|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 15240
|
| Min. Negotiated Rate |
$559.60 |
| Max. Negotiated Rate |
$1,082.58 |
| Rate for Payer: Aetna Commercial |
$1,007.40
|
| Rate for Payer: Aetna Medicare |
$781.86
|
| Rate for Payer: BCBS Complete |
$559.60
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCN Medicare Advantage |
$751.79
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Nomi Health Commercial |
$902.15
|
| Rate for Payer: PACE SWMI |
$751.79
|
| Rate for Payer: PHP Medicare Advantage |
$751.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health Medicare |
$759.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Exchange |
$751.79
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Professional
|
Both
|
$1,399.00
|
|
|
Service Code
|
HCPCS 15240
|
| Hospital Charge Code |
15240
|
| Min. Negotiated Rate |
$559.60 |
| Max. Negotiated Rate |
$1,082.58 |
| Rate for Payer: Aetna Commercial |
$1,007.40
|
| Rate for Payer: Aetna Medicare |
$781.86
|
| Rate for Payer: BCBS Complete |
$559.60
|
| Rate for Payer: BCBS MAPPO |
$751.79
|
| Rate for Payer: BCN Medicare Advantage |
$751.79
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,082.58
|
| Rate for Payer: Cofinity Commercial |
$1,007.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.38
|
| Rate for Payer: Nomi Health Commercial |
$902.15
|
| Rate for Payer: PACE SWMI |
$751.79
|
| Rate for Payer: PHP Medicare Advantage |
$751.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health Medicare |
$759.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$751.79
|
| Rate for Payer: UHC Exchange |
$751.79
|
| Rate for Payer: UHC Medicare Advantage |
$751.79
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$332.26 |
| Max. Negotiated Rate |
$1,388.75 |
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: Aetna Medicare |
$363.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$437.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$437.19
|
| Rate for Payer: BCBS Complete |
$1,388.75
|
| Rate for Payer: BCBS MAPPO |
$349.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,150.12
|
| Rate for Payer: BCN Commercial |
$1,087.72
|
| Rate for Payer: BCN Medicare Advantage |
$349.75
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.75
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,049.25
|
| Rate for Payer: Mclaren Medicaid |
$1,322.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.24
|
| Rate for Payer: Meridian Medicaid |
$1,388.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$402.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: Nomi Health Commercial |
$1,147.18
|
| Rate for Payer: PACE Senior Care Partners |
$332.26
|
| Rate for Payer: PACE SWMI |
$349.75
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: PHP Medicare Advantage |
$349.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,322.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,217.13
|
| Rate for Payer: Priority Health Medicare |
$353.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$937.33
|
| Rate for Payer: Railroad Medicare Medicare |
$349.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,231.12
|
| Rate for Payer: UHC Core |
$1,168.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.75
|
| Rate for Payer: UHC Exchange |
$349.75
|
| Rate for Payer: UHC Medicare Advantage |
$349.75
|
| Rate for Payer: UHCCP Medicaid |
$1,322.53
|
| Rate for Payer: VA VA |
$349.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,049.25
|
|
|
PR FTH/GFT FR DIR CLSR F/C/C/M/N/AX/G/H/F 20SQCM/<
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
15240
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$909.35 |
| Max. Negotiated Rate |
$1,259.10 |
| Rate for Payer: Aetna Commercial |
$1,189.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,142.00
|
| Rate for Payer: BCN Commercial |
$1,081.15
|
| Rate for Payer: Cash Price |
$1,119.20
|
| Rate for Payer: Cofinity Commercial |
$1,203.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,119.20
|
| Rate for Payer: Healthscope Commercial |
$1,259.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,049.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,189.15
|
| Rate for Payer: Nomi Health Commercial |
$1,147.18
|
| Rate for Payer: PHP Commercial |
$1,189.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$909.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,217.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$937.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,231.12
|
| Rate for Payer: UHC Core |
$1,168.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,049.25
|
|
|
PR FTH/GFT FREE W/DIR CLSR N/E/E/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 15261
|
| Min. Negotiated Rate |
$127.97 |
| Max. Negotiated Rate |
$276.90 |
| Rate for Payer: Aetna Commercial |
$171.48
|
| Rate for Payer: Aetna Medicare |
$133.09
|
| Rate for Payer: BCBS Complete |
$170.40
|
| Rate for Payer: BCBS MAPPO |
$127.97
|
| Rate for Payer: BCN Medicare Advantage |
$127.97
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cofinity Commercial |
$184.28
|
| Rate for Payer: Cofinity Commercial |
$171.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.37
|
| Rate for Payer: Nomi Health Commercial |
$153.56
|
| Rate for Payer: PACE SWMI |
$127.97
|
| Rate for Payer: PHP Medicare Advantage |
$127.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.90
|
| Rate for Payer: Priority Health Medicare |
$129.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.97
|
| Rate for Payer: UHC Exchange |
$127.97
|
| Rate for Payer: UHC Medicare Advantage |
$127.97
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/<
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 15260
|
| Min. Negotiated Rate |
$680.00 |
| Max. Negotiated Rate |
$1,150.55 |
| Rate for Payer: Aetna Commercial |
$1,070.65
|
| Rate for Payer: Aetna Medicare |
$830.95
|
| Rate for Payer: BCBS Complete |
$680.00
|
| Rate for Payer: BCBS MAPPO |
$798.99
|
| Rate for Payer: BCN Medicare Advantage |
$798.99
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$1,150.55
|
| Rate for Payer: Cofinity Commercial |
$1,070.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.94
|
| Rate for Payer: Nomi Health Commercial |
$958.79
|
| Rate for Payer: PACE SWMI |
$798.99
|
| Rate for Payer: PHP Medicare Advantage |
$798.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.00
|
| Rate for Payer: Priority Health Medicare |
$806.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.99
|
| Rate for Payer: UHC Exchange |
$798.99
|
| Rate for Payer: UHC Medicare Advantage |
$798.99
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 SQ CM/<
|
Professional
|
Both
|
$1,689.00
|
|
|
Service Code
|
HCPCS 15220
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$1,097.85 |
| Rate for Payer: Aetna Commercial |
$772.79
|
| Rate for Payer: Aetna Medicare |
$599.78
|
| Rate for Payer: BCBS Complete |
$675.60
|
| Rate for Payer: BCBS MAPPO |
$576.71
|
| Rate for Payer: BCN Medicare Advantage |
$576.71
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cash Price |
$1,351.20
|
| Rate for Payer: Cofinity Commercial |
$830.46
|
| Rate for Payer: Cofinity Commercial |
$772.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$576.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$605.55
|
| Rate for Payer: Nomi Health Commercial |
$692.05
|
| Rate for Payer: PACE SWMI |
$576.71
|
| Rate for Payer: PHP Medicare Advantage |
$576.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,097.85
|
| Rate for Payer: Priority Health Medicare |
$582.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$576.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$576.71
|
| Rate for Payer: UHC Exchange |
$576.71
|
| Rate for Payer: UHC Medicare Advantage |
$576.71
|
|
|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$922.00 |
| Rate for Payer: Aetna Commercial |
$857.98
|
| Rate for Payer: Aetna Medicare |
$665.89
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$640.28
|
| Rate for Payer: BCN Medicare Advantage |
$640.28
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$922.00
|
| Rate for Payer: Cofinity Commercial |
$857.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.29
|
| Rate for Payer: Nomi Health Commercial |
$768.34
|
| Rate for Payer: PACE SWMI |
$640.28
|
| Rate for Payer: PHP Medicare Advantage |
$640.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$646.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.28
|
| Rate for Payer: UHC Exchange |
$640.28
|
| Rate for Payer: UHC Medicare Advantage |
$640.28
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Nomi Health Commercial |
$122.17
|
| Rate for Payer: PACE SWMI |
$101.81
|
| Rate for Payer: PHP Medicare Advantage |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health Medicare |
$102.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Exchange |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$65.91
|
| Rate for Payer: BCN Medicare Advantage |
$65.91
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.21
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE SWMI |
$65.91
|
| Rate for Payer: PHP Medicare Advantage |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Medicare |
$66.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.91
|
| Rate for Payer: UHC Exchange |
$65.91
|
| Rate for Payer: UHC Medicare Advantage |
$65.91
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$545.03 |
| Rate for Payer: Aetna Commercial |
$507.18
|
| Rate for Payer: Aetna Medicare |
$393.63
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$378.49
|
| Rate for Payer: BCN Medicare Advantage |
$378.49
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$545.03
|
| Rate for Payer: Cofinity Commercial |
$507.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.41
|
| Rate for Payer: Nomi Health Commercial |
$454.19
|
| Rate for Payer: PACE SWMI |
$378.49
|
| Rate for Payer: PHP Medicare Advantage |
$378.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$382.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.49
|
| Rate for Payer: UHC Exchange |
$378.49
|
| Rate for Payer: UHC Medicare Advantage |
$378.49
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$433.21 |
| Rate for Payer: Aetna Commercial |
$403.13
|
| Rate for Payer: Aetna Medicare |
$312.87
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCBS MAPPO |
$300.84
|
| Rate for Payer: BCN Medicare Advantage |
$300.84
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$433.21
|
| Rate for Payer: Cofinity Commercial |
$403.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.88
|
| Rate for Payer: Nomi Health Commercial |
$361.01
|
| Rate for Payer: PACE SWMI |
$300.84
|
| Rate for Payer: PHP Medicare Advantage |
$300.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health Medicare |
$303.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.84
|
| Rate for Payer: UHC Exchange |
$300.84
|
| Rate for Payer: UHC Medicare Advantage |
$300.84
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$45.21
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$33.74
|
| Rate for Payer: BCN Medicare Advantage |
$33.74
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Cofinity Commercial |
$45.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.43
|
| Rate for Payer: Nomi Health Commercial |
$40.49
|
| Rate for Payer: PACE SWMI |
$33.74
|
| Rate for Payer: PHP Medicare Advantage |
$33.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$34.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.74
|
| Rate for Payer: UHC Exchange |
$33.74
|
| Rate for Payer: UHC Medicare Advantage |
$33.74
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$212.55 |
| Rate for Payer: Aetna Commercial |
$182.62
|
| Rate for Payer: Aetna Medicare |
$141.73
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$136.28
|
| Rate for Payer: BCN Medicare Advantage |
$136.28
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$196.24
|
| Rate for Payer: Cofinity Commercial |
$182.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.09
|
| Rate for Payer: Nomi Health Commercial |
$163.54
|
| Rate for Payer: PACE SWMI |
$136.28
|
| Rate for Payer: PHP Medicare Advantage |
$136.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$137.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.28
|
| Rate for Payer: UHC Exchange |
$136.28
|
| Rate for Payer: UHC Medicare Advantage |
$136.28
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: Nomi Health Commercial |
$2.65
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Exchange |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$42.33
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$40.70
|
| Rate for Payer: BCN Medicare Advantage |
$40.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.73
|
| Rate for Payer: Nomi Health Commercial |
$48.84
|
| Rate for Payer: PACE SWMI |
$40.70
|
| Rate for Payer: PHP Medicare Advantage |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$41.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.70
|
| Rate for Payer: UHC Exchange |
$40.70
|
| Rate for Payer: UHC Medicare Advantage |
$40.70
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$20.75
|
| Rate for Payer: BCN Medicare Advantage |
$20.75
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$27.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.79
|
| Rate for Payer: Nomi Health Commercial |
$24.90
|
| Rate for Payer: PACE SWMI |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.75
|
| Rate for Payer: UHC Exchange |
$20.75
|
| Rate for Payer: UHC Medicare Advantage |
$20.75
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$436.73 |
| Max. Negotiated Rate |
$986.70 |
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna Medicare |
$454.20
|
| Rate for Payer: BCBS Complete |
$607.20
|
| Rate for Payer: BCBS MAPPO |
$436.73
|
| Rate for Payer: BCN Medicare Advantage |
$436.73
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cofinity Commercial |
$628.89
|
| Rate for Payer: Cofinity Commercial |
$585.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.57
|
| Rate for Payer: Nomi Health Commercial |
$524.08
|
| Rate for Payer: PACE SWMI |
$436.73
|
| Rate for Payer: PHP Medicare Advantage |
$436.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.70
|
| Rate for Payer: Priority Health Medicare |
$441.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$436.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.73
|
| Rate for Payer: UHC Exchange |
$436.73
|
| Rate for Payer: UHC Medicare Advantage |
$436.73
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$991.25 |
| Max. Negotiated Rate |
$1,615.90 |
| Rate for Payer: Aetna Commercial |
$1,328.28
|
| Rate for Payer: Aetna Medicare |
$1,030.90
|
| Rate for Payer: BCBS Complete |
$994.40
|
| Rate for Payer: BCBS MAPPO |
$991.25
|
| Rate for Payer: BCN Medicare Advantage |
$991.25
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cofinity Commercial |
$1,427.40
|
| Rate for Payer: Cofinity Commercial |
$1,328.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$991.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,040.81
|
| Rate for Payer: Nomi Health Commercial |
$1,189.50
|
| Rate for Payer: PACE SWMI |
$991.25
|
| Rate for Payer: PHP Medicare Advantage |
$991.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.90
|
| Rate for Payer: Priority Health Medicare |
$1,001.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$991.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$991.25
|
| Rate for Payer: UHC Exchange |
$991.25
|
| Rate for Payer: UHC Medicare Advantage |
$991.25
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$242.50 |
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: BCBS Complete |
$137.20
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$170.08
|
| Rate for Payer: Priority Health Medicare |
$170.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Exchange |
$168.40
|
| Rate for Payer: UHC Exchange |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$214.80 |
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$150.66
|
| Rate for Payer: Priority Health Medicare |
$150.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Exchange |
$149.17
|
| Rate for Payer: UHC Exchange |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$564.72 |
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: BCBS Complete |
$350.00
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health Medicare |
$396.09
|
| Rate for Payer: Priority Health Medicare |
$396.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Exchange |
$392.17
|
| Rate for Payer: UHC Exchange |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$1,048.40 |
| Max. Negotiated Rate |
$1,883.68 |
| Rate for Payer: Aetna Commercial |
$1,752.87
|
| Rate for Payer: Aetna Medicare |
$1,360.43
|
| Rate for Payer: BCBS Complete |
$1,048.40
|
| Rate for Payer: BCBS MAPPO |
$1,308.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.11
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,883.68
|
| Rate for Payer: Cofinity Commercial |
$1,752.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.52
|
| Rate for Payer: Nomi Health Commercial |
$1,569.73
|
| Rate for Payer: PACE SWMI |
$1,308.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health Medicare |
$1,321.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.11
|
| Rate for Payer: UHC Exchange |
$1,308.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.11
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$1,032.40 |
| Max. Negotiated Rate |
$1,839.27 |
| Rate for Payer: Aetna Commercial |
$1,711.54
|
| Rate for Payer: Aetna Medicare |
$1,328.36
|
| Rate for Payer: BCBS Complete |
$1,032.40
|
| Rate for Payer: BCBS MAPPO |
$1,277.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.27
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,839.27
|
| Rate for Payer: Cofinity Commercial |
$1,711.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.13
|
| Rate for Payer: Nomi Health Commercial |
$1,532.72
|
| Rate for Payer: PACE SWMI |
$1,277.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.65
|
| Rate for Payer: Priority Health Medicare |
$1,290.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,277.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,277.27
|
| Rate for Payer: UHC Exchange |
$1,277.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.27
|
|
