|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$2,195.61 |
| Rate for Payer: Aetna Commercial |
$174.23
|
| Rate for Payer: Aetna Medicare |
$135.22
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$130.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,195.61
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: BCN Medicare Advantage |
$130.02
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$187.23
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.52
|
| Rate for Payer: PACE SWMI |
$130.02
|
| Rate for Payer: PHP Medicare Advantage |
$130.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.10
|
| Rate for Payer: Priority Health Medicare |
$130.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.02
|
| Rate for Payer: UHC Medicare Advantage |
$133.92
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$1,273.00
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$391.47 |
| Max. Negotiated Rate |
$1,729.73 |
| Rate for Payer: Aetna Commercial |
$1,060.26
|
| Rate for Payer: Aetna Medicare |
$822.89
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS MAPPO |
$791.24
|
| Rate for Payer: BCBS Trust/PPO |
$391.47
|
| Rate for Payer: BCN Commercial |
$1,166.96
|
| Rate for Payer: BCN Medicare Advantage |
$791.24
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cash Price |
$1,018.40
|
| Rate for Payer: Cofinity Commercial |
$1,139.39
|
| Rate for Payer: Cofinity Commercial |
$1,060.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$791.24
|
| Rate for Payer: Mclaren Medicaid |
$515.03
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$830.80
|
| Rate for Payer: PACE SWMI |
$791.24
|
| Rate for Payer: PHP Medicare Advantage |
$791.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,729.73
|
| Rate for Payer: Priority Health Medicare |
$791.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,729.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$791.24
|
| Rate for Payer: UHC Medicare Advantage |
$814.98
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$117.10 |
| Max. Negotiated Rate |
$172.80 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: BCBS Trust/PPO |
$148.38
|
| Rate for Payer: BCN Commercial |
$148.38
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.20
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.96
|
| Rate for Payer: UHC Core |
$160.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$2,153.41 |
| Rate for Payer: Aetna Commercial |
$163.20
|
| Rate for Payer: Aetna Medicare |
$49.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.00
|
| Rate for Payer: BCBS Complete |
$2,153.41
|
| Rate for Payer: BCBS MAPPO |
$48.00
|
| Rate for Payer: BCBS Trust/PPO |
$149.28
|
| Rate for Payer: BCN Commercial |
$149.28
|
| Rate for Payer: BCN Medicare Advantage |
$48.00
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$165.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.00
|
| Rate for Payer: Healthscope Commercial |
$172.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.00
|
| Rate for Payer: Mclaren Medicaid |
$2,050.87
|
| Rate for Payer: Meridian Medicaid |
$2,153.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.20
|
| Rate for Payer: PACE Senior Care Partners |
$45.60
|
| Rate for Payer: PACE SWMI |
$48.00
|
| Rate for Payer: PHP Commercial |
$163.20
|
| Rate for Payer: PHP Medicare Advantage |
$48.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,050.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.04
|
| Rate for Payer: Priority Health Medicare |
$48.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.10
|
| Rate for Payer: Railroad Medicare Medicare |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.96
|
| Rate for Payer: UHC Core |
$160.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.44
|
| Rate for Payer: VA VA |
$48.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.00
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,808.90 |
| Rate for Payer: Aetna Commercial |
$138.98
|
| Rate for Payer: Aetna Medicare |
$107.87
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$103.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| Rate for Payer: BCN Medicare Advantage |
$103.72
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.72
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.91
|
| Rate for Payer: PACE SWMI |
$103.72
|
| Rate for Payer: PHP Medicare Advantage |
$103.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.66
|
| Rate for Payer: Priority Health Medicare |
$103.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.72
|
| Rate for Payer: UHC Medicare Advantage |
$106.83
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,808.90 |
| Rate for Payer: Aetna Commercial |
$138.98
|
| Rate for Payer: Aetna Medicare |
$107.87
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$103.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| Rate for Payer: BCN Medicare Advantage |
$103.72
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$149.36
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.72
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.91
|
| Rate for Payer: PACE SWMI |
$103.72
|
| Rate for Payer: PHP Medicare Advantage |
$103.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.66
|
| Rate for Payer: Priority Health Medicare |
$103.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.72
|
| Rate for Payer: UHC Medicare Advantage |
$106.83
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$1,229.20 |
| Rate for Payer: Aetna Commercial |
$479.09
|
| Rate for Payer: Aetna Medicare |
$371.83
|
| Rate for Payer: BCBS Complete |
$240.20
|
| Rate for Payer: BCBS MAPPO |
$357.53
|
| Rate for Payer: BCBS Trust/PPO |
$65.80
|
| Rate for Payer: BCN Commercial |
$575.20
|
| Rate for Payer: BCN Medicare Advantage |
$357.53
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cofinity Commercial |
$514.84
|
| Rate for Payer: Cofinity Commercial |
$479.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.53
|
| Rate for Payer: Mclaren Medicaid |
$228.76
|
| Rate for Payer: Meridian Medicaid |
$240.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$375.41
|
| Rate for Payer: PACE SWMI |
$357.53
|
| Rate for Payer: PHP Medicare Advantage |
$357.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,229.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$545.88
|
| Rate for Payer: Priority Health Medicare |
$357.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$545.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.53
|
| Rate for Payer: UHC Medicare Advantage |
$368.26
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$2,177.00 |
| Rate for Payer: Aetna Commercial |
$1,405.97
|
| Rate for Payer: Aetna Medicare |
$1,091.20
|
| Rate for Payer: BCBS Complete |
$718.37
|
| Rate for Payer: BCBS MAPPO |
$1,049.23
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$1,557.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,049.23
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cofinity Commercial |
$1,510.89
|
| Rate for Payer: Cofinity Commercial |
$1,405.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,049.23
|
| Rate for Payer: Mclaren Medicaid |
$684.16
|
| Rate for Payer: Meridian Medicaid |
$718.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,101.69
|
| Rate for Payer: PACE SWMI |
$1,049.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,049.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$684.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,627.95
|
| Rate for Payer: Priority Health Medicare |
$1,049.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,627.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,049.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,049.23
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.71
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$2,151.10 |
| Rate for Payer: Aetna Commercial |
$1,325.07
|
| Rate for Payer: Aetna Medicare |
$1,028.41
|
| Rate for Payer: BCBS Complete |
$677.88
|
| Rate for Payer: BCBS MAPPO |
$988.86
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| Rate for Payer: BCN Medicare Advantage |
$988.86
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cofinity Commercial |
$1,423.96
|
| Rate for Payer: Cofinity Commercial |
$1,325.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$988.86
|
| Rate for Payer: Mclaren Medicaid |
$645.60
|
| Rate for Payer: Meridian Medicaid |
$677.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,038.30
|
| Rate for Payer: PACE SWMI |
$988.86
|
| Rate for Payer: PHP Medicare Advantage |
$988.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,535.53
|
| Rate for Payer: Priority Health Medicare |
$988.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,535.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$988.86
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.53
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$22.57 |
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Medicare |
$16.30
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$15.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.90
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Medicare Advantage |
$15.67
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.46
|
| Rate for Payer: PACE SWMI |
$15.67
|
| Rate for Payer: PHP Medicare Advantage |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health Medicare |
$15.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.67
|
| Rate for Payer: UHC Medicare Advantage |
$16.14
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$29.04 |
| Rate for Payer: Aetna Commercial |
$27.03
|
| Rate for Payer: Aetna Medicare |
$20.97
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$20.17
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: BCN Medicare Advantage |
$20.17
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$29.04
|
| Rate for Payer: Cofinity Commercial |
$27.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$21.18
|
| Rate for Payer: PACE SWMI |
$20.17
|
| Rate for Payer: PHP Medicare Advantage |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$20.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.17
|
| Rate for Payer: UHC Medicare Advantage |
$20.77
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$680.45 |
| Rate for Payer: Aetna Commercial |
$138.68
|
| Rate for Payer: Aetna Medicare |
$107.63
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$103.49
|
| Rate for Payer: BCBS Trust/PPO |
$680.45
|
| Rate for Payer: BCN Commercial |
$155.89
|
| Rate for Payer: BCN Medicare Advantage |
$103.49
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$138.68
|
| Rate for Payer: Cofinity Commercial |
$149.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.66
|
| Rate for Payer: PACE SWMI |
$103.49
|
| Rate for Payer: PHP Medicare Advantage |
$103.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.37
|
| Rate for Payer: Priority Health Medicare |
$103.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.49
|
| Rate for Payer: UHC Medicare Advantage |
$106.59
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,098.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$316.45 |
| Max. Negotiated Rate |
$3,568.60 |
| Rate for Payer: Aetna Commercial |
$978.00
|
| Rate for Payer: Aetna Medicare |
$759.04
|
| Rate for Payer: BCBS Complete |
$499.63
|
| Rate for Payer: BCBS MAPPO |
$729.85
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| Rate for Payer: BCN Medicare Advantage |
$729.85
|
| Rate for Payer: Cash Price |
$4,078.40
|
| Rate for Payer: Cash Price |
$4,078.40
|
| Rate for Payer: Cofinity Commercial |
$978.00
|
| Rate for Payer: Cofinity Commercial |
$1,050.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.85
|
| Rate for Payer: Mclaren Medicaid |
$475.84
|
| Rate for Payer: Meridian Medicaid |
$499.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$766.34
|
| Rate for Payer: PACE SWMI |
$729.85
|
| Rate for Payer: PHP Medicare Advantage |
$729.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$475.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,568.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,192.03
|
| Rate for Payer: Priority Health Medicare |
$729.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,192.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.85
|
| Rate for Payer: UHC Medicare Advantage |
$751.75
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,309.68
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$1,029.92 |
| Rate for Payer: Aetna Commercial |
$843.77
|
| Rate for Payer: Aetna Medicare |
$654.87
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS MAPPO |
$629.68
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$629.68
|
| Rate for Payer: Cash Price |
$1,047.74
|
| Rate for Payer: Cash Price |
$1,047.74
|
| Rate for Payer: Cofinity Commercial |
$906.74
|
| Rate for Payer: Cofinity Commercial |
$843.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$629.68
|
| Rate for Payer: Mclaren Medicaid |
$411.52
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$661.16
|
| Rate for Payer: PACE SWMI |
$629.68
|
| Rate for Payer: PHP Medicare Advantage |
$629.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$916.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.92
|
| Rate for Payer: Priority Health Medicare |
$629.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,029.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$629.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$629.68
|
| Rate for Payer: UHC Medicare Advantage |
$648.57
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$217.66
|
| Rate for Payer: BCN Commercial |
$177.14
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Mclaren Medicaid |
$18.04
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.14
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$661.18 |
| Rate for Payer: Aetna Commercial |
$432.81
|
| Rate for Payer: Aetna Medicare |
$335.91
|
| Rate for Payer: BCBS Complete |
$222.98
|
| Rate for Payer: BCBS MAPPO |
$322.99
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: BCN Medicare Advantage |
$322.99
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$465.11
|
| Rate for Payer: Cofinity Commercial |
$432.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.99
|
| Rate for Payer: Mclaren Medicaid |
$212.36
|
| Rate for Payer: Meridian Medicaid |
$222.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$339.14
|
| Rate for Payer: PACE SWMI |
$322.99
|
| Rate for Payer: PHP Medicare Advantage |
$322.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.05
|
| Rate for Payer: Priority Health Medicare |
$322.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.99
|
| Rate for Payer: UHC Medicare Advantage |
$332.68
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 22522
|
| Min. Negotiated Rate |
$282.00 |
| Max. Negotiated Rate |
$493.50 |
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.50
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX
|
Professional
|
Both
|
$5,631.00
|
|
|
Service Code
|
HCPCS 22521
|
| Min. Negotiated Rate |
$2,252.40 |
| Max. Negotiated Rate |
$3,941.70 |
| Rate for Payer: BCBS Complete |
$2,252.40
|
| Rate for Payer: Cash Price |
$4,504.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,941.70
|
|
|
PR PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX
|
Professional
|
Both
|
$7,687.00
|
|
|
Service Code
|
HCPCS 22520
|
| Min. Negotiated Rate |
$3,074.80 |
| Max. Negotiated Rate |
$5,380.90 |
| Rate for Payer: BCBS Complete |
$3,074.80
|
| Rate for Payer: Cash Price |
$6,149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,380.90
|
|
|
PR PERCUT DILATN RENAL TRACT
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 50395
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$238.00 |
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
|
|
PR PERCUT INSERT KIDNEY CATH/DRAIN
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 50392
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$250.60 |
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.60
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, EA ADD
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 22525
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: BCBS Complete |
$198.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$346.50
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, LUMBAR
|
Professional
|
Both
|
$1,054.00
|
|
|
Service Code
|
HCPCS 22524
|
| Min. Negotiated Rate |
$421.60 |
| Max. Negotiated Rate |
$737.80 |
| Rate for Payer: BCBS Complete |
$421.60
|
| Rate for Payer: Cash Price |
$843.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.80
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, THOR
|
Professional
|
Both
|
$1,119.00
|
|
|
Service Code
|
HCPCS 22523
|
| Min. Negotiated Rate |
$447.60 |
| Max. Negotiated Rate |
$783.30 |
| Rate for Payer: BCBS Complete |
$447.60
|
| Rate for Payer: Cash Price |
$895.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.30
|
|
|
PR PEREYRA PX W/ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 57289
|
| Min. Negotiated Rate |
$510.56 |
| Max. Negotiated Rate |
$2,673.73 |
| Rate for Payer: Aetna Commercial |
$1,054.49
|
| Rate for Payer: Aetna Medicare |
$818.41
|
| Rate for Payer: BCBS Complete |
$536.09
|
| Rate for Payer: BCBS MAPPO |
$786.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,673.73
|
| Rate for Payer: BCN Commercial |
$1,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$786.93
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.18
|
| Rate for Payer: Cofinity Commercial |
$1,054.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$786.93
|
| Rate for Payer: Mclaren Medicaid |
$510.56
|
| Rate for Payer: Meridian Medicaid |
$536.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$826.28
|
| Rate for Payer: PACE SWMI |
$786.93
|
| Rate for Payer: PHP Medicare Advantage |
$786.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$510.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,129.59
|
| Rate for Payer: Priority Health Medicare |
$786.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,129.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$786.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$786.93
|
| Rate for Payer: UHC Medicare Advantage |
$810.54
|
|
