|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$782.41 |
| Max. Negotiated Rate |
$2,150.18 |
| Rate for Payer: Aetna Commercial |
$1,906.97
|
| Rate for Payer: Aetna Medicare |
$1,480.03
|
| Rate for Payer: BCBS Complete |
$979.59
|
| Rate for Payer: BCBS MAPPO |
$1,423.11
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: BCN Commercial |
$2,150.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,423.11
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$2,049.28
|
| Rate for Payer: Cofinity Commercial |
$1,906.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,423.11
|
| Rate for Payer: Mclaren Medicaid |
$932.94
|
| Rate for Payer: Meridian Medicaid |
$979.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,494.27
|
| Rate for Payer: PACE SWMI |
$1,423.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,423.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$932.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,691.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,037.40
|
| Rate for Payer: Priority Health Medicare |
$1,423.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,037.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,423.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,423.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.80
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$1,990.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$859.24 |
| Max. Negotiated Rate |
$1,983.05 |
| Rate for Payer: Aetna Commercial |
$1,747.29
|
| Rate for Payer: Aetna Medicare |
$1,356.11
|
| Rate for Payer: BCBS Complete |
$902.20
|
| Rate for Payer: BCBS MAPPO |
$1,303.95
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: BCN Commercial |
$1,983.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.95
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Cash Price |
$1,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,877.69
|
| Rate for Payer: Cofinity Commercial |
$1,747.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.95
|
| Rate for Payer: Mclaren Medicaid |
$859.24
|
| Rate for Payer: Meridian Medicaid |
$902.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,369.15
|
| Rate for Payer: PACE SWMI |
$1,303.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$859.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,393.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,879.03
|
| Rate for Payer: Priority Health Medicare |
$1,303.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,879.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,303.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.95
|
| Rate for Payer: UHC Medicare Advantage |
$1,343.07
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,431.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$858.49 |
| Max. Negotiated Rate |
$2,584.13 |
| Rate for Payer: Aetna Commercial |
$2,293.56
|
| Rate for Payer: Aetna Medicare |
$1,780.07
|
| Rate for Payer: BCBS Complete |
$1,176.85
|
| Rate for Payer: BCBS MAPPO |
$1,711.61
|
| Rate for Payer: BCBS Trust/PPO |
$858.49
|
| Rate for Payer: BCN Commercial |
$2,584.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,711.61
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Cash Price |
$2,744.80
|
| Rate for Payer: Cofinity Commercial |
$2,464.72
|
| Rate for Payer: Cofinity Commercial |
$2,293.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,711.61
|
| Rate for Payer: Mclaren Medicaid |
$1,120.81
|
| Rate for Payer: Meridian Medicaid |
$1,176.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,797.19
|
| Rate for Payer: PACE SWMI |
$1,711.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,711.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,401.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,448.59
|
| Rate for Payer: Priority Health Medicare |
$1,711.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,448.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,711.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,711.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,762.96
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$531.44 |
| Max. Negotiated Rate |
$1,222.67 |
| Rate for Payer: Aetna Commercial |
$1,090.73
|
| Rate for Payer: Aetna Medicare |
$846.54
|
| Rate for Payer: BCBS Complete |
$558.01
|
| Rate for Payer: BCBS MAPPO |
$813.98
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: BCN Commercial |
$1,222.67
|
| Rate for Payer: BCN Medicare Advantage |
$813.98
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$1,172.13
|
| Rate for Payer: Cofinity Commercial |
$1,090.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.98
|
| Rate for Payer: Mclaren Medicaid |
$531.44
|
| Rate for Payer: Meridian Medicaid |
$558.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$854.68
|
| Rate for Payer: PACE SWMI |
$813.98
|
| Rate for Payer: PHP Medicare Advantage |
$813.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$531.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$940.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,158.54
|
| Rate for Payer: Priority Health Medicare |
$813.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,158.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$813.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$813.98
|
| Rate for Payer: UHC Medicare Advantage |
$838.40
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,024.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$2,116.80 |
| Rate for Payer: Aetna Commercial |
$1,847.15
|
| Rate for Payer: Aetna Commercial |
$1,847.15
|
| Rate for Payer: Aetna Medicare |
$1,433.61
|
| Rate for Payer: Aetna Medicare |
$1,433.61
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS Complete |
$952.75
|
| Rate for Payer: BCBS MAPPO |
$1,378.47
|
| Rate for Payer: BCBS MAPPO |
$1,378.47
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,378.47
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$1,985.00
|
| Rate for Payer: Cofinity Commercial |
$1,847.15
|
| Rate for Payer: Cofinity Commercial |
$1,985.00
|
| Rate for Payer: Cofinity Commercial |
$1,847.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,378.47
|
| Rate for Payer: Mclaren Medicaid |
$907.38
|
| Rate for Payer: Mclaren Medicaid |
$907.38
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Medicaid |
$952.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,447.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,447.39
|
| Rate for Payer: PACE SWMI |
$1,378.47
|
| Rate for Payer: PACE SWMI |
$1,378.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,378.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,116.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health Medicare |
$1,378.47
|
| Rate for Payer: Priority Health Medicare |
$1,378.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,983.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,983.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,378.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,378.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,378.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.82
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,500.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$788.95 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,600.75
|
| Rate for Payer: Aetna Medicare |
$1,242.37
|
| Rate for Payer: BCBS Complete |
$828.40
|
| Rate for Payer: BCBS MAPPO |
$1,194.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.35
|
| Rate for Payer: BCN Commercial |
$1,821.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,194.59
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,720.21
|
| Rate for Payer: Cofinity Commercial |
$1,600.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,194.59
|
| Rate for Payer: Mclaren Medicaid |
$788.95
|
| Rate for Payer: Meridian Medicaid |
$828.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,254.32
|
| Rate for Payer: PACE SWMI |
$1,194.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,194.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,726.23
|
| Rate for Payer: Priority Health Medicare |
$1,194.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,726.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,194.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,194.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,230.43
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$117.84 |
| Rate for Payer: Aetna Commercial |
$109.65
|
| Rate for Payer: Aetna Medicare |
$85.10
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$81.83
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: BCN Commercial |
$60.97
|
| Rate for Payer: BCN Medicare Advantage |
$81.83
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$109.65
|
| Rate for Payer: Cofinity Commercial |
$117.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.92
|
| Rate for Payer: PACE SWMI |
$81.83
|
| Rate for Payer: PHP Medicare Advantage |
$81.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$81.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.83
|
| Rate for Payer: UHC Medicare Advantage |
$84.29
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Aetna Commercial |
$8.95
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$8.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Mclaren Medicaid |
$4.26
|
| Rate for Payer: Meridian Medicaid |
$4.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.01
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.46
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.88
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$1,926.71 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.71
|
| Rate for Payer: BCN Commercial |
$8.80
|
| Rate for Payer: BCN Medicare Advantage |
$5.61
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.89
|
| Rate for Payer: PACE SWMI |
$5.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.51
|
| Rate for Payer: Priority Health Medicare |
$5.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$2,312.90 |
| Rate for Payer: Aetna Commercial |
$16.48
|
| Rate for Payer: Aetna Medicare |
$12.79
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$12.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.90
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.30
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$17.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.92
|
| Rate for Payer: PACE SWMI |
$12.30
|
| Rate for Payer: PHP Medicare Advantage |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.97
|
| Rate for Payer: Priority Health Medicare |
$12.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.30
|
| Rate for Payer: UHC Medicare Advantage |
$12.67
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,920.00 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,800.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$3,360.00 |
| Rate for Payer: Aetna Commercial |
$2,885.67
|
| Rate for Payer: BCBS Complete |
$1,920.00
|
| Rate for Payer: BCBS Trust/PPO |
$129.77
|
| Rate for Payer: BCN Commercial |
$3,009.06
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Cash Price |
$3,840.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,360.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,276.80
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$174.80 |
| Max. Negotiated Rate |
$1,711.69 |
| Rate for Payer: Aetna Commercial |
$1,089.06
|
| Rate for Payer: Aetna Medicare |
$845.24
|
| Rate for Payer: BCBS Complete |
$174.80
|
| Rate for Payer: BCBS MAPPO |
$812.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.69
|
| Rate for Payer: BCN Commercial |
$1,270.56
|
| Rate for Payer: BCN Medicare Advantage |
$812.73
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cash Price |
$349.60
|
| Rate for Payer: Cofinity Commercial |
$1,089.06
|
| Rate for Payer: Cofinity Commercial |
$1,170.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$812.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$853.37
|
| Rate for Payer: PACE SWMI |
$812.73
|
| Rate for Payer: PHP Medicare Advantage |
$812.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,229.46
|
| Rate for Payer: Priority Health Medicare |
$812.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,229.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$812.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$812.73
|
| Rate for Payer: UHC Medicare Advantage |
$837.11
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$1,973.73 |
| Rate for Payer: Aetna Commercial |
$194.15
|
| Rate for Payer: Aetna Medicare |
$150.69
|
| Rate for Payer: BCBS Complete |
$95.50
|
| Rate for Payer: BCBS MAPPO |
$144.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.73
|
| Rate for Payer: BCN Commercial |
$208.66
|
| Rate for Payer: BCN Medicare Advantage |
$144.89
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$208.64
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.89
|
| Rate for Payer: Mclaren Medicaid |
$90.95
|
| Rate for Payer: Meridian Medicaid |
$95.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.13
|
| Rate for Payer: PACE SWMI |
$144.89
|
| Rate for Payer: PHP Medicare Advantage |
$144.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.15
|
| Rate for Payer: Priority Health Medicare |
$144.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.89
|
| Rate for Payer: UHC Medicare Advantage |
$149.24
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$2.48
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$3.44
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: PACE SWMI |
$2.39
|
| Rate for Payer: PHP Medicare Advantage |
$2.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.39
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$612.75 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: Aetna Commercial |
$2,193.00
|
| Rate for Payer: Aetna Medicare |
$670.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$806.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$806.25
|
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: BCBS MAPPO |
$645.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.95
|
| Rate for Payer: BCN Commercial |
$2,005.95
|
| Rate for Payer: BCN Medicare Advantage |
$645.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$2,218.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$645.00
|
| Rate for Payer: Healthscope Commercial |
$2,322.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.00
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$677.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$741.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: PACE Senior Care Partners |
$612.75
|
| Rate for Payer: PACE SWMI |
$645.00
|
| Rate for Payer: PHP Commercial |
$2,193.00
|
| Rate for Payer: PHP Medicare Advantage |
$645.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,244.60
|
| Rate for Payer: Priority Health Medicare |
$645.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,573.54
|
| Rate for Payer: Railroad Medicare Medicare |
$645.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,270.40
|
| Rate for Payer: UHC Core |
$2,154.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$645.00
|
| Rate for Payer: UHC Medicare Advantage |
$664.35
|
| Rate for Payer: VA VA |
$645.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.00
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,024.58
|
| Rate for Payer: Aetna Medicare |
$795.19
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS MAPPO |
$764.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$764.61
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,024.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.61
|
| Rate for Payer: Mclaren Medicaid |
$500.76
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.84
|
| Rate for Payer: PACE SWMI |
$764.61
|
| Rate for Payer: PHP Medicare Advantage |
$764.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Medicare |
$764.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,191.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.61
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,580.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,806.00 |
| Rate for Payer: Aetna Commercial |
$1,024.58
|
| Rate for Payer: Aetna Medicare |
$795.19
|
| Rate for Payer: BCBS Complete |
$525.80
|
| Rate for Payer: BCBS MAPPO |
$764.61
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$764.61
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$1,024.58
|
| Rate for Payer: Cofinity Commercial |
$1,101.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$764.61
|
| Rate for Payer: Mclaren Medicaid |
$500.76
|
| Rate for Payer: Meridian Medicaid |
$525.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$802.84
|
| Rate for Payer: PACE SWMI |
$764.61
|
| Rate for Payer: PHP Medicare Advantage |
$764.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$500.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,191.35
|
| Rate for Payer: Priority Health Medicare |
$764.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,191.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$764.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$764.61
|
| Rate for Payer: UHC Medicare Advantage |
$787.55
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,580.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,573.54 |
| Max. Negotiated Rate |
$2,322.00 |
| Rate for Payer: Aetna Commercial |
$2,193.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,993.82
|
| Rate for Payer: BCN Commercial |
$1,993.82
|
| Rate for Payer: Cash Price |
$2,064.00
|
| Rate for Payer: Cofinity Commercial |
$2,218.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,064.00
|
| Rate for Payer: Healthscope Commercial |
$2,322.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,935.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,193.00
|
| Rate for Payer: PHP Commercial |
$2,193.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,806.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,244.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,573.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,270.40
|
| Rate for Payer: UHC Core |
$2,154.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,935.00
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$91.47
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$36.59 |
| Max. Negotiated Rate |
$100.72 |
| Rate for Payer: Aetna Commercial |
$93.72
|
| Rate for Payer: Aetna Medicare |
$72.74
|
| Rate for Payer: BCBS Complete |
$36.59
|
| Rate for Payer: BCBS MAPPO |
$69.94
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: BCN Medicare Advantage |
$69.94
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Cash Price |
$73.18
|
| Rate for Payer: Cofinity Commercial |
$100.72
|
| Rate for Payer: Cofinity Commercial |
$93.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.44
|
| Rate for Payer: PACE SWMI |
$69.94
|
| Rate for Payer: PHP Medicare Advantage |
$69.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.03
|
| Rate for Payer: Priority Health Medicare |
$69.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.94
|
| Rate for Payer: UHC Medicare Advantage |
$72.04
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,862.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$716.90 |
| Max. Negotiated Rate |
$2,006.02 |
| Rate for Payer: Aetna Commercial |
$1,741.17
|
| Rate for Payer: Aetna Medicare |
$1,351.36
|
| Rate for Payer: BCBS Complete |
$1,144.80
|
| Rate for Payer: BCBS MAPPO |
$1,299.38
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.38
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cofinity Commercial |
$1,871.11
|
| Rate for Payer: Cofinity Commercial |
$1,741.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,364.35
|
| Rate for Payer: PACE SWMI |
$1,299.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,003.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,941.12
|
| Rate for Payer: Priority Health Medicare |
$1,299.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,941.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,299.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,299.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,338.36
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$1,818.86 |
| Rate for Payer: Aetna Commercial |
$1,578.51
|
| Rate for Payer: Aetna Medicare |
$1,225.11
|
| Rate for Payer: BCBS Complete |
$482.00
|
| Rate for Payer: BCBS MAPPO |
$1,177.99
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$1,818.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.99
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$1,578.51
|
| Rate for Payer: Cofinity Commercial |
$1,696.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,236.89
|
| Rate for Payer: PACE SWMI |
$1,177.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,760.01
|
| Rate for Payer: Priority Health Medicare |
$1,177.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,760.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,177.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,177.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,213.33
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$263.60 |
| Max. Negotiated Rate |
$1,678.12 |
| Rate for Payer: Aetna Commercial |
$1,453.38
|
| Rate for Payer: Aetna Medicare |
$1,127.99
|
| Rate for Payer: BCBS Complete |
$263.60
|
| Rate for Payer: BCBS MAPPO |
$1,084.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.77
|
| Rate for Payer: BCN Commercial |
$1,678.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,084.61
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cofinity Commercial |
$1,453.38
|
| Rate for Payer: Cofinity Commercial |
$1,561.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,084.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,138.84
|
| Rate for Payer: PACE SWMI |
$1,084.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,084.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$461.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,623.83
|
| Rate for Payer: Priority Health Medicare |
$1,084.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,623.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,084.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,084.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,117.15
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,761.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$541.87 |
| Max. Negotiated Rate |
$1,361.27 |
| Rate for Payer: Aetna Commercial |
$1,137.35
|
| Rate for Payer: Aetna Medicare |
$882.72
|
| Rate for Payer: BCBS Complete |
$568.96
|
| Rate for Payer: BCBS MAPPO |
$848.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$1,250.53
|
| Rate for Payer: BCN Medicare Advantage |
$848.77
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cash Price |
$1,408.80
|
| Rate for Payer: Cofinity Commercial |
$1,222.23
|
| Rate for Payer: Cofinity Commercial |
$1,137.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$848.77
|
| Rate for Payer: Mclaren Medicaid |
$541.87
|
| Rate for Payer: Meridian Medicaid |
$568.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$891.21
|
| Rate for Payer: PACE SWMI |
$848.77
|
| Rate for Payer: PHP Medicare Advantage |
$848.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,361.27
|
| Rate for Payer: Priority Health Medicare |
$848.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,361.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$848.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$848.77
|
| Rate for Payer: UHC Medicare Advantage |
$874.23
|
|
