
$795.34 |
| Max. Negotiated Rate |
$1,884.82 |
| Rate for Payer: Aetna Commercial |
$1,585.21
|
| Rate for Payer: Aetna Medicare |
$1,230.31
|
| Rate for Payer: BCBS Complete |
$835.11
|
| Rate for Payer: BCBS MAPPO |
$1,182.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,086.18
|
| Rate for Payer: BCN Commercial |
$1,796.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.99
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cash Price |
$1,744.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.51
|
| Rate for Payer: Cofinity Commercial |
$1,585.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.99
|
| Rate for Payer: Mclaren Medicaid |
$795.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,242.14
|
| Rate for Payer: Meridian Medicaid |
$835.11
|
| Rate for Payer: Nomi Health Commercial |
$1,419.59
|
| Rate for Payer: PACE SWMI |
$1,182.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$795.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,417.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,884.82
|
| Rate for Payer: Priority Health Medicare |
$1,194.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,884.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,182.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.99
|
| Rate for Payer: UHC Exchange |
$1,182.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.99
|
| Rate for Payer: UHCCP Medicaid |
$795.34
|
|
